Taking the perspective of the other contributes to awareness of illness in schizophrenia. Schizophr Bull

Two approaches dominate research on the lack of aware-ness of illness that characterizes schizophrenia. The ‘‘def-icit’ ’ approach uses standardized neuropsychological batteries to identify the neural underpinnings of intact in-sight; the ‘‘nondeficit’ ’ approach investigates the psycho-logical defense mechanisms that motivate denial of illness. We adopt, instead, a cognitive neuropsychological approach to model the cognitive processes which underpin insight and which might be either damaged (because of neu-ropathology) or not used (because of motivational forces). We conceive of these processes in terms of a metacognitive capacity ‘‘to see ourselves as others see us.’ ’ We predict that a general difficulty with adopting other mental per-spectives (with ‘‘seeing the world as others do’’), indexed by performance deficits on theory of mind (ToM) tasks, will impair insight in schizophrenia. Thirty schizophrenic patients (also assessed for insight) and 26 healthy controls completed a battery of ToM tasks which varied presenta-tion modality, response mode and instruction type (picture sequencing, joke appreciation and story comprehension tasks). While patients performed more poorly than controls on all ToM tasks, impairment in patients was not concor-dant across tasks. ToM scores from the picture sequencing and joke appreciation tasks, and not the story comprehen-sion task, intercorrelated significantly in patients and pre-dicted insight. Findings support the view that insight relies upon a cognitive capacity to adopt the other perspective, which, if intact, contributes to the metacognitive capacity to reflect upon ‘‘one’s own’ ’ mental health from the other perspective. Findings also suggest that the nature of per-spective-taking difficulty which disrupts insight in schizo-phrenia is best revealed using ToM tasks with ‘‘indirect’’ instructions. Key words: social cognition/anosognosia/perspective-taking/psychosi