A Comparative study of Insight in Schizophrenia and Mania.

Introduction: Impaired awareness of illness has been known for hundreds of years. In 1604 in his play, "the honest whore", thomas dekker has a character say: "that proves you mad because you know it not". Among neurologists, Unawareness of illness is well known since it also occurs in some individuals With stroke, brain tumors, alzheimer's disease and huntington's disease. The Term “anosognosia” was first used by a french neurologist in 1914 (prigatono And schacter, 1991). The oxford english dictionary defines insight as "an inner sight, a Discernment, a wisdom (or) glimpse of you beneath the surface”. To put it Simply, it means the capacity to understand the hidden truth. Insight, as a Concept of a symptom, got introduced during the later part of the 19th century By dagonet (1881). In 1934, aubrey lewis provided a temporary definition of insight: “a Correct attitude to morbid change in oneself”, but warned that the words ‘correct’, ‘attitude’, ‘morbid’ and ‘change’ each called for discussion. He also Said, “all questions of the judgment of reality, such as…. The consideration of Insight, go to the root of the psychopathology of different conditions” The usage of the word by gestalt psychologists for an “aha” experience (harre and lamb, 1983; conrad, 1958) and the psychoanalytic classification Into ‘emotional’ and ‘intellectual’ is avoided here (zilborg, 1952; sandler et al., 1973). Our study is restricted to the usage of the word for recognizing one’s Own mental disorder, medication effects, social consequences, awareness and Attribution of signs and symptoms. Even in our clinical setting, some patients with schizophrenia do accept That they have something wrong in them even though they decline to accept That they have a psychiatric illness. Probably their sociocultural and religious matrix colors their expression. At times even if the patient denies mental disorder, he accepts distress And accepts drugs without protesting. So, here is the question whether insight is An all (or) none phenomenon. Insight is a multidimensional and not an unitary phenomenon (amador, Et al., 1993). The component dimensions of insight are continuous rather than Dichotomous phenomena. In other words one can have partial insight. Insight into mental disorder may be modality specific i.e. The level of Insight can vary across the many manifestations of illness. For example a Patient may be aware of his flat affect, but he may be unaware of his asociality. Insight comprises of the processes of awareness and attribution. Awareness is the recognition of signs or symptoms of illness, while attribution Refers to explanations about the cause or source of the signs or symptoms. A patient may be aware of "alogia" but may not attribute the decrease in Verbal abilities to a mental disorder. A patient may deny that he is currently mentally ill, but may accept that He was mentally ill in the past. Again, a patient may deny having mental illness and still accept Treatment and vice versa