In psychiatry/clinical psychology, the language of psychopathology remains the main clinical and research tool as it seeks to capture the clinical phenomena underlying mental disorders. It is thus important periodically to review it in order to clarify and refine its relationship to its referent phenomena. This paper argues for a fundamental distinction to be made, in a technical sense, between awareness and insight as, respectively, the narrower and wider form of self-knowledge patients have concerning their conditions.This distinction is based on differences between “objects” of such self-knowledge. Where “objects” refer to impairment of function, as in the neurosciences, the corresponding phenomenon of self-knowledge (awareness) is narrow, based on a direct appraisal of impairment, and evaluated quantitatively . Where “objects” refer to mental symptoms/disorders, as in clinical psychology/psychiatry, the corresponding phenomena of self-knowledge (insight) are wide, based on both direct and indirect appraisals of change, and are evaluated quantitatively and qualitatively. The technical distinction between awareness and insight is important because it differentiates between structural differences in phenomena, indicative of differences in underlying mechanisms, and in turn suggesting the need to adopt different approaches to their study.
Agnew, S.K., & Morris, R.G. ( 1998). The heterogeneity of anosognosia for memory impairment in Alzheimer’s disease: A review of the literature and a proposed model . Aging & Mental Health, 2, 7-19.
2.
Amador, X.F., Strauss, D.H., Yale, S.A., & Gorman, J.M. ( 1991). Awareness of illness in schizophrenia. Schizophrenia Bulletin, 17, 113-132.
3.
Anton, G. ( 1899). Ueber die Selbstwahrnehmung der Herderkrankungen des Gehirns durch den Kranken bei Rindenblindheit und Rindentaubheit [On the self-awareness of focal brain diseases by the patient in cortical blindness and cortical deafness]. Archiv für Psychiatrie und Nervenkrankheiten , 32, 86-127.
4.
Babinski, M.J. ( 1914). Contribution à l’étude des troubles mentaux dans l’hémiplégie organique cérébrale (anosognosie) [Contribution to the study of mental disorders in cerebral organic hemiplegia (anosognosia)]. Revue Neurologique, 27, 845-848.
5.
Balibar, É. ( 2004). Conscience. In B. Cassin (Ed.), Dictionnaire des Intraduisables [Dictionary of untranslatables] (pp. 260-273). Paris, France: Le Robert.
6.
Beard, D.J. ( 2000). Drapetomania - A disease called freedom. Fort Lauderdale, FL: Broward Public Library Foundation .
7.
Berganza, C.E., Mezzich, J.E., & Pouncey, C. ( 2005). Concepts of disease: Their relevance for psychiatric diagnosis and classification. Psychopathology, 38, 166-170.
8.
Berrios, G. E., & Porter, R. (Eds.). (1995). A history of clinical psychiatry. The origin and history of psychiatric disorders. London, UK: Athlone Press.
9.
Bisiach, E., Vallar, G., Perani, D., Papagno, C., & Berti, A. ( 1986). Unawareness of disease following lesions of the right hemisphere: Anosognosia for hemiplegia and anosognosia for hemianopia. Neuropsychologia, 24, 471-482.
10.
Clare, L., Marková, I.S., Verhey, F., & Kenny, G. ( 2005). Awareness in dementia: A review of assessment methods and measures. Aging and Mental Health, 9, 394-413.
11.
Condillac, E.B., Abbé de. ( 1924). Essai sur l’origine des connaissances humaines [Essay on the origin of human knowledge]. Paris, France: Librairie Armand Colin. (Original work published 1746)
12.
Falret, J.P. ( 1866). Discussion sur la folie raisonnante [Discussion on reasoning insanity]. Annales Médico-Psychologiques, 7, 382-426.
13.
Flashman, L.A., McAllister, T.W., Andreasen, N.C., & Saykin, A.J. ( 2000). Smaller brain size associated with unawareness of illness in patients with schizophrenia. American Journal of Psychiatry , 157, 1167-1169.
14.
Flashman, L.A., McAllister, T.W., Johnson, S.C., Rick, J.H., Green, R.L., & Saykin, A.J. ( 2001). Specific frontal lobe subregions correlated with unawareness of illness in schizophrenia: A preliminary study. Journal of Neuropsychiatry and Clinical Neurosciences, 13, 255-257.
15.
Ghaemi, S.N. ( 2003). The concepts of psychiatry: A pluralistic approach to the mind and mental illness. Baltimore, MD: John Hopkins Press.
16.
Ghaemi, S.N., Hebben, N., Stoll, A.L., & Pope, H.G. ( 1996). Neuropsychological aspects of lack of insight in bipolar disorder: A preliminary report. Psychiatry Research, 65, 113-120.
17.
Guislain, J. ( 1852). Leçons orales sur les phrénopathies, ou traité théorique et pratique des maladies mentales [Oral lessons on the phrenopathies, or theoretical and practical treaty on mental disorders] . Ghent, Belgium: Hebbelynck.
18.
Harré, R. ( 2004). Setting benchmarks for psychiatric concepts. In J. Radden (Ed.), The philosophy of psychiatry: A companion (pp. 409-414). Oxford, UK: Oxford University Press.
19.
Harré, R. ( 2005). Positioning and the discursive construction of categories . Psychopathology, 38, 185-188.
Marková, I.S., & Berrios, G.E. ( 2000). Insight into memory deficits. In G. E. Berrios & J. R. Hodges (Eds.), Memory disorders in psychiatric practice (pp. 204-233). Cambridge, UK: Cambridge University Press.
24.
Marková, I.S., & Berrios, G.E. ( 2001). The "object" of insight assessment: Relationship with insight "structure." Psychopathology, 34, 245-252.
Marková, I.S., Clare, L., Wang, M., Romero, B., & Kenny, G. ( 2005). Awareness in dementia: Conceptual issues. Aging and Mental Health, 9, 386-393.
27.
Mesulam, M.-M. ( 1986). Frontal cortex and behavior. Annals of Neurology, 19, 320-325.
28.
Mullen, R., Howard, R., David, A., & Levy, R. ( 1996). Insight in Alzheimer’s disease. International Journal of Geriatric Psychiatry, 11, 645-651.
29.
Mysore, A., Parks, R.W., Lee, K.-H., Bhaker, R.S., Birkett, P., & Woodruff, P.W.R. (2007). Neurocognitive basis of insight in schizophrenia. British Journal of Psychiatry, 190, 529-530.
30.
Nisbett, R.E., & Wilson, T.D. ( 1977). Telling more than we can know: Verbal reports on mental processes. Psychological Review, 84, 231-259.
31.
Prichard, J.C. ( 1835). A treatise on insanity and other disorders affecting the mind. London, UK: Sherwood, Gilbert and Piper.
32.
Prigatano, G.P. ( 1991). Disturbances of self-awareness of deficit after traumatic brain injury. In G. P. Prigatano & D. L. Schacter (Eds.), Awareness of deficit after brain injury (pp. 111-126). Oxford, UK: Oxford University Press.
33.
Prigatano, G. P., & Schacter, D. L. (Eds.). (1991). Awareness of deficit after brain injury. Oxford, UK: Oxford University Press.
34.
Ryle, G. ( 1949). The concept of mind. Harmondsworth , UK: Penguin Books.
35.
Schacter, D.L. ( 1990). Toward a cognitive neuropsychology of awareness: Implicit knowledge and anosognosia. Journal of Clinical and Experimental Neuropsychology, 12, 155-178.
36.
Sherer, M., Hart, T., & Nick, T.G. ( 2003). Measurement of impaired self-awareness after traumatic brain injury: A comparison of the patient competency rating scale and the awareness questionnaire. Brain Injury, 17, 25-37.
37.
Starkstein, S.E., Fedoroff, J.P., Price, T.R., Leiguarda, R., & Robinson, R.G. (1992). Anosognosia in patients with cerebrovascular lesions. A study of causative factors. Stroke, 23, 1446-1453.
38.
Stuss, D.T., & Benson D.F. ( 1986). The frontal lobes. New York, NY: Raven Press.
39.
Wilson, T.D., & Dunn, E.W. ( 2004). Self-knowledge: Its limits, value, and potential for improvement. Annual Review of Psychology, 55, 493-518.
40.
Young, D.A., Davila, R., & Scher, H. ( 1993). Unawareness of illness and neuropsychological performance in chronic schizophrenia. Schizophrenia Research, 10, 117-124.
