Thought Insertion and Insight: Disease and Illness Paradigms of Psychotic Disorder

Abstract

Present day psychiatry displays contradictory attitudes to the concept of insight. The conventional line is that the distinction between psychotic and non-psychotic disorders, as marked traditionally by loss of insight, has outlived its usefulness (Gelder et al. 1983). Insight is considered too obscure a notion, too opaque to clear, descriptive definition, for the notion of psychosis to be incorporated into modern classifications of mental illness (World Health Organization, 1978). Yet the term psychosis continues to be widely employed in academic journals as well as in everyday clinical work. Indeed, the intentions of their authors notwithstanding, the concept of psychotic disorder remains firmly embedded even in our official classifications. DSM-III (American Psychiatric Association, 1980) and ICD-10 (World Health Organization, 1991), for example, both contain a category for psychotic disorders “not elsewhere classified”.