The psychopathology of insight

About insight as a psychiatric problem little has been written; but in many places more or less casual evidence may be met with of prevalent notions which seem loose or ill-founded. In order to clear the ground a formal and necessarily incomplete essay is offered as a basis for further clinical study. Insight is not a word of plain and single meaning. For a Gestalt psychologist it is an act or an ability to effect a direct configuration, a connected whole which is evident in the meaningful reaction to a stimulusstructure. Spearman seems to mean by it the quality in consciousness that attaches to belief based on adequate (self-experienced) evidence. In ordinary speech it refers to the quality by which we penetrate into the essence of things or happenings. In psychiatry, it is none of these things. Where its meaning is not assumed to be self-evident – and vague; or restricted to delusions, in which ex hypothesi it is impaired, it is said to cover “the amount of realization the patient has of his own condition” – a quantitative relative judgment by the physician, expressed in such terms as “total lack of insight”, “little real insight”; or a, often implicitly all-or-