Expanding the epistemological horizons of insight in psychosis : toward an anthropological and phenomenological re-framing

Abstract

By re-examining the epistemological foundations upon which the ego-centric clinical construct of insight in psychosis rests, research conducted with the narratives of patients who participated in the clinical project, Psychosis and Culture: The Role of Spaces of Negotiation (Between Patients, Families, and Practitioners) During Consultation was aimed to explore and formulate a socio-centric model of insight construction more sensitive to patients' intersubjective and cultural milieus. Collected interviews---conducted with recently diagnosed psychotic patients using the Turning Point Interview (TPI) grid---were approached from a phenomenological and hermeneutical perspective in order to illustrate the processual manner in which patients' insight (into the cause and reason of illness) was the cognitive and epistemic derivative of dialogical relations with other persons set within a socio-cultural matrix. The results of this research indicate that the production of patients' insight in psychosis is an inherently intersubjective and dialogic phenomenon which, in the clinical context, occurs at two points of juncture: (1) a synchronic juncture where the patient is interpellated by the clinician and hence positioned as a speaking subject, and (2) a diachronic juncture where the patient, as a result of having been called into a speaking position, constructs and authors a narrative account of significant events related to his/her illness experience based on biographical memory. Insight was shown to consist of 3 stages: (1) Detection of alteration of lived experience, (2) Causal attribution, and (3) Global construction of meaning . Each stage was shown to form the intersubjective and dialogic basis for the production of a subjectively meaningful account of insight, using the lifeworid of the patients and the patients' entourage as subjective frames of reference