Recovery Enhancement Practices for Psychosis

3. The extent to which a person is willing to receive treatment for the causes of the unusual experience or behavior.

When insight is particularly low, the person may be experiencing anosognosia; simply put, the person’s brain does not automatically or effectively update information about their experience. The person may not fully realize the aspects of their thoughts and behavior that are out of the ordinary (or not part of other peoples’ “consensus reality” that we mentioned in the first section). For example, a person may not shower for a long time and may not realize that others would notice this as a problem. Because this behavior is related to underlying difficulties the brain experiences in processing information, it is better viewed as a cognitive difficulty rather than a personality problem. In other words, when a person shows signs that they do not believe they are ill, it often has more to do with injury and processing problems than with defiance or denial.

How to respond to differing levels of insight: It is always best to begin with the person’s understanding of and language for their experiences. For example, if the person reports that they have been diagnosed with an illness called “schizophrenia,” it is helpful to first get an understanding of what they have been told and how well they understand this information.

If the person states, “There is nothing wrong;” it is not helpful to directly challenge their statement. It may rather be more beneficial to learn about what brought them to services and to learn about things they would like to do (back to befriending and socializing). You are looking for something in common, something you may be able to work on together. Again, it is important to not directly contradict or confront a strongly held belief or experience. In fact, it is often helpful to substitute the word “experience” or “event” in place of words like symptom, hallucination, or delusion. Consider the following additional examples: 43