Data Bases • Custom Term Papers • Free Term Papers • Free Research Papers • Free Essays • Free Book Reports • Plagiarism? Links • Top 100 Term Paper Sites • Top 25 Essay Sites • Top 50 Essay Sites • Search 97,000 Papers @ DirectEssays.com • Search 101,000 Papers @ ExampleEssays.com • Search 90,000 Papers @ MegaEssays.com Free Essays • Term Paper Sites • Chuck III's Free Essays • Free College Essays • TermPaperSites.com • My Term Papers • Get Free Essays • Essay World • Planet Papers	Search Lots of Essays Back to Subjects - Psychology Out of touch with reality Out of touch with reality In my lifetime, I have spent months with my Grandmother, Florence Ernstead, who is a diagnosed paranoid delusional schizophrenic. During this time I have realized that schizophrenics have difficulty realizing the seriousness of their disorders. This inability to acknowledge a problem is known by psychiatrists as lack of insight. Many psychotic patients, especially schizophrenics, display a lack of insight into their disorder (Keefe 9). Lack of insight refers to an unawareness of having a disorder, unawareness of having psychotic symptoms, and a refusal of treatment. Some scientists include other more specific aspects such as patients’ views on cause of their disorder and/or symptoms, hospitalization, control of situation, or perception of the environment. Only the three aspects listed previously, though, seem common to all definitions of what lack of insight encompasses. Lack of insight has been associated with schizophrenia for a while, with all studies on the subject reaching at least this minimal conclusion. However, there have been some differing conclusions on what causes lack of insight in schizophrenia. Two main hypotheses have been presented so far: one is a neuropsychological explanation for lack of insight in schizophrenia while the other is a cognitive explanation. Is lack of insight caused by frontal lobe dysfunction, as in anosognosia and Alzheimer’s disease? Or is lack of insight simply a cognitive dysfunction with no connection to brain damage? A third idea is that lack of insight in schizophrenia is related to stigma. Many patients with schizophrenia may deny their disorder because of the stigma related to having schizophrenia. In this paper, I will cover first how lack of insight is actually associated with schizophrenia. Then I will discuss the hypotheses concerning the cause of lack of insight in schizophrenia. Ultimately, I will have to conclude that more research is needed to answer these questions. Lack of insight has been diagnosed by several different testing methods. Peralta and Cuesta interviewed patients based on three components (unawareness of illness, unawareness of symptoms, and refusal of treatment) and also on the Lack of Insight Index while several other scientists have used the Positive and Negative Syndrome Scale for schizophrenia (PANSS). Still other scientists have altered existing tests (such as the Hamilton Depression Scale) to fit psychotic disorders. While these tests ask similar questions, there is no standard by which to evaluate lack of insight. The differences in conclusions on lack of insight in schizophrenia may very well be because of all the different testing methods. Peralta and Cuesta concluded that lack of insight seemed to be “an independent dimension” from other schizophrenic symptoms, both positive and negative (560). Their data point to lack of insight as part of the schizophrenic process, not just a symptom. Unlike Peralta and Cuesta, Debowska, Grzywa, and Kucharska-Pietura found that lack of insight correlated with positive and negative symptoms of patients with schizophrenia, hostility, blunted affect, emotional withdrawal, and stereotyped thinking included (257). Debowska also found a correlation between specific kinds of delusions and lack of insight. Patients with delusions of thought broadcasting were more likely to refuse treatment. Patients with delusions of grandeur or a sexual nature had worse insight than patients with other types of delusions (Debowska 259). While Fennig et al. did not find as many correlations as Debowska, their data did show that lack of insight corresponded significantly with negative symptoms (785). Most of these conclusions have been found in multiple studies but this does not explain the difference in conclusions. Is lack of insight a diagnosable symptom or part of the process of schizophrenia? Further testing is needed to conclude this issue, preferably with some kind of standardized test for lack of insight. While little research has been done on brain abnormalities and lack of insight in schizophrenia, an association has been found in some studies for a connection between frontal lobe abnormalities (evidenced by poor performance on the Wisconsin Card Sorting Test) and lack of insight in schizophrenia. Lack of insight is definitely correlated with frontal lobe abnormalities as shown by studies of anosognosia and Alzheimer’s disease. There is a possibility, then, that anosognosia and schizophrenia have a common cause for lack of insight (Ghaemi 786). There are other neurological impairments in schizophrenics. According to Husted, studies have shown that many patients with schizophrenia have small hippocampi, enlarged ventricles, and possibly communication damage between the hippocampus and cerebral cortex. Unfortunately, there is not enough evidence to for any of these abnormalities including frontal lobe dysfunction to be “necessary or sufficient for the diagnosis of schizophrenia” (37). Many scientists have found some association between frontal lobe dysfunction and schizophrenia, but just as many have also found no association. Dickerson, Boronow, Ringel, and Parente did comprehensive neuropsychological testing including “the Vocabulary, Arithmetic, Digit Span, Block Design, and Digit Span subtests of the patient, the Logical Memory test of the Wechsler Memory Scale, the Rey-Osterreith Complex Figure Test, the Wisconsin Card Sorting Test, the Trail Making Test, the Halstead-Wepman Aphasia Screening Test, and the Chicago Word Fluency test” (196). Despite their thoroughness, Dickerson et al. found no significant correlations between neurological impairment and lack of insight. In another study, Peralta and Cuesta, show a correlation between lack of insight and better performance on verbal and visual memory tasks (560). Ghaemi suggests an alternate explanation for this, “patients with better left-hemispheric than right-hemispheric functioning, which is manifested in less awareness of illness or symptoms [...] could have enhanced verbal and visual functioning” (786-87). The evidence still stands that some studies show a correlation of lack of insight with frontal lobe abnormalities while some do not. Some studies that show no correlation show evidence for cognitive deficits causing lack of insight. Ghaemi discusses A third hypothesis in his preliminary report on the neuropsychological aspects of lack of insight in bipolar disorder. The force of stigma is overlooked in many studies of lack of insight in schizophrenia. Many psychological disorders are stigmatized by our society so that people with these disorders are made fun of and thought poorly of. It is no wonder then that most people do not want to have a psychological disorder, to the extent that some deny their illness. Most studies assume that the judgers of lack of insight are correct and do not discuss the possibility of stigma. While the possibility should be broached, there is a difference between denying an illness and believing one does not have an illness. The tests done to assess lack of insight judge the actual lack of insight, not just stigmatized denial. While the force of stigma is a good thing to consider then, patients with lack of insight are actually unaware of their situation and their symptoms. Because of this unawareness, it makes sense that many patients with lack of insight deny treatment (Ghaemi 786). Studies into lack of insight and schizophrenia have uncovered several preliminary conclusions and hypotheses. Lack of insight, I think all researchers will agree, definitely has a part in the lives of patients with schizophrenia. Contradictory data has been found, though, as to what this part is. Some scientists have found correlations between lack of insight and negative symptoms, but as a counterpoint, lack of insight has also seen to be associated with positive symptoms and specific delusions. And oddly enough, other scientists have found none of these correlations, thus concluding that lack of insight is an independent part of the process of schizophrenia. Explanations for the cause of lack of insight are just as contradictory. Evidence has been found for neurological causes as shown by some lack of functioning in the frontal lobes of some patients with schizophrenia. However, not all patients have this lack of functioning, and there is evidence that lack of insight is caused by cognitive deficits. There is even other evidence, though, that denies both of these claims in the face of "psychosocial" (Torrey 127) factors. Because there are multiple studies backing up all these conclusions, it is hard to tell which one(s) is (are) correct. Ultimately, more research is needed to support any conclusions. Lack of insight in schizophrenia is a relatively new topic, and most studies on it have been done in the last ten years. A consensus needs to be reached concerning the definition of lack of insight. Are there three main aspects to lack of insight (unawareness of illness, unawareness of symptoms, refusal for treatment) or are there more? Also, the association of lack of insight with schizophrenia has been established, but is lack of insight a symptom or a more fundamental part of the problem of schizophrenia? Does lack of insight correlate with specific symptoms of schizophrenia (just positive or just negative symptoms, or with specific delusions)? Not only does the general nature of lack of insight in schizophrenia need to be researched but the causes of lack of insight need to be researched as well. Which hypothesis is correct? Is lack of insight in schizophrenia caused by neuropsychological deficits, cognitive deficits, some combination of the two, or even by psychosocial factors? Answering these questions is important because the nature of the relationship of lack of insight in schizophrenia will affect how schizophrenia is diagnosed and treated. Husted discusses this in his article Insight in Severe Mental Illness: Implications for Treatment Decisions. Overall lack of insight is associated with more severe symptoms and more enduring illness. To effectively treat patients with schizophrenia who also have little or not insight into their condition, one must persuade the patients to accept treatment anyway (Husted 45). If there were a way to force insight on a patient with schizophrenia, then curing or at least lessening the degree of the patient's symptoms would be more likely. Lack of insight in schizophrenia is a very important topic to research because of the implications on treatment of schizophrenia. To start with, much larger samples are needed for any generalizable conclusions. More control groups are needed as well. They should include neurologically and psychologically normal individuals, as well as groups of patients with mood disorders (bipolar, depressive, etc.), and groups of patients with other kinds of schizophrenic disorders (schizoaffective, schizoid, etc.). Research that has already been done is heading in the right direction but needs to be duplicated to verify the results and conclusions. As I mentioned earlier in this paper, a standard should be developed for measuring lack of insight. Basically, the topic of lack of insight in schizophrenia is so new that research can skew in any direction and find new and useful information to add to diagnosing and treating schizophrenia. Bibliography: Works Cited Corsini, Raymond J. Current Psychotherapies. 3rd ed. Ithaca: Peacock, 1984. Cuesta MJ, Peralta V., "Lack of insight: Its status within schizophrenic psychopathology." Logical Psychiatry 38.8 (1998): 359-366, 559-561. Debowska G, Grzywa A, Kucharska-Pietura K. "Insight in paranoid schizophrenia: Its relationship to psychopathology and premorbid adjustment." Contemporary Psychiatry 39.5, (1999): 255-260. Dickerson F.B., et al. "Lack of insight among outpatients with schizophrenia." Psychiatric Resources 65.2 (1997): 195-199. Fennig S., et al. "Insight in first-admission psychotic patients." Schizophrenia Resource 22.3 (1996): 782-790. Ghaemi S.N., "Insight and psychiatric disorders: A review of the literature, with a focus on its clinical relevance for bipolar disorder." Psychiatric Annual 27.12 (1997): 782-790. Ghaemi S.N., et al. "Neuropsychological aspects of lack of insight in bipolar disorder: A preliminary report." Psychiatric Resources, 48.2 (1996): 113-120. Husted J.R., "Insight in severe mental illness: Implications for treatment decisions." Psychiatric Law 27.1 (1999): 33-49. Keefe, Richard S.E., and Philip D. Harvey. Understanding Schizophrenia: A guide to the New Research on Causes and Treatments. New York: Macmillan, 1994. Knittle, Mary E., Personal Interview. 24 Nov. 2000. "Schizophrenia." Encyclopedia of Psychology. 2000 ed. "Schizophrenia." Gale Encyclopedia of Psychology. 1996 ed. Torrey, E. Fuller. Surviving Schizophrenia. New York: Harper, 1995. "Understanding the Causes of Schizophrenia." Editorial. The New England Journal of Medicine 340.8 (1999): 645-47. Word Count: 1755
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