Latest report

Not yet available

Link/Download

Insight

The principal focus of this workstream is the concept of insight.  The term “insight” occurs frequently in clinical discourse.  A patient who is aware that they are suffering from a mental disorder and is able to articulate their condition in the language of symptoms will often be described by their clinical care team as “having insight.”  A patient who is unwell but unaware of their own illness may be described as “lacking insight” or “having impaired insight.” 

Key workstream collaborators

Background

The presence and absence of awareness of illness is a palpable reality in clinical settings, and a significant variable in the population of patients.  Clinical approaches to patients are of necessity different, depending on the nature and degree of the patient’s insight into their own illness.  Where insight is present, there is a common basis for the clinical encounter from the outset.  Where insight is lacking this common ground is diminished.  Coercion and treatment non-compliance become more likely.

From a legal perspective, the concept of insight is fraught.  Anecdotal evidence suggests that insight is sometimes used as a proxy for decision-making capacity (DMC), and a lack-of-insight is sometimes taken as sufficient evidence of lack of DMC.   But at least in England and Wales, insight is not included in the legal definition of capacity.   Some have argued that the concept of insight has no place in legal proceedings.  The aim of WS4 is to investigate the clinical concept of insight, the variety of forms that insight (and absence-of-insight) can take in different patient populations, and to develop guidance for the use of evidence regarding impaired insight in legal proceedings that impact upon a patient’s autonomy and human rights.

Approach

We shall seek to identify the structure of insight and lack-of-insight as a feature of a person’s experience.  Using a large corpus of rich interview data unanalysed for this purpose, and deploying a methodology of “second person phenomenology” developed in earlier work, we shall study the presence and absence of experience-of-illness in four groups of persons with mental disorder.

We shall interview legal and clinical professionals, observe at ward rounds, and undertake a systematic study of case law to develop an analysis of the use of the concept of insight in clinical and legal discourse.

We shall undertake a “translational” exercise, mapping clinical uses of the concept of insight onto three legal concepts:  legal capacity, DMC and appreciation. Finally, drawing on the preceding phases, and engaging our service user-research collaborators, we shall develop guidelines for increasing service user involvement in articulating areas of shared understanding and areas of divergence between the clinician’s and the service user’s perspective, and identifying strategies for support of decision-making capacity where insight is impaired. 

Expected Outcomes

We will innovate in application of philosophical analysis to a core clinical concept in mental health that is fraught from a legal perspective and will re-formulate the concept from a non-discrimination perspective. The work-stream will produce guidelines for clinical and legal professionals regarding insight that will inform difficult decisions, create a uniformity of practice and increase service user involvement. 

Workstream Members


Wayne Martin
Wayne Martin
Prinicipal Invesitgator

Professor of philosophy and director of the Essex Autonomy Project, University of Essex. Wayne has interests in phenomenology, philosophy of psychiatry, qualitative methods and human rights and policy. He will lead on Work Stream 4 and the first policy lab on “evidence”. He will contribute widely across the research network.

Sabine Michalowski
Sabine Michalowski
Core Member

Sabine Michalowski – Professor of law, University of Essex. Sabine has interests in medical law and human rights. She will conduct research within Work Stream 4.

Matt Burch
Matt Burch
Core member

Lecturer in philosophy, University of Essex. Matt works on issues at the intersection of phenomenology, action theory, and research in the cognitive and social sciences. At the moment, his research is focused in particular on the stance of objectivity in legal contexts, autonomy in mental health, risk in the care professions, and, his favourite topic, the quintessentially human failure to act on one’s better judgment.

Sándor Gurbai
Sándor Gurbai
Postdoctoral Research Assistant

Senior research officer, University of Essex. Sándor has interests in human rights and disability studies. He will conduct research within Work Stream 4.

Wayne Martin
Wayne Martin
Prinicipal Invesitgator

Professor of philosophy and director of the Essex Autonomy Project, University of Essex. Wayne has interests in phenomenology, philosophy of psychiatry, qualitative methods and human rights and policy. He will lead on Work Stream 4 and the first policy lab on “evidence”. He will contribute widely across the research network.

Sabine Michalowski
Sabine Michalowski
Core Member

Sabine Michalowski – Professor of law, University of Essex. Sabine has interests in medical law and human rights. She will conduct research within Work Stream 4.

Matt Burch
Matt Burch
Core member

Lecturer in philosophy, University of Essex. Matt works on issues at the intersection of phenomenology, action theory, and research in the cognitive and social sciences. At the moment, his research is focused in particular on the stance of objectivity in legal contexts, autonomy in mental health, risk in the care professions, and, his favourite topic, the quintessentially human failure to act on one’s better judgment.

Sándor Gurbai
Sándor Gurbai
Postdoctoral Research Assistant

Senior research officer, University of Essex. Sándor has interests in human rights and disability studies. He will conduct research within Work Stream 4.

Polona Curk
Polona Curk
Research Affiliate

Executive research fellow, University of Essex. With a background in psychoanalytic theory, Polona is interested in relational autonomy. She will conduct research within WS4, on the concept of insight in psychoanalysis and comparisons with psychiatry.

Polona Curk
Polona Curk
Research Affiliate

Executive research fellow, University of Essex. With a background in psychoanalytic theory, Polona is interested in relational autonomy. She will conduct research within WS4, on the concept of insight in psychoanalysis and comparisons with psychiatry.