When Lay Knowledge is a Symptom: The Uses of Insight in Psychiatric Interventions
DOI:
https://doi.org/10.26522/ssj.v16i1.2681Keywords:
mental health, ethnography, qualitative, psychiatry, social work, Fricker, FoucaultAbstract
In psychiatry, the concept of “insight” commonly refers to a patient’s judgment that they have a mental illness and need clinical treatment. However, this concept has been criticized because it imposes psychiatric knowledge on the subjective experiences of mental illness and possible interventions. A significant body of literature is critical of mental health interventions; however, insight remains under-explored in this realm. This paper adds to critical analyses of insight by exploring how it is defined and deployed by mental health professionals in an acute inpatient mental health unit in a Canadian general hospital and what disciplinary and epistemic effects it has on patients. To this end, I draw on Foucault’s theories of psychiatric power and Fricker’s concept of epistemic injustice to analyze results from an ethnographic study conducted in an inpatient mental health unit. The results show how patients’ resistance to medical compliance is framed by staff as a lack of insight, which reinforces the psychiatric model of mental illness.
References
Anthony, W. A. (1993). Recovery from mental illness: The guiding vision of the mental health service system in the 1990s. Psychosocial Rehabilitation Journal, 16(4), 11-23.
Beck-Sander, A. (1998). Is insight into psychosis meaningful? Journal of Mental Health, 7(1), 25-34.
Ben-Moshe, L. (2014). Alternatives to (disability) incarceration. In L. Ben-Moshe, C. Chapman & A. C. Carey (Eds.), Disability incarcerated: Imprisonment and disability in the United States and Canada (pp. 255-272). Palgrave Macmillan.
Ben-Moshe, L. (2020). Decarcerating disability: Deinstitutionalization and prison abolition. University of Minnesota Press.
Braun, V., & Clarke, V. (2006). Using thematic analysis in psychology. Qualitative Research in Psychology, 3(2), 77-101.
Chapman, C., & Withers, A. J. (2019). A violent history of benevolence. University of Toronto Press.
Conrad, P. (2005). The shifting engines of medicalization. Journal of Health & Social Behavior, 46(1), 3-14.
Crichton, P., Carel, H., & Kidd, I. J. (2017). Epistemic injustice in psychiatry. BJPsych Bulletin, 41(2), 65-70.
David, A. S. (1990). Insight and psychosis. The British Journal of Psychiatry, 156(6), 798-808.
Deegan, G. (2003). Discovering recovery. Psychiatric Rehabilitation Journal, 26(4), 368-376.
Diesfeld, K., & Sjöström, S. (2007). Interpretive flexibility: Why doesn’t insight incite controversy in mental health law? Behavioral Sciences & the Law, 25(1), 85-101.
Fabris, E. (2011). Tranquil prisons: Chemical incarceration under community treatment orders. University of Toronto Press.
Fabris, E., & Aubrecht, K. (2014). Chemical constraint: Experiences of psychiatric coercion, restraint, and detention as carceratory techniques. In L. Ben-Moshe, C. Chapman & A. C. Carey (Eds.), Disability incarcerated: Imprisonment and disability in the United States and Canada (pp. 185-199). Palgrave Macmillan.
Foucault, M. (1979). Discipline and punish: The birth of the prison. Vintage Books.
Foucault, M. (2006). Psychiatric power: Lectures at the Collège de France, 1973–74. Palgrave Macmillan.
Fricker, M. (2007). Epistemic injustice: Power and the ethics of knowing. Oxford University Press.
Galasiński, D., & Opaliński, K. (2012). Psychiatrists’ accounts of insight. Qualitative Health Research, 22(11), 1460-1467.
Goffman, E. (1968). Asylums: Essays on the social situation of mental patients and other inmates. Anchor Books/Doubleday.
Guibet Lafaye, C. (2015). Représentations de la maladie mentale et recours à la contrainte. Psychiatrie & Violence, 14(1). https://www.erudit.org/fr/revues/pv/2015-v14-n1-pv02896/1039168ar/
Hamilton, B., & Roper, C. (2006). Troubling ‘insight’: Power and possibilities in mental health care. Journal of Psychiatric & Mental Health Nursing, 13(4), 416-422.
Joseph, A. J. (2015). Beyond intersectionalities of identity or interlocking analyses of difference: Confluence and the problematic of ‘anti’-oppression. Intersectionalities: A Global Journal of Social Work Analysis, Research, Polity, & Practice, 4(1), 15-39.
Kelly, C., & Chapman, C. (2015). Adversarial allies: Care, harm, and resistance in the helping professions. Journal of Progressive Human Services, 26(1), 46-66.
Khoury, E., & Rodriguez del Barrio, L. (2015). Recovery-oriented mental health practice: A social work perspective. British Journal of Social Work, 45(S1), i27-i44.
Kilty, J. M., & Dej, E. (Eds.). (2018). Containing madness: Gender and ‘psy’ in institutional contexts. Springer.
Klein, A., Guillemain, H., & Thifault, M. C. (2018). La fin de l’asile? Histoire de la déshospitalisation psychiatrique dans l’espace francophone au xxe siècle. Presses universitaires de Rennes.
Konstantakopoulos, G. (2019). Insight across mental disorders: A multifaceted metacognitive phenomenon. Psychiatriki, 30(1), 13-16.
Kristensen, G. K., & Ravn, M. N. (2015). The voices heard and the voices silenced: Recruitment processes in qualitative interview studies. Qualitative Research, 15(6), 722-737.
Laplantine, F. (2010). La description ethnographique. Armand Colin.
LeBlanc, S., & Kinsella, E. A. (2016). Toward epistemic justice: A critically reflexive examination of ‘sanism’ and implications for knowledge generation. Studies in Social Justice, 10(1), 59-78.
Madison, D. S. (2019). Critical ethnography: Method, ethics, and performance. Sage Publications.
Marková, I. (2005). Insight in psychiatry. Cambridge University Press.
Marková, I., & Berrios, G. E. (1995). Insight in clinical psychiatry revisited. Comprehensive Psychiatry, 36(5), 367-376.
Mental Health Act, R.S.O. 1990, c. M.7. https://www.ontario.ca/laws/statute/90m07
Mills, C., & LeFrançois, B. A. (2018). Child as metaphor: Colonialism, psy-governance, and epistemicide. World Futures, 74(7/8), 503-524.
Mintz, A. R., Dobson, K. S., & Romney, D. M. (2003). Insight in schizophrenia: A meta-analysis. Schizophrenia Research, 61(1), 75-88.
Perron, A., Fluet, C., & Holmes, D. (2005). Agents of care and agents of the state: Bio‐power and nursing practice. Journal of Advanced Nursing, 50(5), 536-544.
Pilling, M., D., Daley, A., Gibson, M. F., Ross, L. E., & Zaheer, J. (2018). Assessing ‘insight’, determining agency and autonomy: Implicating social identities. In J. M. Kilty & E. Dej (Eds.), Containing madness: Gender and ‘psy’ in institutional contexts (pp. 191-213). Springer.
Procknow, G. (2018). (Dis)arming the madman: Sane supremacy and the Second Amendment. Disability & Society, 33(7), 1165-1169.
Rimke, H. (2018). Sickening institutions: A feminist sociological analysis and critique of religion, medicine, and psychiatry. In J. M. Kilty & E. Dej (Eds.), Containing madness: Gender and ‘psy’ in institutional contexts (pp. 15-39). Springer.
Rimke, H., & Brock, D. (2012). The culture of therapy: Psychocentrism is everyday life. In D. Brock, A. Martin, R. Raby & M. Thomas (Eds.), Power and everyday practices (pp. 182-202). Nelson Education Ltd.
Rivest, M.-P. (2017). Être « patiente » aujourd’hui: Entre assujettissement normatif et résistances à l’imposition d’une carrière. Regards croisés sur des expériences au sein d’institutions contemporaines en santé mentale [Unpublished doctoral dissertation]. University of Ottawa.
Rivest, M.-P., & Moreau, N. (2015). Between emancipatory practice and disciplinary interventions: Empowerment and contemporary social normativity. British Journal of Social Work, 45(6), 1855-1870.
Roberts, M. (2005). The production of the psychiatric subject: Power, knowledge and Michel Foucault. Nursing Philosophy, 6(1), 33-42.
Roy, M. (2019). Les conduites éthiques et le rétablissement: Analyse d’une revue de littérature en travail social. Nouvelles Pratiques Sociales, 30(2), 234-248.
Roy, M., Rivest, M.-P., & Moreau, N. (2017). The banality of psychology. Social Work, 62(1), 86-88.
Sealy, P., & Whitehead, P. C. (2004). Forty years of deinstitutionalization of psychiatric services in Canada: An empirical assessment. Canadian Journal of Psychiatry, 49(4), 249-257.
Segarra, R., Ojeda, N., Pena, J., Garcia, J., Rodriguez-Morales, A., Ruiz, I., Hidalgo, R., Buron, J. A., Eguiluz, J. I. I., & Gutierrez, M. (2012). Longitudinal changes of insight in first episode psychosis and its relation to clinical symptoms, treatment adherence and global functioning: One-year follow-up from the Eiffel study. European Psychiatry, 27(1), 43-49.
Tate, A. J. M. (2019). Contributory injustice in psychiatry. Journal of Medical Ethics, 45(2), 97-100.
Thomas, J. (1993). Doing critical ethnography. Sage Publications.
Downloads
Published
Issue
Section
License
Copyright (c) 2022 Marie-Pier Rivest
This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.
Articles are published in Studies in Social Justice under the Creative Commons "Attribution/Non-Commercial/No Derivative Works" Canada licence.
The copyright for the articles published in this journal is retained by the authors, with first publication rights granted to the journal. By virtue of their appearance in this open access journal, articles may be used, with proper attribution, in educational and other non-commercial settings. The submission of a manuscript to Studies in Social Justice will be taken to mean that the author understands and agrees to the following:
- the manuscript represents original work not previously published;
- the manuscript is not being considered elsewhere for publication in the same language (publication elsewhere in an alternate language does not preclude acceptance of submission to Studies in Social Justice);
- appropriate written copyright permissions have been secured for republication of any copyrighted material contained in the manuscript;
- copyright for this article is retained by the author, with first publication rights granted to Studies in Social Justice;
- by virtue of its appearance in this open access journal, it is understood that the article is freely available for use, with proper attribution, for educational and other non-commercial purposes;
- reuse of the article for commercial purposes by anyone other than the author requires permission of the author;
- the author agrees to cite Studies in Social Justice as a source whenever h/she later republishes or reuses the article in other platforms.
