The British Journal of Psychiatry (2007) 190: 243-247. doi: 10.1192/bjp.bp.106.029363
© 2007 The Royal College of Psychiatrists
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Assessing insight in schizophrenia: East meets West

Balasubramanian Saravanan, MD

Institute of Psychiatry, London and Christian Medical College, Vellore, India

K. S. Jacob, MD, PhD and Shanthi Johnson

Christian Medical College, Vellore, India

Martin Prince, MD, MRCPsych, Dinesh Bhugra, PhD, FRCPsych and Anthony S. David, MD, FRCP, FRCPsych

Institute of Psychiatry, King's College London, London, UK

Correspondence: Professor Anthony David, Section of Cognitive Neuropsychiatry, PO Box 68, Institute of Psychiatry, King's College London, Denmark Hill, London SE5 8AF, UK. Email: a.david{at}iop.kcl.ac.uk

Declaration of interest None.

Funding detailed in Acknowledgements.

Background Lack of insight has been observed in people with schizophrenia across cultures but assessment of insight must take into account prevailing illness models.

Aims To determine whether culturally specific and Western biomedical interpretations of insight and psychosis can be reconciled.

Method Patients with schizophrenia (n=131) were assessed during their first contact with psychiatric services in Vellore, South India. Patients'explanatory models, psychopathology and insight were investigated using a standard schedule translated into Tamil.

Results Supernatural explanations of symptoms were frequent. Some insight dimensions were weakly associated (inversely) with severity of symptoms whereas preserved insight was associated with anxiety, help-seeking and perception of change. Willingness to attribute symptoms to disease, in others and in one's self, but notto supernatural forces was strongly associated with insight.

Conclusions The relationship between insight, awareness of illness and other clinical variables is similar in South India to elsewhere. However, the assessment of insight might have failed to capture locally accepted explanatory frameworks. An inclusive conceptual model which emphasises help-seeking is recommended.