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Title: Making sense of unusual experiences : a discursive approach to insight
Author: Taylor, Gavin Brendan
ISNI:       0000 0004 2718 4815
Awarding Body: University of East London
Current Institution: University of East London
Date of Award: 2011
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Insight is a term in psychological and psychiatric practice, most frequently used when referring to individuals who have been given diagnoses of schizophrenia or other psychotic disorders. It is often used to define a range of different situations in which a service user resists or disagrees with the professional account of their difficulties and/or treatment. Dominant psychological and psychiatric models construct a lack of insight as a symptom of illness that can be linked to specific deficits of psychological process (e.g. denial or Theory of Mind) or brain functioning (e.g. lesions to specific parts of the brain or blood flow). A lack of insight is considered to be a relatively stable deficit, which takes a period of time to resolve, particularly in service users defined as 'chronically' unwell. The present research aimed to examine the concept of insight from a social constructionist perspective. This approach was used to examine the naively realist assumptions underpinning the concept and its utility in re-labelling disagreement between professionals and service users. The first aim was to explore how service users who had been given a diagnosis of schizophrenia or other psychotic disorder, constructed the term. A second aim was to explore how service users rhetorically managed issues of stake and accountability during discussion of disagreements with mental health professionals. The final aim was to explore fluctuation or contradictions in service users' accounts of insight and disagreement with mental health professionals. Eight participants who had been given a diagnosis of schizophrenia or a related psychotic disorder were recruited. Participants took part in semi-structured interviews about their experiences of mental health services and their understanding of 'insight'. The transcripts were analysed using a discursive psychology methodology. The results showed that the term 'insight' was relatively unknown to the participants, although all participants discussed disagreements with mental health professionals. Those who had heard of the term drew on a variety of constructions of insight during the interviews. These constructions seemed to relate to the factuality and credibility of the participants' account in different ways (e.g. aligning the account with the dominant psychiatric view). The participants also drew on several rhetorical strategies to manage stake and accountability (e.g. constructing the doctor's diagnostic decision as personally motivated). Fluctuation between positions that could be defined as 'insightful' and 'insightless' was found throughout the accounts. These findings clearly demonstrated the limited validity of the term insight. Furthermore, they suggested that it clinically functions as a discursive form of control, limiting the challenges that can be made by service users, rather than a meaningful clinical construct. The findings also suggested that even with this threat of undermining, service users found complex and subtle methods to discursively challenge the psychiatric position. The applications of these findings for service users, professionals and researchers are discussed.
Supervisor: Not available Sponsor: Not available
Qualification Name: Thesis (D.Clin.Psych.) Qualification Level: Doctoral
EThOS ID:  DOI: Not available