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  • Perspective
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From diagnostic conformity to co-narration of self-insight in mental health care

Nature Mental Health volume 2, pages 883–892 (2024)Cite this article

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Abstract

In mental health care, large differences in perspective between individuals with psychosis and professionals are an everyday reality. Such discrepancies become apparent in the substantial number of patients judged to lack illness insight. This Perspective argues that ‘illness insight’ typically refers to patient conformity to medical views rather than denoting true understanding into their condition. We outline limitations of the current conceptualization of illness insight (‘clinical insight’) and discuss an alternative, narrative understanding, drawing on literature from various academic disciplines. After addressing definitional ambiguities, etiological complexities and methodological inconsistencies inherent to the current understanding, this paper highlights several normative, cultural and ethical issues surrounding clinical insight. A narrative approach allows patients to find more meaningful explanations that resonate better with the complexity of their experiences and tackles other problems identified with clinical insight. We argue that narrative insight is inherently co-constructed, emphasizing the shared meaning-making process between individuals with psychosis and professionals.

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  • 12 August 2024

    In the version of the article initially published, the corresponding author's email address was incorrect and has now been amended in the HTML and PDF versions of the article.

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Authors and Affiliations

  1. GGZ inGeest, Amsterdam, Netherlands

    N. J. Ermers

  2. Faculty of Humanities, University of Amsterdam, Amsterdam, Netherlands

    G. E. H. I. Franssen

  3. Department of Psychiatry, University Medical Center, Utrecht, Netherlands

    F. E. Scheepers & N. van Sambeek

  4. Education Center, University Medical Center, Utrecht, Netherlands

    S. M. van Geelen

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  1. N. J. Ermers
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  2. G. E. H. I. Franssen
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  3. F. E. Scheepers
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  4. N. van Sambeek
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  5. S. M. van Geelen
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Contributions

N.J.E. led the initial conceptualization and drafted the original manuscript. G.E.H.I.F., F.S., N.V.S. and S.M.V.G. contributed to this conceptualization; revised, reviewed and edited subsequent drafts of the paper, and read and agreed to the final version.

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Correspondence to N. J. Ermers.

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Ermers, N.J., Franssen, G.E.H.I., Scheepers, F.E. et al. From diagnostic conformity to co-narration of self-insight in mental health care. Nat. Mental Health 2, 883–892 (2024). https://doi.org/10.1038/s44220-024-00284-4

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