Philosophy, Psychiatry, & Psychology

Abstract:

Patients with psychosis often have poor insight into their illness. Poor insight into illness is, at least among patients with psychosis, a good predictor of treatment non-adherence. This is no mystery, for as Xavier Amador asks, "Who would want to take medicine for an illness they did not believe they had?" What is curious is that some patients with psychosis do adhere to treatment despite a lack of insight. Why do these patients adhere to treatment, given that they do not believe they are ill to begin with? In this paper, I attempt to answer this question. I do so by first considering cases of non-psychotic patients who adhere to treatment despite a lack of insight. I point out that these sorts of cases are commonplace, and attempt to explain why they arise. The explanation is given in terms of anticipated treatment benefits. However, these benefits are not conceptualized by the patient in terms of pathology. The patient does not, in other words, think of such benefits in terms of illness, symptoms, treatment, and so forth. I then argue that the proposed explanation can be extended to account for why psychotic patients without insight sometimes adhere to treatment. I conclude by drawing out some of the practical implications of the proposed view. I first argue, on practical as well as ethical grounds, that improving insight for purposes of treatment adherence is misguided. I then suggest that such adherence might be increased simply by explaining treatment benefits in language that does not presuppose that the patient is, in any sense, "ill," "diseased," "sick," "unwell," and so on.