Insight in Psychiatry and Neurology: State of the Art, and Hypotheses

In spite of the increasing number of studies on insight in psychiatry and also in neurology and psychology, its nature is still elusive. It encompasses at least three fundamental characteristics: the awareness of suffering from an illness, an understanding of the cause and source of this suffering, and an acknowledgment of the need for treatment. As such, insight is fundamental for patients' management, prognosis, and treatment. Not surprisingly, the majority of available data, which have been gathered on schizophrenia, show a relationship between low insight and poorer outcomes. For mood disorders, however, insight is associated with less positive results. For other psychiatric disorders, insight has rarely been investigated. In neurology, the impaired ability to recognize the presence of sensory, perceptual, motor, affective, or cognitive functioning-referred to as anosognosia-has been related to damage of specific brain regions. This article provides a comprehensive review of insight in different psychiatric and neurological disorders, with a special focus on brain areas and neurotransmitters that serve as the substrate for this complex phenomenon.

A natural science approach to consciousness

We begin with premises about natural science, its fundamental protocols and its limitations. With those in mind, we construct alternative descriptive models of consciousness, each comprising a synthesis of recent literature in cognitive science. Presuming that consciousness arose through natural selection, we eliminate the subset of alternatives that lack selectable physical phenotypes, leaving the subset with limited free will (mostly in the form of free won't). We argue that membership in this subset implies a two-way exchange of energy between the conscious mental realm and the physical realm of the brain. We propose an analogy between the mental and physical phases of energy and the phases (e.g., gas/liquid) of matter, and a possible realization in the form of a generic resonator. As candidate undergirdings of such a system, we propose astroglial-pyramidal cell and electromagnetic-field models. Finally, we consider the problem of identification of the presence of consciousness in other beings or in machines.