Over the past 15 years there has been a wealth of research investigating the nature of insight in psychiatric and neurological disorders. Insight, at a clinical level, refers to the extent to which a patient is aware of their illness, their symptoms, how they interpret them, whether they comply with treatment, to name but a few aspects. Insight is therefore key to patient management and prognosis, yet intriguingly, as Markova explains, research is often inconclusive, sometimes even contradictory in its findings, and there is little concordance in how researchers conceptualise and assess insight.
The burgeoning literature on the subject of insight in various patient groups reflects its clinical importance and interest to researchers, yet few volumes have appeared that aim to explore research findings across neurological as well as psychiatric groups, ask why findings are so often not replicated, and then explore possible reasons for this.
The book is arranged in two sections with the first addressing the history and evolution of the meaning of insight, and how different schools of science and philosophy have sought to conceptualise its nature. Most research investigating insight has concentrated on schizophrenia, dementia and patients with brain injury. Accordingly, there follows an invaluable and concise summary of empirical investigations into insight in each of these patient groups. The reader is, as is intended, left feeling that despite a long history of investigation into how patients may lack insight into their respective disorders, few hard facts can be drawn. However, what is missing is consideration of insight in the dynamic tradition as empirical research in this area is lacking
The second half of the book takes place on a much more abstract level and focuses on the author's own conceptulisation of insight which can, it is proposed, explain this high degree of inconsistency within the literature. While Markova draws many useful distinctions, for example, between ‘awareness’ and ‘insight’, and between different ‘objects’ of insight in different clinical populations, this section may prove too theoretical and insufficiently succinct for the average reader. However, despite being theoretically complex, Markova is successful in urging the reader to consider the critical importance of determining the object at which insight is directed, and how the object determines the phenomenon of insight.
As a whole, this book succeeds in making the reader aware of the complex nature of insight, and the conceptual and methodological problems that are associated with trying to assess it, while providing a framework that aims to resolve the causes of the inconsistencies in empirical findings.
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