The Relation Between Empathy and Insight in Psychiatric Disorders: Phenomenological, Etiological, and Neuro-Functional Mechanisms

Abstract

Lack of insight, i.e., unawareness of one's mental illness, is frequently encountered in psychiatric conditions. Insight is the capacity to recognize (psychical insight) and accept one's mental illness (emotional insight). Insight growth necessitates developing an objective perspective on one's subjective pathological experiences. Therefore, insight has been posited to require undamaged self-reflexion and cognitive perspective-taking capacities. These enable patients to look objectively at themselves from the imagined perspective of someone else. Preserved theory-of-mind performances have been reported to positively impact insight in psychosis. However, some patients with schizophrenia or obsessivecompulsive disorders, although recognizing their mental disease, are still not convinced of this and do not accept it. Hence, perspective-taking explains psychical insight (recognition) but not emotional insight (acceptance). Here, we propose a new conceptual model. We hypothesize that insight growth relies upon the association of intact self-reflexion and empathic capacities. Empathy (feeling into someone else) integrates heterocentered visuospatial perspective (feeling into), embodiment, affective (feeling into) and cognitive processes, leading to internally experience the other's thought. We posit that this subjective experience enables to better understand the other's thought about oneself and to affectively adhere to this. We propose that the process of objectification, resulting from empathic heterocentered, embodiment, and cognitive processes, generates an objective viewpoint on oneself. It enables to recognize one's mental illness and positively impacts psychical insight. The process of subjectification, resulting from empathic affective processes, enables to accept one's illness and positively impacts emotional insight. That is, affectively experiencing the thought of another person about oneself reinforces the adhesion of the emotional system to the objective recognition of the disease. Applying our model to different psychiatric disorders, we predict that the negative effect of impaired self-reflexion and empathic capacities on insight is a transnosographic state and that endophenotypical differences modulate this common state, determining a psychiatric disease as specific.

Which personality traits can mitigate the impact of the pandemic? Assessment of the relationship between personality traits and traumatic events in the COVID-19 pandemic as mediated by defense mechanisms

“…In this regard, these data suggest the usefulness of intervening to increase and support the use of mature defensive styles for dealing with the stressful experiences related to COVID-19 [ 69 ]. Treatments could focus, for example, on favoring increases in mentalizing or insight levels, which were positively associated with functional defenses and inversely with maladaptive defensive mechanisms [ 70 , 71 ], as well as related to higher levels of mental health, meaningfulness, and satisfaction [ 72 – 74 ]. Finally, the psychological vulnerability of subjects with the trait of neuroticism was highlighted [ 15 , 55 ], underlining the need to place a greater focus on both intervention and preventive perspectives in different life contexts.…”

The Characteristics of Care Provided to Population(s) in Precarious Situations in 2015. A Preliminary Study on the Universal Health Cover in France

“…One plausible hypothesis is that precarious patients do not seek care or therapeutic treatment because they are unaware of their disease due to socio-educational difficulties, triggering an incapability to recognize their symptoms and health status. For instance, lack of insight, i.e., unawareness of one's mental illness, is frequently encountered in psychiatric conditions and has deleterious effects on prognosis, adherence to treatment, acceptance of hospitalisation and risk of relapse [31]. A comparable lack of awareness relative to somatic diseases (different from pure anosognosia, which is a core etiological element of given neurological pathologies) could also explain why precarious patients do not seek care.…”

Cortical morphology and illness insight in patients with schizophrenia

“…Furthermore, this study showed significant associations between OSSTI scores and CG in the right superior frontal, both CG and CT in M1 as well as CG in the left superior frontal gyrus and CT in pars triangularis. Since illness insight consists of at least three different dimensions, i.e., psychical, emotional, and somaesthetic [56], these findings support the neurobiological basis of this model for several reasons: first, the superior frontal region plays a crucial role in introspection, self-judgment, and self-awareness [21]. From a pathomechanistic perspective, aberrant frontoparietal structure in SZ might modulate the processes of selfreflexion/-awareness (recognition) and emotional capacities (feeling into oneself) leading to impaired illness insight [53].…”