Insight, Psychological Phenomenon
- Jon Weingarden
- May 19
- 6 min read
Updated: Jun 11
Anonymous poster queries:
Can anyone explain or have a theory about how people are so self deceived when it comes to MH?
My response:
I think this is a broad topic and wonder if you mean it generally or have something more specific in mind, but I think the idea of self-perception/deception and insight are foundational at least in Western psychology. Hypnosis arguably being the first technique was geared toward accessing the unconscious and crossing that barrier of self-deception. It [insight] was core to Freud's theories, topographic and structures. His daughter and 2nd gen of psychoanalysts, ego psychologists, focused on defense mechanisms which serve to keep bothersome things out of consciousness by distorting reality or blatantly disregarding [it]. There are ecological theories like the End of History phenomenon that suggest it would be deleterious to our sense of self and consequently stability to see ourselves as inconsistent, so distortions in the past or to present changes in ourselves allows us a sense of stability at the cost of accuracy/insight. I'm sure there are biological/neurological mechanisms at play, such as people with florid psychotic (including manic) states frequently have no recollection when they come out of it. Parents who struggle with a newborn almost ubiquitously state that repression allowed them to have another child and it must be evolutionary or humans would cease to exist! High emotional states have well documented effects on memory such as flashbulb memories and other trauma-related phenomenon in which we remember vividly albeit not necessarily accurately, or do not encode the memories. Encoding issues may be fundamental to PTSD in which memories are stuck in a live, emotional format, resulting in a sense of reliving, rather than fully processed into typical long-term memory as factual experiences. [Cortisol released during HPA-axis response results in dysregulation of the system and sweeping effects including difficulty with memory and concentration, chronic sympathetic arousal that leads to anxiety and depression, and inflammation that effects physical health].
My background knowledge of insight
My doctoral dissertation focused on insight in depression. At the time, it was partially inspired by the rift between cognitive and dynamic theories (and the professors who identified with each): cognitively oriented folks were okay with the idea of automatic thoughts (the automaticity is allowed by the lack of conscious awareness or insight) but didn't want to be bothered with the complex notion of insight beyond this. It was and is still arguably misunderstood or not adequately fleshed out. However, the role of consciousness is fundamental to dynamic theories. I was interested to see if people who had experienced depression described insight as a key process (of course not necessarily labeling it as such), utilizing a qualitative study to explored the phenomenological experience of each individual.
Ubiquitously, study participants described a period in which they lacked awareness of the depression, its causes and at least it's severity, which, in retrospect, they described as unconscious but effortful ignoring in order to psychological self-protect from recognizing their own depressed state ("not only have I felt awful about myself, but now I have to label it as depression and take responsibility to treat it?"). This is the definition of a defense mechanism. Each participant described an experience that put the depression front-and-center in their mind - they could no longer ignore it. One participant described self harm - cutting their arm with a knife and showing their brother: not only did they have to see their own blood-red pain, but were able to communicate their pain vividly despite inability to put it into words.
While this gaining of insight is/was painful to each study participants, they also stated it was essential - the fulcrum - to recovery: now that the cat was out of the bag, they were obligated and able to address the depression. The research team labeled this "the sword and the salve," referring to the pain (sword) of insight, but also it's healing capacity (salve).
Theoretical Orientations
Most theoretical orientations have a way of handling insight as it relates to their perspective on psychology. As described above, cognitive theorists discuss automatic thoughts, and also believe that core beliefs are rarely well defined in our conscious mind until we take the time in therapy to identify them.

Psychodynamic theories incorporate this in many ways. Freud had his topological model and broadened it with his structural model in which the Id is out of conscious awareness, and the Superego is as likely to be working consciously as unconsciously, and the ego is often working within our conscious experience. Ego psychologists study defenses and how they function to hold threatening information in the unconscious or distort reality to defend our ego. Kohut's Self-Psychology posits that there is a bipolarity in narcissistic personality structure in which a depressed, hurt sense-of-self due to lack of mirroring is masked by grandiosity. Similarly, interpersonalists view personality as consisting of a "me" (how we want to see ourselves and be seen), "bad me" (things we don't like about ourselves but can acknowledge) and "not me" (things we reject to the degree we push out of our conscious awareness). Likewise, they posit we use selective inattention to overlook the things that challenge the way want to be seen.
Similar to the interpersonalist conceptualization of personality (me, bad me and not me), Internal Family Systems hinges on the belief our personality consists of various parts, each with various functions that create a homeostatis. Part of this homeostasis is ostensibly protecting but functionally shunning exiled parts from conscious awareness and experience. The act of shunning betrays the shame and reiterates the original trauma - the exile is unacceptable.
Gestalt therapists believe the sum is greater than the parts, but if a part is missing or shunned, the whole is greatly effected. For example, someone afraid of conflict projects their feelings of aggression onto others, and consequently may "lack a voice" or "not have a spine." Respectively in those presentations, the person would display these characteristics physically such as speaking quietly (or not speaking) or slouching. By re-owning their voice/spine and aggression, they can be assertive, whole and authentic.
Types of Insight
Insight is not a one size fits all term. It is a phenomenon that suffers from lack of tangibility - it isn't like sad mood that can easily be recognized by subjective emotion, or objectively in affect or behavior. Consequently we have difficulty defining it. Some assessments ask only one question: "does the client have insight?" Many, seemingly with a psychiatric-pragmatic focus on whether the patient will take medicine, are focused on awareness of illness. As described above, individuals with depression repress or deny their depression until they can no longer maintain their blinders - this is common and more pronounced in other mental health conditions, such as mania or psychosis in which people frequently have little insight into becoming ill (and consequently see no reason to take medication), or recollection of the events of their illness.
Another facet of insight is attributional style. While the depressive person internalizes negative, but inaccurate (and thereby not insightful) attributes, the psychotic individual externalizes and projects negative attributes incorrectly (and thereby not insightfully) onto others.
Beck's cognitive insight seems to measure cognitive flexibility - an important factor and one that has found relevance in understanding contemporary political divisions (multiple articles imply that people with liberal views are higher on cognitive flexibility while those who are conservative may have more rigidity or concrete cognitions), but not consistent with other perspectives on insight. This is more about our ability to change our perspective rather than conscious awareness, but could be important such as, for example, a person with mania having the capacity to consider that their behavior might be a medical illness. I suspect cognitive flexibility correlates to the personality factor, openness, as well as concreteness that occurs with neurocognitive deficits to the executive functioning cognitive domain.
Insight in Practice
We can ask ourselves various questions about any given client:
How do they distort their experience of reality?
How do they manage unpleasant or (personally) unacceptable internal experience?
How aware are they of their illness?
How aware are they of their actions and the impact on others?
What is their attributional style: internalizing or externalizing?
What is their cognitive flexibility: highly open or concrete?
What parts of their self are exiled, repressed or projected onto others, and what parts to they want or need me to see, acknowledge and validate?
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