Self-reflection in illness and health: literal and metaphorical?

Anthony David

doi:10.1057/palcomms.2017.91

Abstract

Self-reflection describes a series of processes whereby a person appraises, evaluates or judges themselves. This appraisal can be in terms of physical, psychological or moral attributes. A number of self-reflection tasks have been designed and applied in experimental psychology and clinical settings. What is not known is whether self-reflection is a valid construct for study and whether it has any clinical implications for psychiatric patients deemed to have impaired self-reflection or “insight”. One design is to contrast the appraisal of another person with that of the self. Although it would be useful to measure this appraisal against a gold standard, that is not always possible. Similarly there may be doubt about what the person really thinks as opposed to what they may say. Nevertheless, the simple act of self-reflection can be studied using cognitive neuroscience methods. It appears that a certain brain network, the central midline system (CMS), is engaged in this task. People with mental disorders, especially those at the psychotic end of the spectrum, often see themselves differently from how others see them and the term lack of insight may be used to describe this situation. Recent neuroimaging research has shown that those whose self-appraisal accords most with others, especially their doctors’, show greater activation in the CMS and may have a better clinical outcome. One potential therapeutic approach with such patients to encourage self-reflection has been to make use of literal self-reflection through photographs and video.

Highlights

Self-detection if not self-reflection is a crucial biological function
For example a study comparing mental illness related terms and their selfappraisal in healthy subjects and patients with schizophrenia who had been categorised as having good or poor insight, revealed that not all trait adjectives are treated in a predictable way
The self-reference effect states that encoded material in relationship to the self, such as “are you such and such” has a mnemonic advantage over the same material encoded in relation to another person or another feature and this is because ofthe organisation of the self-semantic structure (Symons and Johnson, 1997). We used this to test the hypothesis that schizophrenia patients with poor insight would have a reduced self-reference effect versus good insight patients and controls because ofpoor self-reflection when recalling mental illness trait words (Bedford and David, 2014)

Summary

Introduction

Self-detection if not self-reflection is a crucial biological function. Any complex organism has to be able to detect “what is me” and “what is not me”—from an immunological point of view so that the organism can mount a defence against what is not them, and this has to be accurate enough to prevent an inadvertent self-destructive attack. For example a study comparing mental illness related terms and their selfappraisal in healthy subjects and patients with schizophrenia who had been categorised as having good or poor insight, revealed that not all trait adjectives are treated in a predictable way. In the third person condition participants rated the statements made on three dimensions of insight (David, 1990), namely: this person has something wrong with them like a mental illness; this person needs treatment for what is happening to them; these events and experiences are in this person’s mind.

Results

Conclusion