The Role of Dialogue, Otherness and the Construction of Insight in Psychosis: Toward a Socio-Dialogic Model

Abstract

The focus is on the intersubjective, narrative and dialogic aspects of the clinical phenomenon of insight in psychosis. By introducing a socio-dialogic model for the clinical production of insight, it can be learned how insight, as a form of self-knowledge (of a morbid alteration in one's relation to the world/others), is a product of the clinical interview, namely the dialogic relation between patient and clinical interviewer. Drawing upon the philosophy of Emmanuel Levinas, expressly his notion of the ethical encounter, the production of insight in the clinical interview is elucidated as both a synchronic and diachronic phenomenon—a provisional form of self-knowledge based on historically-produced frames of meaning which are recalled and narrated, i.e., produced at a specific moment in time. The production of insight, based on auto-biographical memory, is ultimately a processual and transactional phenomenon which arises out of the narrative construction of experience and the dialogic negotiation of the individual's "authored" experience. This process may be understood as a synergistic dynamic between intersubjective micro-processes (dialogue) and symbolic macro-processes (such as "culture"), which may, when crystallized at the individual level, precipitate a subjectively insightful account of the prodromal illness experience.

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