The experience of psychosis is traumatic and confusing, and the course of the illness is unpredictable and frequently changes. Many patients with schizophrenia can remain symptom free and others can lead reasonably productive lives. However, the majority of them will still experience a degree of impairment of function, and many will suffer frank relapses or chronic levels of their positive symptoms. Remission of symptoms, or a ‘recovery’ state, is achieved through independent, productive functioning, and maintaining satisfying personal relationships. However, most people with schizophrenia do not feel they have recovered even after treatment and lack faith in the possibility of recovery. In other words, they are hopeless and helpless. Approximately 40% of people with schizophrenia are unable to understand that they have the disorder, because the part of the brain that is damaged by schizophrenia is also responsible for self-analysis. This topic is seldom raised by professionals, and this issue is compounded by the fact that patients are not able to address these feelings without adequate knowledge of their own illness. Developing effective interventions that can improve the functional and subjective well-being of patients is important in this population. Recovery in schizophrenia has been a focus of research since the 1940s (2). The concept of recovery from serious mental illness such as schizophrenia includes the combination of subjective experiences and objective outcomes.
In patients with schizophrenia, insight into illness is associated with fewer symptoms, better psychosocial functioning, and better compliance with antipsychotic medication. However, recent studies show that insight is related to increased rates of depression, hopelessness, and lower self-esteem. The complex relationship between insight into illness and quality of life should be considered when striving to improve the treatment and recovery of patients with schizophrenia. Quality of life measurements have become an important aspect in evaluating the treatments and care provided to patients with schizophrenia (1).
A cross-sectional study was conducted in the psychiatric department of a French public university teaching hospital. The study included stable schizophrenic patients, ages 18 and older. Their findings highlighted the negative relationship between awareness of mental disorder and quality of life (1). Perhaps patients with good insight of their mental illness realize the consequences it has on different aspects of their life, such as restrictions in daily living, barriers to rehabilitation, and stigmatizations held about mental illness. Accepting a definition of oneself as mentally ill, and assuming that mental illness means incompetence and inadequacy, impact hope and self-esteem, further impacting suicide risk, coping, social interaction, vocational functioning, and symptom management. Furthermore, patients with poor insight might overestimate their quality of life because they believe that they are more competent and able to cope with the illness.
If insight leads to an impoverished sense of self, worse quality of life, and pessimism about the future, should attempts be made to increase it? Ignoring the importance of illness identity may lead to difficult barriers in treatment and rehabilitation for patients with severe mental illness. Treatment focused on illness identity can have a positive effect on outcomes by specifically addressing patient attitudes related to illness identity. Insight into illness, marital status, and employment should be considered when developing specific interventions to improve quality of life for patients with schizophrenia.
Nursing interventions should be developed to become more systematic and implementable. The main goal is the understanding of recovery from mental illness and learning practical recovery strategies regarding communication skills, management of self-care, medication adherence, crisis