Assessing ‘Insight’, Determining Agency and Autonomy: Implicating Social Identities

In this chapter, we draw on a critical analysis of 120 inpatient charts from a large psychiatric institution in Toronto, Ontario to examine the concept of ‘insight’ as it is operationalized by psychiatrists in chart documentation. We argue that psychiatrists use insight as a discursive means to delegitimize patient perspectives that diverge from the medical model of mental illness, particularly those that are more likely to be held by marginalized people. Patients who expressed the logics and lived realities of white, middle class, male heteronormativity were often accorded more respect and were more likely to be perceived as insightful. The construct of ‘insight’ plays a fundamental role in the justification of coercive measures such as involuntary hospitalization or detention and compulsory treatment. Thus, the attribution of ‘insight’ and its associated discursive logic has serious implications for patient agency and bodily autonomy.