Deficits of insight and awareness of illness may be related to the etiology of schizophrenia as well as denial of illness, insufficient knowledge, and stigma about mental illness. There are commonalities such as difficulties of recognizing problems of the mind or stigma associated with various psychiatric disorders. Deficits of insight and/or awareness of illness are common symptoms of schizophrenia, which are considered to be due to dysfunction of the brain such as meta-cognition. Those would be improved in the acute phase with pharmacotherapy to some extent as psychiatric symptoms have been improving. Specific treatments for improving chronic and residual deficits of insight and/or awareness of illness in randomized controlled studies have shown limited effects until recently. Fostering insight and/or awareness of illness in the acute and recovery phases and recognizing residual disability were concisely introduced based on the author's clinical experience. For these purposes, it is important to observe patients' subjective experiences from their standpoint, empathize their loneliness due to the fact that no one can co-experience their subjective symptoms, and understand their challenge to re-build their lives from the viewpoint of co-production with therapists, patients, and family members. Pessimistic statements about schizophrenia such as "you must take pills as long as you live" at an early stage of therapy are harmful for both the patients and their families. No one wants to accept a negativistic label. What and how our society and psychiatrists recognize schizophrenia are key issues when thinking about insight and/or awareness of illness.
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