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Effect of Insight
Having lots of Insight has several effects to your game. The most obvious is the first one, which is the activation of the Plain Doll in Hunter’s Dream, which is the sole source of leveling up in the game.
You need exactly 1 Insight to start leveling, and you usually acquire it when you fight the Cleric Beast. Additionally, each point of Insight will reduce your Beasthood stat, and spending Insight will increase it.
Insight also seems to make the game more difficult; certain enemies will gain additional abilities after you exceed 20 Insight, which will make them much more unpredictable and much harder to kill.
At 40 Insight, the Lesser Amygdala in the Cathedral Ward become visible as well.