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Handbook of Forensic Psychiatric Practice in Capital Cases


Medicine and psychiatry versus psychology


Even within mental health disciplines, there are often disparities in the meaning of words, and also in the method of inquiry (see further above, and below). Hence, in broad terms psychiatry, as a branch of medicine, adopts ‘categorical’ constructs, whereas clinical psychology adopts ‘dimensional’ ones.


Te difference in constructs and methods of inquiry between psychiatry and psychology determine different incongruities between each and the law and legal process. In broad terms, psychiatry is ‘less incongruous’ with law than is psychology, because the more categorical and ‘binary’ approach it adopts is less incongruous with the similar ‘binary’ approach adopted within law. Hence a doctor may be prepared to answer the question put to him in the witness box: “Well, doctor, was he ill or not?”, whereas a clinical psychologist may wish to revert to statistical description against a population.6


Ultimate disparity


Ultimately, the purposes of all mental health sciences are focused on the welfare of the individual, who should expect to receive some health benefit from treatment, albeit sometimes with additional gain accruing to others; for example, potential third party victims. Law is concerned with justice for all, including concern for the rights of both the defendant and victims, or society. Hence, the manner of striking the balance between pursuit of patient welfare and public protection is bound to be different between mental health care professionals and legal agencies. Psychiatry and law address related concerns with potentially different values, negotiating the interface between the two is ethically, and legally, both difficult and crucially important.


Autopoesis versus reflexivity Varying degrees of incongruence


Since the law is more or less binary and categorical in its approach within different legal contexts, the degree of incongruity between it and either psychiatry or psychology may, again, vary. For example, since criminal law at trial is concerned with the presence or absence of responsibility, its definitions of mental disorder (and there are a number) are characteristically tight, and, of course, address justice7 and not human welfare. By contrast, the constructs utilised in sentencing sometimes relating to public protection are often more loosely defined, although again without reference to the welfare of the individual concerned (except where sentencing occurs by way of mental health legislation). Certainly within all criminal domains the constructs derived are wholly different from the biological or psychological constructs adopted within medicine, psychiatry and clinical psychology, which are concerned chiefly with aetiology, and/or with treatment


Related to the foregoing, the terms ‘autopoesis’ and ‘reflexivity’ refer to law’s openness, or otherwise, to adopting the concepts used in other disciplines.


6 From here on, even though the constructs of medicine, or psychiatry, and psychology are distinct in their nature and derivation, they have sufficient in


common at least to be distinguished from mental constructs which occur in law, such that the reader should interpret ‘medicine, or ‘psychiatry’, to infer the inclusion of psychology, unless we specify a distinction.


7 Justice can mean, from the perspective of the individual, proportionality, or ‘just deserts’. Tere are other meanings attributed to the concept also. 10


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