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Handbook of Forensic Psychiatric Practice in Capital Cases


Minimising errors in translation


Although a perfect translation may be impossible, the effects of the inherent mismatch between concepts can be minimised where:


• Lawyers ask psychiatrists clear legal questions, especially when giving instructions – for example ‘please explain how the defendant’s diagnosis might or might not amount to a defect of reason’, as opposed to ‘please give a report on the defendant’s mental condition’


• Psychiatrists understand how the law will wish to use the answers they give to questions; that is, to determine justice and not to achieve what is in the interests of the defendant (who may


coincidentally be a patient under treatment)


• Psychiatrists recognise the limits of their professional expertise and role, and do not, for example, attempt to address the ultimate issue


Psychiatry as forensically special


Te problems in the relationship between psychiatry and law are very different from those between, say, forensic pathology and law, where the law is interested only in matters of fact, the nature of a wound and therefore how it was probably inflicted. Psychiatry deals with constructs apparently, but only apparently similar to those of law; for example, volition in psychiatry and intention in law. Although these are distinct constructs, they are apparently sufficiently close for the essential difference between them often not to be apparent to psychiatrists and lawyers. Tis can lead to mutual misunderstanding and, for the psychiatrist, ethical tension.


Some detail of ‘Constructs from Purposes’


Compare and contrast psychosis within psychiatry and insanity within law, each of which involve a loss of reality testing, and/or the ability to recognise the true nature of actions. Similarly, ‘abnormality of mind’ within diminished responsibility, although appearing almost medical, is distinct from anything medical. Psychiatry defines psychosis by its symptoms and aetiology, so that it can be reliably identified by different doctors, and classified within separate diagnoses, so as to make a prognosis and to facilitate appropriate treatment, but not to determine whether the psychotic defendant should be found unfit to plead, or unfit for execution.


To the criminal law, the concepts of insanity and diminished responsibility exist only to allocate criminal responsibility justly, in different ways. It defines unfitness to plead in order to determine whether a fair trial is possible, and it defines fitness for execution in similar terms, of ‘whether it would be fair to execute’. Since, for example, the consequence of a finding of insanity is to remove responsibility entirely, whereas that of diminished responsibility is merely to reduce it, the law adopts different definitions which, to a doctor, look entirely inconsistent with one another, but which are legally coherent in their difference, given their different justice functions.


What, of course, a doctor must not do is to give effect to any ‘disagreement’ with the law’s established construct of a given ‘legal capacity’ s/he may hold, or to give an opinion on the matter on what


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