Law and Psychiatry
amounts to his or her own ‘made up’ legal definition. Instead s/he must ‘accept’ the law’s definition and simply give medical evidence which is deemed relevant to whether the legal test is satisfied or not, whatever his or her own views about how the definition in law should be drawn.
Use of information History versus evidence
Psychiatry and law also regard information in quite different ways.
To a court, any piece of information is evidence, to be admitted or excluded, deemed truthful or false, and given greater or lesser weight, all according to the rules of evidence.
To a psychiatrist, however, the same piece of information forms part of the patient’s history, or observation of their mental state, to be taken into consideration diagnostically or therapeutically. Tere is much less concern to consider in great detail and according to an established standard of proof whether each individual each piece of information is ‘true’ (although some assessment of the reliability of the source will still be made). Rather what is looked at is the total pattern of information (for example, of symptoms) and whether, overall, it is sufficient to make a particular diagnosis or formulation, within which it is to be expected that some known symptoms of the condition will be absent, or there will be symptoms inconsistent with the diagnosis8
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Tat is, medical process amounts to consideration of whether the information available is sufficient, taken together, to infer the diagnostic (or other) conclusion, rather as with a jigsaw puzzle, in terms of whether there are enough pieces of a particular picture to be convincing that the picture is really there. Such an approach infers that the combination of pieces of evidence can be mutually reinforcing in terms of the weight to be attached to each piece. Although law does sometimes apply, ‘corroboration’ probatively, validation in medicine is very different from truth finding in law.
Tese two very different approaches, not only what information is to be considered, but also to the manner in which they are to be considered, essentially reflects the disparity between the adversarial and investigative methods of inquiry of law and medicine respectively; but with the added factor that, within the investigative method of medicine (by comparison with legal domains within which the law does adopt an investigative approach), what is at its core is ‘pattern recognition’, within a strictly medical paradigm.
Methods of gathering and selecting information
Tese also differ between law and psychiatry. Courts will only consider evidence that is put before it by the parties, and which is deemed ‘admissible’; it will then test each piece of information adversarially. A forensic psychiatrist will actively seek out information from the patient, corroborate or contrast it with that given by the others, and will look at anything available in an investigative fashion.
However, if numerous or significant, they challenge the psychiatrist to question whether the perceived pattern (diagnosis, formulation) is correct, or the whole explanation.
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