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Philosophy, Psychiatry, & Psychology 7.3 (2000) 223-228



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Unordered Lives

Jan M. Broekman


The close ties between law and psychiatric illness challenge our effort to understand the complex semantics of Western culture and the foundations of law in the heart of that culture. It is, however, difficult to be immediately confronted with the limitations of these semantics. Can one ever achieve a refined precision of psychiatric issues? Lawyers and psychiatrists tend to disregard the fact that people live within different realms of expressiveness, even where the same phenomena seem apparent. They neutralize all relativity and design a quasi-universal body of legal doctrines or construct an all-embracing medical nosology. The question remains what practices of judgment are justifiable when the history books demonstrate the ever-changing character of the idea of a common good and a well-ordered life. Notions of relativity accompany decisions to punish or to cure, to exclude or to include, to disregard or to consider. In these decisions, there are never supracultural notions at hand and only rarely ideas that reach beyond the boundaries of either profession's own discourse.

Confusion

The unordered is element of an order. Verwirrtheit (confusion) is a central notion in psychiatry from Griesinger to Jaspers; it became for Jaspers a starting point toward diagnostic refinement. One even encounters the notion in the DSM-IV. What characterizes confusion or disorder in a person's life? The answer is in narratives. "You are confused" really means: "I cannot find out where you stand or which is your viewpoint when you tell me what goes on." And also: "I cannot follow you; I do not find any causality in your story." Furthermore: "You do not show me what it is all about; it has apparently no meaning or sense. What drives your narration? For what reason or purpose do you produce your story? You seem confused; you live an unordered life." That type of interrogation (in court) or conversation (in consultation) takes place in legal as well as in psychiatric discourse. Both are ordering discourses, and they diagnose disorder where Verwirrtheit seems the immediate cause. Disorder leads to corrective or curative commands--does the difference between correction and curing really matter? Robinson's doubts about the relevance of that difference are in tune with philosophical and psychiatric literature on that subject.

Keep in mind that the "insanity defense" is a legal issue; it does not unfold in psychiatric discourse, and the defense never uses solely the language of psychiatry or medicine. The defense is a legal issue, not a matter of psychiatric judgment. However, psychiatrists do function in legal discourse, for instance, in criminal law where one must be declared fit to stand trial, declared non compos mentis, or in a state of diminished responsibility. Where a differentiation between retribution and cure must be made, experts serve the law by clarifying this focal point. How to translate psychiatric expertise in legal grammar is a well-known problem to judges and courts. Courts of appeal and supreme courts in common [End Page 223] law, as well as in civil law systems, tend to quote medical or psychiatric handbooks to defend an opinion. This use of such texts touches the foundations of law, as Robinson correctly suggests, and those foundations are not exclusive for the legal discourse; they unite psychiatrists, lawyers, and other professionals as well as citizens. Law, medicine, and psychiatry, all powerful discourses in Western culture, share the foundations of that culture. The three are of course not the product of individuals, although they are man-made. Legal scholars bridge the gap between the generality of culture and the contributions of the individual when they give their cases the names of the parties, their legislation the names of politicians, and their doctrines the names of legal scholars. The same holds for nosology in medicine--many clinical pictures bear personal names. Agents in law and medicine appear as human beings, as responsive and responsible individuals. There is, however, a restriction: responsibility and responsiveness must fit into legal discourse. The latter is the prevalent channel of power and empowerment in social...

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