Mental health articles

OF mental health care and mentally ill

Mentally disordered offenders

Forensic psychiatry is concerned with the management of those who are ‘doubly deviant’ – those who are considered to have committed a criminal act and who are deemed to be mentally abnormal. Forensic psychiatry is charged with the management of lawbreakers and others who come before the courts. Thus, its area of jurisdiction is principally in relation to referrals from the criminal justice system and those patients who are detained in hospitals subject to restriction orders. The view of control discussed at the start of this chapter locates power in the hand of State organizations and agencies and their professional employees (psychiatrists and lawyers).

Foucault provides an alternative view of the emergent relationship between psychiatry and the law. Psychiatry’s involvement with penal law in the eighteenth and nineteenth centuries came about with the shift from a criminology that focused on the offence and penalty, to one concerned with the crime, the criminal and means of repression. The shift from crime to the criminal meant that the focus changed from what must be punished and how, to who must be punished: It is not enough for the accused to say in reply to that question ‘I am the author of the crimes before you, period. Judge since you must, condemn if you will’. Much more is expected of him. Beyond admission, there must be confession, self examination, explanation of oneself, revelations of what one is.

For Foucault, psychiatry took its place in the legal machinery through the concept of ‘homicidal mania’ (a killing that took place in a domestic setting in the absence of any apparent motive) in the latter half of the eighteenth century. From this moment, crime and insanity became the same thing. He illustrates this type of crime/insanity with reference to notorious cases: a mother who kills her child; a man who breaks into a house, kills an elderly woman and departs without stealing and fails to hide himself; a son who kills his mother with whom he has always got on well. Psychiatry justified its involvement in order to make the unintelligibility of this type of crime intelligible. By claiming that insanity manifested itself in crime and vice versa, forensic psychiatry adopted a different focus of interest from the rest of the profession. Foucault links forensic psychiatry to a type of public hygiene where the focus is on the ‘societal body’ and social danger rather than the ‘individual soul’.

Homicidal mania represents insanity in its most harmful form – minimum warning, maximum consequences – which only a specialist eye can detect. According to Foucault, forensic psychiatry’s claim to monomania did not include a desire to take over criminality and was not a form of psychiatric imperialism. Rather, it was a means of justifying its function, namely the control of danger emanating from the human condition.

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