Forensic Psychiatry in India: The Road Ahead

Article excerpt

Byline: T. Asokan

"I construct my memories with my present. I am lost, abandoned in the present.

I try in vain to rejoin the past: I cannot escape."

Jean-Paul Charles Aymard Sartre: Nausea (1938)

Distinguished guests, fellow members, friends, ladies, and gentlemen, let me express my deep gratitude for bestowing the honor by electing me as the President of Indian Psychiatric Society (IPS) for the year 2014. I pray that I prove worthy of your choice and pledge to work for the betterment of our great fraternity to the best of my capacity. I have chosen "Forensic psychiatry in India - The road ahead" as my theme for today's presidential address.

"Concepts carry consequences-classifying things one-way rather than another has important implications for the way we share toward such things. [sup][1]" There is no consensus view about a definition of forensic psychiatry. It is the field of activity which is still defining its boundaries. [sup][2]

Differing legislative, philosophical, and community traditions shape the style of forensic psychiatry from one jurisdiction to another. Clinical psychiatry operates within therapeutic contexts and forensic psychiatry operates within legal contexts.

Pollack [sup][3] construed forensic psychiatry as limited to psychiatric evaluations for legal purposes and described it as a "broad general field in which psychiatric theories, concepts, principles, and practices are applied to any and all legal issues." The history of forensic psychiatry is often conceived of as "the entrance of medicine into court" or even a "medicalization of law."

Forensic psychiatrist has to substantiate and prove the bases for his opinions, differentiate between what he sincerely believes and what he can demonstrate, and distinguish the hard data and the Meta psychological theories that purport to explain the data.

The need to establish a sophisticated forensic mental health system is the result of the global trend of deinstitutionalization of the mentally ill. [sup][4]

Modern forensic psychiatry has benefited from the evolution in the medico-legal understanding and appreciation of the relationship between mental illness and criminality, evolution of the legal tests to define legal insanity and the new methodologies for the treatment of mental conditions that provide alternatives to custodial care.

Ancient tragic narratives described by Aristotle were arguably the first forensic examination of the psychology of human cruelty and misfortune. Their form and structure still influence the contemporary criminal courts that investigate the terrible events that occur between people and decide what to do with the perpetrators.

De Praestigs Demonium by the German Physician Weyer [sup][5] (1515-1518) which appeared in Latin in 1563 may be considered as the first medical treaties in the common milieu of mental disorders and law. Medico-legal perception of mental illnesses came into existence in 17 [sup]th century. Custodial placement was decided by the judges based on the request of the relatives of the mentally ill. Prisoners were segregated from the mentally disordered with the reorganization of existing institutions and creations of asylums. Ray's [sup][6] "treatise on medical jurisprudence on insanity"(1838) was used as a reference by defense in the trial of Daniel McNoughton (report 3 and 4 [sup]th March 1843: Ref: 26, 31, 33, 39, and 43).

The role of medical witness gradually changed in 19 [sup]th century and physicians became more involved in detecting insanity, especially within the legal system. [sup][7] Psychiatric services surfaced the criminal justice system in 20 [sup]th century. [sup][8]

In this presidential address, I would like to focus on the legislations in the Indian mental health milieu which guided the destiny of psychiatry in India. The second issue is a contentious one, the ethical dilemma faced by the forensic psychiatrist, who has to wear two hats at the same time providing treatment for the patient and making an assessment for the evaluee. …