Ambivalence, alliance, and advocacy: misunderstood dualities in psychiatry and law.

Law and psychiatry operate through differing models of reasoning, understanding, even of reality. I For the clinician first encountering the legal system, the fundamental concept of the law perhaps most difficult to grasp is the nature of the adversary process. Whether such a first encounter occurs during a commitment proceeding on a manifestly psychotic patient, in the preliminaries or dispositions of a divorce or other civil action, or in the confrontations of the courtroom, the uninitiated psychiatrist will be in an environment built around alien modes of thinking and perceiving often antithetical to his or her own psychiatric perceptions and views. As a witness, for example, the psychiatrist may be subject to an attack on the stand such as he or she has never encountered outside of psychotic transferences. 2 The energy and occasionally abusive intensity of the cross-examination, in this example, derives in part from the underlying principle that the attorney for the "other side" owes his client the most zealous, "thrusty" efforts in the service of advancing that side of the case. At the heart of this issue lies the assumption offering the central justification of the adversary system: that the truth can best be determined, and justice served, by drawing the substance of the case upon the rack of disputation, by examination and cross-examination, by selective admissibility of evidence, and by other long-established rules and procedures. * In playing a role in these proceedings, the trial attorney is an advocate for his/her side of the case. In common with the qualities expected of the advocate in other settings (for example, patient advocate in a hospital), the attorney is expected to present a view that might be termed unambivalent; that is, to function successfully in litigation, the attorney must present a unified and unqualified, even unrestrained version of the client's view, be the client plaintiff or defendant.