Toward a critical forensic psychiatry.

About 20 years ago, Dr. Alan Stone stunned forensic psychiatrists when he delivered the text of “The Ethics of Forensic Psychiatry: A View from the Ivory Tower” to an annual meeting of the American Academy of Psychiatry and the Law. In his remarks, he first questioned the coherence of the intellectual underpinnings of the ethics of forensic psychiatry. He then expressed grave misgivings about the wisdom— and by implication, the desirability—of standard forensic psychiatric practice. Furthermore, he did so not as an outsider, but rather as (by all appearances) a quintessential insider, being both a former president of the American Psychiatric Association and the Touroff-Glueck Professor of Law and Psychiatry at Harvard. He took law seriously, he took psychiatry seriously—and he took them both to task. To this day, forensic psychiatrists find themselves grappling with, and distancing themselves from, his remarks. In the ensuing years, few other insiders have put forward arguments similar in critical spirit to Dr. Stone’s. On the other hand, there are many forensic psychiatrists who may not consider Dr. Stone an insider at all. To many he appears to represent someone on the margin—someone who, because of his credentials, must be given a forum to be heard, yet someone who remains enigmatic and at times unhelpful. It is precisely this spot on the margin that I want to analyze in this article. I want to examine not only how one may define and then arrive at this position, but also what one might be able to do from there. By doing so, I hope to move toward making a place for a critical forensic psychiatry: a practice that takes seriously both law and psychiatry, yet a practice that allows for a profound questioning of the most basic assumptions of both fields. I will argue that one can only engage in critical forensic psychiatry on the margin as an insider who must forever act like—and eventually be treated as—an outsider. Yet, I will also argue that from that spot one can provide insights that, while radical, may help to invigorate forensic psychiatry, or at least keep the field fresh and reflective, in much the way that Dr. Stone’s thoughts have influenced the field for almost a quarter of a century.