Law and psychiatry as political symbolism

Abstract

The conventional view of law, and of psychiatry as well, focuses on how they change the world and people’s lives, usually for the better. Both law and psychiatry do have that effect, but it is not their only consequence and often not their paramount one. Both influence perceptions of the social world as well as actions and conditions. Their evocations of beliefs, perceptions, and assumptions constitute their most important political and social consequences, though not necessarily their most important clinical or legal effects. The publicized, discussed, and debated legal and psychiatric actions concentrate on procedures to change individuals, often people defined as offenders, as anti-social, or as otherwise pathological. They create public expectations of social change and confidence in amelioration, though accounts of successes by practitioners are chiefly anecdotal. Research that concentrates on the long term, on outcomes (rather than procedures) and on social structure (rather than individuals) typically finds a high degree of stability in social structure, and in the inequalities and problems that publicized legal and psychiatric programs promise to improve or eliminate. These studies typically conclude that social programs often fail, that recidivism is common, and that successes are problematic. What law and psychiatry are in modern society, as well as what they do, seems to hinge on the presuppositions of observers, on their methods of observation and analysis, and on their positions and roles. But some presuppositions, methods, and roles are more adequate than others. The more adequate ones, in my view, justify the conclusion that law and psychiatry as professions chiefly influence public beliefs and perceptions rather than social conditions or personal well-being. Their paramount effect is to encourage acceptance of established institutions, partly by creating an expectation of future change to correct inequalities and ameliorate grievances, and partly by encouraging people to define themselves as getting what they deserve. So far as these political effects are concerned, law and psychiatry display some intriguing similarities. In their most publicized forms, both promise improvement in the lives of distressed and disadvantaged people and a more equitable society. The legislation and litigation that are constantly in the news deal with problems growing out of inequalities in income, status, and power: civil rights, affirmative action, welfare policy, and regulation of business to protect consumers, workers, and neighbors. In spite of continuous governmental activity and public discussion, these are also the problems that are never solved and the forms of law that are largely symbolic and tokenistic. These laws bring im-