Party or patient? : Discursive practices relating to coercion in psychiatric and legal settings

Sammanfattning: The subject matter of this study is professional discourse concerning psychiatric assessments, particularly those relating to compulsory care. Discursive practices in two institutional settings are compared, namely a psychiatric clinic and an administrative court.In Sweden, psychiatric coercion is regulated in the Compulsory Psychiatric Care Act (Sw: LPT), introduced in 1992. This new law was designed to improve patients' legal rights. The most important change was the introduction of obligatory court hearings to try psychiatrists' decisions to apply compulsory care. An important aim of the study is to investigate how psychiatric cases are recontextualised in the new legal setting.Eighteen months of ethnographic fieldwork was carried out at two psychiatric units: an emergency/admission unit and a closed, so called LPT unit. In court, fourteen LPT hearings were audiotaped.At the clinic, staff to a large extent use vernacular terminology to describe patients. Furthermore, personal knowledge of each patient is an important interpretative framework. The meaning of descriptions depends on the local context. The discourse at the clinic often follows a circular logic: one has to assume illness in order to construe descriptions of symptoms as indications of illness. When clinicians apply legal criteria, their primary concern is to act according to a clinical conception of what is in the best interests of the patient. Occasionally, they may set aside what they believe is required by law in order to conform to clinical priorities. Thus, staff often seek informal solutions to clinical problems. To clinicians, LPT may also become a tool to solve certain organisational problems related to, for example, issues of transferring patients.In LPT court hearings, the patient is formally an adverse party to a chief psychiatrist. The analysis suggests, however, that the status of patient becomes crucial also in the court discourse. Several features, which can be associated with a clinical understanding of cases as patients, are adopted by the legal professionals, e.g. an assumption of illness and a tendency by public defenders not to take an adversarial approach. As a consequence, the function of court hearings to independently evaluate psychiatric decisions may be questioned.