The Concept of Normality: A Forensic Psychiatry Perspective

Abstract

Background: The concept of normality has eluded a single universal, static and linear definition, despite extensive investigation by such diverse areas of knowledge as philosophy, anthropology, medicine, psychology, statistics, among others. The pathological is in continuous dialogue with normality and, therefore, this debate is of interest to forensic psychiatry (FP).

Aims: To understand the role of FP in helping define the limits and exceptions (within Law) to a presumed “legal normality” and the tensions that arise in such task.

Methods: We undertook a selective literature review, focused on philosophy of law and forensic psychiatry.

Results and Conclusions: While beginning by recounting the efforts to define normal within the field of psychiatry, through the works of Alejandro Raitzin, Daniel Offer and Melvin Sabshin, we restart again from the implicit model of Man in the Law according to Michael Moore: human behavior is explained by practical reasoning, with autonomy, motivated by reasons and having intentionality and agency. Inasmuch Law presumes that all adult citizens have this “legal normality”, therefore possessing rights, capacity and responsibility, FP may be called upon investigate the scientific reasons to exceptions to this so-called “legal normality” (e.g. involuntary admission, not guilty by reason of insanity, interdição/inabiliação [concepts similar to limited and general guardianship]). In doing so, FP will struggle with areas of tension, where border disputes exist, whether because it’s in their nature (normality is a dynamic concept) but also because the influence of other agents. In this presentation several areas of tension are explored, with detailed analysis of the problems of personality disorders (e.g. involuntary admission, not guilty by reason of insanity) and the problem of fabricated nosology (e.g. the so called parental alienation syndrome). In this effort, FP navigates in a tight canal between two systems (not always overlapping) for which it has the task of establishing a fruitful dialogue (Law and Medicine). The frontiers of “legal normality” must be watched zealously, with an ethical stance, avoiding FP instrumentalization without letting go of the humanist role of medicine (and psychiatry) in caring for people, be they sick criminals or criminal patients.