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Paper short abstract

Drawing on interviews, I examine psychiatrists’ conflicting duties in criminal courts. They are mandated to provide individual risk assessments. However, they also worry about psychiatry’s role in reproducing inequality. I read their ambivalence as a reckoning with diverging responsibilities.

Paper long abstract

This paper reads doctors' recognition of their structural position in the carceral apparatus of the state as a form of ambivalence.

I conducted 12 interviews with psychiatrists and psychologists who work as expert witnesses, and 5 interviews with legal professionals. Clinicians write medicolegal reports that are used in the court process. They document the client's thoughts regarding the offence of which they are accused. One part of the report-writer's task is to assess the risk that the client may commit further offences. Clinicians had diverse, contradictory responses to my questions regarding how relevant feelings of guilt and shame were to future risk. That is, the medicolegal report-writing process did not function as a simple technology of individual responsibilisation with respect to the client.

Instead, several of the clinicians thought deeply about their own responsibilities. They worried about the role of criminal law and mental health practice in entrenching pre-existing inequalities. Interpreting these competing responsibilities as a form of ambivalence can help to guide analysis.

Ambivalence has been at the heart of psychoanalytic thought from Freud onwards. Carveth, following Klein, has argued that it is only from the depressive position that reparative guilt can be felt, reflecting genuine concern for the other. The self-punishment of persecutory guilt – a practised performance for the contemporary professional managerial class – can be understood as a narcissistic evasion of true guilt. This paper traces clinicians’ ambivalence, documenting how they are working through these emotions. Inner polarisation is avoided, but the political ends remain unclear.