Expertise and Existence: Re-Telling Stories in Forensic Psychiatry
Regarding the fact, that the individual biography always has a bodily aspect, it seems almost trivial to place the body at the very beginning of every human experience. The story of a life is always also a story of the associated body. From the perspective of Cultural Studies and Anthropology, but also from a more sociological point of view, body and story cannot be separated. Rather, the unique story of a body-biography facilitates a unique perspective. The biographical knowledge, we can get about a person depends on the source of the specific story, we hear. In terms of Literature Studies this implies that we have to bring to mind the position of the storyteller and in general the context of a particular story, like time and space. In this sense, we speak about authorship. The story of a life and therefore of a body is never written by just one author. Every-body is part of different social systems. Family structures, educational systems, employment markets and also medical practice have a strong impact on the stories we tell about ourselves. Especially medicine provides explanations for bodily and psychological experiences, which strongly impact cultural body and psyche perceptions in western societies. A very special part of medical practice is expertise. In our society we can find different biographical points of intersection, where a physician can become the co-author of an individual’s life story through expertise. Some examples are school enrolment examinations for the first class pupils or the diagnosis of invalidity.
One of the most interesting fields, where physicians have to do expertise is that of forensic psychiatry. Here, the medical expertise is a strong component of a regulated law practice between medical knowledge, institutional structures and individual biography. This initial point of view raises specific questions. One of them asks for the production conditions of medical expertise. The first part of the planned study thus considers the perspective of psychiatrists, who are confronted with patient stories of different kind in their daily work. How do they find their final expert opinion in a particular case? Regarding the fact that physicians doing expertise in forensic psychiatry work in very different spheres of the social system, a need for “translation” arises in different stages of the process. First the bodily and psychological state of an individual has to be translated into medical terms and by writing down his or her report the expert also has to incorporate the present law system. In this way, medical expertise becomes a strong part in court decision making processes, which can make the difference between the treatment of a person as a patient, who is in need of medical help and the treatment as a criminal, who has to serve a sentence.
From the perspective of an individual, who has to pass through a medical examination aiming at a psychiatric expertise, other questions arise. This perspective is the second part of the planned study. A crucial question here focuses on the patients’ side: What are the experiences of patients, who are involved in such an expertise process? How does the professional medical opinion affect the individual’s perception of his or her own bodily and psychological condition and how is it integrated in a biographical narrative? The fixed story of an expert’s report is able to rewrite the story of a person’s life. Especially in forensic psychiatry the final judgment of a physician is of great importance for the future life of a human being.
Medical expertise – and this is a very important point – is neither neutral judgment nor does it belong exclusively to the sphere of medical practice. The process of doing expertise in forensic psychiatry is a complex interaction: information, terminology, institutional expectations and different sources of professional and lay knowledge have to be connected and fixed in a single final judgment. And this judgment becomes a point, where new biographical story lines are enclosed. In my project I use the qualitative methods of social sciences, like narrative interviews, ethnomethodology and the analysis of documents, to make visible the process of doing expertise in forensic psychiatry. The study is aiming at an account of the different stories, provided by different actors, who are involved in a complex and detailed process, called medical expertise.
Author: Alena Kunkel