Medico-legal aspects of alcoholism.

Abstract

The gulf between the thinking of physicians and lawyers is most vividly illustrated by their different concepts of alcoholism. To the physician, alcoholism is a disease: an alcoholic is a sick person. To the jurist (or at least to the law, as written and practiced) alcoholism is a bad habit and the alcoholic has a character defect. To be sure, many individual judges and attorneys accept the thesis that alcoholism is a disease; but this only complicates the problem because the word "disease" means one thing to the doctor and something quite different to the lawyer. Since psychiatrists frequently report to judges, probation officers and lawyers on problems of alcoholism, it is worth taking time to review this semantic confusion. The Social and Legal Concept of AlcoholismTo the doctor, disease is a deviation from health. Alcoholism is unhealthy, and therefore by this broad definition it is a disease. Since the alcoholic deviates from the norm of good health, he is in that sense a sick man.However, the word "disease" presents quite a different picture to the layman. In nonmedical eyes, a disease is an affliction; something which "falls upon" a person; something he does not seek; it requires treatment by a doctor, and the treatment consists in the doctor doing something to the patient. When the doctor tells the court that this defendant has a sickness, namely alcoholism, he does not mean to put the alcoholism in the same semantic category as pneumonia or pernicious anemia. But that is precisely the way the judge will read the report. He will reason-and this fallacy is understandablesomething like this: "In pneumonia a patient might have a delirium during which he might assault his attendant. This assault is obviously the result of an unfortunate illness which the patient did not seek, and which the doctor will cure with sulfa drugs. But the psychiatrist says that alchoholism too is an illness. I must believe him 132

The problematic label of suicide gesture: Alternatives for clinical research and practice.

“…and the psychotic or annihilating type which is malignant; under this heading come the actual suicides of the depressives, praecoxes and involutionals.” Lewis (1933) similarly differentiated between “ineffective gestures and bids for attention” and what were considered to be “serious, genuine attempts” (p. 270). In psychoanalytic interpretations of self-destructive behaviors, Davidson (1941) suggested that suicidal behavior can be related to both the unconscious aspects of personality (e.g., when behavior has specific symbolic meaning), and to the conscious aspects of personality (e.g., in relation to feelings of guilt or unworthiness). As a specific example of the latter, he referred to suicidal behavior of “the psychopathic variety, as a gesture to one's ends” (p. 42, italics added).…”

The Insanities of Reproduction: Medico-legal Knowledge and the Development of Infanticide Law

“…Davidson claimed that, while some infanticidal mothers suffered from mental illnesses which wholly negated their responsibility in line with insanity law, others frequently had some degree of diminished responsibility. Davidson (1941) gives a psychoanalytic version of the atavism theory to explain this diminished responsibility: Infanticide, i.e. by the mother of her offspring, of the quoted variety, may be psychiatrically interpreted as a regression of the individual to a primitive form of activity akin to other biological weapons of defence .…”