The use of legal rhetoric in a clinical setting: advocating the advocates.

The continuing intervention by courts and legislatures in the decisions traditionally reserved to psychiatry is generally perceived by mental health professionals as a threat to their practice. As jurists insist upon supervising therapists' decisions to medicate, I to hospitalize patients,2 and, indeed, to discharge them, clinicians, as might reasonably be expected, retreat into a "siege mentality"4 as their expertise is called into question: Commentators remark that "legal developments ... presage a depressing future for psychiatry";5 and the law is portrayed as hindering effective patient care, rather than as protecting the rights of the neglected and underprivileged. In view of the uncomfortable liaison between law and psychiatry, it would seem odd indeed were practitioners to be assisting the efforts of those whom they see as the intruders while, at the same time, complaining of that intrusion. Yet this very phenomenon may be occurring. Ironically, clinicians are unwittingly encouraging the expansion of legal influence by adopting legal rhetoric in the treatment setting. Legal rhetoric appears more frequently in the daily dialogue between therapists and the severely disturbed patient. In that dialogue, it promotes antagonism between the treatment team and the patient and among members of the team themselves. The psychiatric community believes that the lawyers have introduced this antagonism. Yet therapists' own use of legal rhetoric in the context of psychiatric treatment may, paradoxically, lead to advocacy of the advocates and away from the invaluable task of further developing psychiatric expertise and defining more closely the parameters of decent care for the severely disturbed.