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The United States Supreme Court and psychiatry in the 1990s.

In the 1990s, the Supreme Court has decided several cases that have had an impact on psychiatry and psychiatric patients in the criminal justice system, on psychiatric hospitalization, and on psychotherapist-patient privilege. Of the seven cases discussed in this article, Chief Justice Rehnquist and Justice Scalia voted similarly in all seven cases. Since joining the court, Justice Thomas has voted with them. Justice Scalia interprets the Constitution, using what has been termed "textualism": avoid reference to legislative history, and interpret the Constitution according to the plain language meaning of the relevant section. Chief Justice Rehnquist and Justices Scalia and Thomas are inclined to protect states' rights from court decisions that expand US Constitutional power in cases involving civil plaintiffs and criminal defendants. They seek to protect states from being sued in federal courts, and, if there is doubt, lean toward not interfering with state prerogatives. They tend to not find unenumerated rights and prefer clear-cut rules over amorphous standards. Justices Kennedy and O'Connor, at times joined by Justice Souter in the middle of the court, provide the deciding votes in many cases. They seem to prefer a case-by-case pragmatism over a global jurisprudential philosophy. Approaching cases one at a time, they usually avoid broad philosophic pronouncements when they join with Chief Justice Rehnquist. Justice Stevens, joined by Justices Breyer and Ginsburg since they have been appointed to the court, is more likely to favor a broader reading of the 14th Amendment's Due Process and Equal Protection clauses. Of the seven cases, Kennedy and O'Connor voted with the majority in five cases, the dissent in one case (Zinermon v Burch), and split their votes in one case (Foucha v Louisiana, with O'Connor siding with the Court and Kennedy with the dissent). Commager, a noted historian, believed that political issues can be explored, explained, and debated and that the people of the new American democracy, armed with knowledge and freedom to defend, argue, and choose, will make the right decisions for their common welfare. This theory applies equally to the court: Whenever questions involving psychiatry and psychiatric patients are brought to the court, American psychiatry must make its views known in that forum. To do so requires awareness and knowledge of the cases that involve psychiatry and psychiatric patients that the court has decided, including those decided in the 1990s. To participate effectively, psychiatrists must understand the political landscape in which the cases arrive at the court's doorstep and the composition and leanings of the court and examine carefully the fact patterns (understanding that some fact patterns are more sympathetic than others). This awareness should result in amicus briefs that are scholarly, rely on empiric data, and are scrupulously honest about the limitations of our knowledge. In this way, psychiatrists may fully participate in the debate and aid the court in its exploration and analysis of the issues involving psychiatry and psychiatric patients.[1]


  1. The United States Supreme Court and psychiatry in the 1990s. Ciccone, J.R. Psychiatr. Clin. North Am. (1999) [Pubmed]
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