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Am J Psychiatry 1963;119:713-720.
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Dept. of Psychiatry, University of Michigan, Ann Arbor, Mich.

Dept. of Psychiatry, Western Psychiatric Institute, Pittsburgh, Pa.

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We have described the breakdown of a vital social system necessitating collaboration between two highly respected professions. The confused statute regarding incompetency to stand trial and its distorted application by both physician and lawyer tends to subvert the social and legal principle inherent in the concept of competency and in so doing to sacrifice the professional identity of both lawyer and physician as well as their appropriate functions as assigned by society and which their client has the right to expect.In this process, the legal position becomes untenable. The court cannot use the psychiatrist effectively because it cannot understand him and because it does not demand that which could be understood. Therefore, in lieu of using his competence, it must accept his pronouncements and tacitly his usurpation of its role. The valued and traditional legal insistence on the right to determine fact is passively given over to the acceptance of opinion as fact. The result is that from start to finish the physician occupies a foremost yet counterfeit role in incompetency proceedings. The abhorence of the psychiatric discipline for actions based on value judgments involving the moral and ethical behavior of the patient is well known. Yet, in dealing with his legal brethren, the psychiatrist seems willing not only to evaluate his client's psychological status but to judge his behavior, evaluate its social significance in an ethical sense, and to decide the fitting consequence of such behavior. In short, often the physician usurps the function of the law and in so doing relinquishes his therapeutic opportunity. The process all too often ends at the hospital where we have seen the therapeutic confusion, the contradictory practice of parole, and the dismal treatment results.The individual truly has been victimized by a process designed to protect his rights and it may be stated that a social system that victimizes its individuals will soon find itself the victim.

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