Civil commitment due to mental illness and dangerousness: the union of lawand psychiatry within a treatment-control system

This article discusses the use of 'dangerousness' as a legal criterion for civil commitment. The notion of dangerousness is defined within the perspec tive of the relationship between judicial and medical-psychiatric instituti ons. By reviewing empirical evidence concerning the possibility of a link b etween mental illness and dangerousness, we critically evaluate the main po stulate supporting the inclusion of this notion in the civil laws. We then examine empirical studies of psychiatric expertise in dangerousness assessm ent and risk prediction. By using observational studies of civil commitment proceedings, we examine how the legal criterion of danger to self or other s is actually operationalised into a series of heuristic criteria. These cr iteria are teleological statements: if being mentally ill and being dangero us are, in this context, interchangeable, so are the finalities of treating and controlling. We conclude that, at the psychiatry-justice interface exe mplified by civil commitment, treatment and control have been equated conce ptually and in practice, even if the written law clearly distinguishes the concepts. With respect to civil commitment, the institutions of mental heal th and justice are not, as usually depicted in sociological analysis, two d ifferent systems that meet and compete at this junction. Rather, they join together - becoming, in effect, one actor - within a treatment-control syst em which has as its function and aim to 'take care of' residual cases viewe d as problematic for society.