Managing the communication channel. Discursive representations of clinical communication in forensic psychiatric reports

Background: Forensic reports require clinicians’ presence as an agent in court-ordered forensic assessment.Aim: We focus on discursive representations of clinical communication in forensic psychiatric reports.Methods: We perform a critical discourse analysis of 142 forensic assessment reports for 33 patients detained and hospitalized on forensic wards in three hospitals in the southwest of Poland. Results: Clinical communication is constructed as controlled by the clinician. All references to patients’ communication are anchored in interpretation by the clinician. While the speaking patient is explicitly constructed as a communicator, the clinician her/himself is only very rarely represented as personally communicating, invoking an impersonal voice of institutional medicine. Discussion: Our study offers insight into the role of communication is forensic psychiatry as serving the clinician to construct an institutionally useful account of the patient. In contrast to psychiatry’s pronouncements, communication is not a means for a clinical dialogue, but for an institutional monologue. Conclusion: The results of our qualitative study are useful as do not only examine how things are done in forensic psychiatry, but also what it means in its context.