Department of Psychiatry, Hospital Gregorio Marañón, Ibiza, Madrid, Spain.
Curr Opin Psychiatry. 2010 Sep;23(5):447-52. doi: 10.1097/YCO.0b013e32833cd1e6.
In this paper, we analyze the concept of objectivity as it is accepted in the 'standard position' on ethical practice in forensic psychiatry and confront it with the current trends of psychiatric nosology, specially the debate that we have now regarding the theoretical orientation of DSM-5, which is intended to be more based on neuroscientific more than on clinical data, as has been the tradition in psychiatry so far.
In view of those elements, we review the skeptical position about the ethics of forensic psychiatry and the obstacles that, in my opinion, are still standing according to Stone's proposal: the fact-value distinction, determinism vs. free will, the deconstruction of the self, the mind-brain problem, and the chasm between morality and normal science. In my opinion the objections made by Stone on the feasibility of forensic psychiatry in the courts continue in full force, to the extent that these objections are the heart of the debate about the theoretical orientation of the DSM-5.
The advocates of the standard position have an overly optimistic view of the capacity of objectification of forensic psychiatry. This problem has also been revealed in the intense debates on the direction of the DSM-5 in general psychiatry, a draft of which appears excessively based on neuroscience and little on traditional clinical practice.
本文分析了在法医精神病学的伦理实践“标准立场”中所接受的客观性概念，并将其与当前精神病学分类学的趋势相对比，特别是目前关于 DSM-5 的理论取向的争论，DSM-5 旨在比迄今为止精神病学传统上更基于神经科学而不是临床数据。
鉴于这些因素，我们回顾了对法医精神病学伦理学的怀疑立场，以及根据斯通的提议，我认为仍然存在的障碍：事实-价值的区别、决定论与自由意志、自我解构、心脑问题，以及道德与正常科学之间的鸿沟。在我看来，斯通对法医精神病学在法庭上的可行性提出的反对意见仍然具有很强的说服力，以至于这些反对意见是关于 DSM-5 理论取向的争论的核心。
标准立场的支持者对法医精神病学的客观化能力持过于乐观的看法。这个问题在一般精神病学中关于 DSM-5 方向的激烈辩论中也暴露出来了，DSM-5 的草案似乎过于基于神经科学，而对传统的临床实践关注较少。
