病壞交織的人— 刑事司法與精神醫學的交界處

Abstract

精神醫學在刑事司法當中扮演愈來愈重要的角色，我們想要知道行為人究竟是「病人」還是「壞人」。不過「病」與「壞」是否得以截然二分？或者是在行為人身上呈現「病壞交織」的聚合樣貌？又是什麼樣的背景因素讓「病壞交織」得以可能？ 首先本文先爬梳精神醫學的發展歷史以及犯罪概念的流變，從中可以發現人類時常以相同的敘事解釋精神疾病和犯罪，從當代的現象或具體案例中，也可發現兩者的難以釐清以及重疊之處。 在說明完病與壞的模糊分界後，本文接著考察「病壞交織的人」自19世紀末至今的形象移轉。特定時空背景下的政治環境、經濟狀況與社會氛圍等等，都會影響到精神疾病的行為人如何被看待與對待。1970年代新自由主義興起後，「健康又脆弱的人」除了強調個人責任，身心健康與否的狀態轉為道德評價、「治療」成為義務；公民被形塑出的脆弱性更正當化對有精神疾病的行為人的懲罰、隔離與排除。 接著，本文將分析為何刑事司法與精神醫學以及二專業所形成的交界處，如何讓「病」與「壞」交織，也會探討為何交界處縱有二專業間的衝突，卻也「合作愉快」。這個交界處重新創造了一個不全然與刑事司法或精神醫學相同的境地，在交界處的重新配置組合之後，對有精神疾病的行為人形成更加難以抗拒的社會控制。 最後，經本文分析，發現其實「病」與「壞」、「病人」與「壞人」、「精神醫學」與「刑事司法」有諸多相類似的側面，因此使得「病人」與「壞人」反而更像是同一人事物的不同面向。既然我們以「精神醫學」的觀點去理解犯罪行為人、認為行為人也是「病人」並給予其「治療」，就不應該挾著醫學的專業權力而掩蓋刑事司法中的處罰慾望以及保安目的，仍應貫徹「治療」的原則（如：以受治療者利益為中心）以緩和現有對行為人的處罰，甚至最終達到去除對行為人的懲罰。

Psychiatry plays an increasing role in criminal justice systems. Whether the criminal is sick or bad seems to be an urgent question. However, I argue that “badness” and “sickness” are not as distinguishable as we might think. The two concepts in fact share common ambiguity and fluidity. First of all, the thesis starts with the introduction of the history of psychiatry and crime, where we shall see the concepts of mental illness and crime often derive from the same narrative and discourse. From the mentioned contemporary phenomena and cases, the overlapping area of the two is also presented. Secondly, the altering presentations of the criminal since the end of the 19th century will be discussed. How the criminal with mental illness (CMI) is perceived and treated is crucially influenced by the political, economic and social milieux. With the advent of Neoliberalism in 1970s, citizens were shaped into people of vulnerability who are particularly concerned about their health. This leads to the ramification that it is morally and legally obligatory that CMI receive compulsory treatment and the punishment and exclusion to CMI are justified by the vulnerability of citizens. Thirdly, the borderland between criminal justice systems and psychiatry will be analyzed. Despite the conflicting traits of both disciplines, they manage to “cooperate” well. The confluence of the expertise is not identical to either criminal justice systems or psychiatry, but rather a reconfiguration where the joint social control from the two disciplines over CMI is exceptionally unescapable and irresistible. Last but not least, with the knowledge of psychiatry being embraced in criminal justice systems, the thesis argues that punishment from the latter should not be camouflaged in the name of treatment. Medical and psychiatric ethics and principles should be observed, with which the punitiveness from criminal justice systems inflicted on CMI will be moderated or even better, eliminated.