On the one hand, the psychiatrist is sworn to do no harm to his patients and, more than that, is obliged to do good for them; on the other hand, the psychiatrist is working for the criminal justice system which is often indifferent or harsh toward offenders. Under a normative psychiatrist-patient relationship, the psychiatrist promotes the patient's autonomy and decisionmaking that is in the patient's own self-interest. The corrections system, notably the prison, aims to reduce the inmate's autonomy and promote subservience and a diminishment of self-esteem. The psychiatrist must also reconcile the concept of punishment and retribution with the aims of mental health. This may be done under the belief that persons only mature when they recognize that there are limits to and consequences for antisocial behavior. The psychiatrist will have a problem, however, if a punishment imposed or administered by the criminal justice system is viewed by the psychiatrist as unjust or harmful to the patient. If the psychiatrist is to develop and maintain the trust of the patient and is to continue to believe in the treatment philosophy, then the psychiatrist must find a way to work with the patient in dealing with those elements of criminal justice policy and practice that damage the patient's progress toward mental health. 8 references