Should we tell the truth?
PSYCHIATRIC VIEWS ON THE DAILY NEWS
“Tell all the truth but tell it slant.”
“Tell the truth and run.”
As these quotes suggest, telling the truth in life is difficult and can have mixed consequences. The other side of the truth coin is lying, and all of us lie to some extent at some times, both to presumably protect relationships and our own perceived well-being. Other values can trump the truth, and the truth can be painful. Not only that, but if the truth humiliates the other, it would not be surprising that some sort of revenge would occur.
Most recently, during President Trump’s administration, Kellyanne Conway used the term “alternative facts” in conveying information. That led to a surge of buying George Orwell’s 1949 book, 1984, which presented “Newspeak,” an alternative language monitored and enforced by the government’s “Big Brother.”1 Similarly, cults are designed to prevent freedom of thought and thereby even knowing the truth, letting alone deciding to tell it or not, as Steven Hassan, PhD, has continued to point out.2 Ronald W. Pies, MD, has voiced concern about conspiracy theories in general and false flag conspiracy theories in particular.3
Last week, stories about truth and lies seemed even more prominent in the news than usual. The most notable was the trial and conviction of Alex Murdaugh. Though he admitted his extensive opiate drug problems caused him to lie at times, he maintained that he was telling the truth about not killing his wife and son. The judge commented that perhaps it was the “monster” he became that was not telling the truth. In the legal system, the quest for truth is paramount: “swear to tell the truth and nothing but the truth” and find out the truth “beyond a reasonable doubt.”
Then there is a House Ethics Committee investigation that was announced to look into the lies of George Santos. Separating health fact from fiction in the Ohio train derailment continues to be of health and mental health concern. As is common in science, the truth evolves, as it has in the evolving studies of mask wearing for the pandemic.
In medicine, truth-telling has undergone a shift over the last generation. An emphasis on physician paternalism, as in the doctor knows best about what to tell the patient to maintain hope, has shifted toward the bioethical principle of patient autonomy.
In psychiatry, how to balance truth-telling can be even more complex due to the influence of a given mental illness on cognition and memory, including degrees of dementia, trauma dissociation, sociopathy, substance abuse, and psychological defense mechanisms like conscious and unconscious denial. Psychiatrists have also been accused of misleading patients about how our medications might work, such as in the serotonin hypothesis for antidepressants.
Psychiatry went through a painful and shifting grappling with memories of patient trauma. With the therapist influencing the patient’s presumed repressed trauma memories, the drawback at times turned out be to a “false memory syndrome” of the past with erroneous accusations. There is no truth serum (though sodium amytal was used at times as if it was one), nor a completely reliable lie detector, though that has been used in legal proceedings.
The truths about us are crucial, as in the saying “Physician, know thyself.” That becomes even more important for psychiatrists in our often close relationships with patients, and why we had a tradition of our own psychotherapeutic exploration to avoid countertransference problems—that is, putting our own problems inappropriately into the patient relationship and issues.
Research has indicated that psychiatric patients commonly lie to their therapists, even though the therapists are bound by the ethical principle of confidentiality.4 Close to 100% of therapy patients recalled times of lying to their therapist about such important evaluative and treatment matters as suicidal thoughts, drug use, suffering, and feedback to the therapist. Younger patients and a weaker therapeutic alliance increased the lying. Avoiding shame, embarrassment, or an imagined negative repercussion like hospitalization were presumed reasons.
Given that truth-telling can have such a wide variety of outcomes, what might be best for mental health?
-In everyday life, try to assess the benefits and drawbacks of lying for yourself and to the other, with the predicted benefits to both taking priority.
-In psychiatry, discuss the benefits of truth-telling from the start of treatment, and empathetically, sensitively, and compassionately ask the patients direct questions about important information.
-In society, given the importance of mutual trust, accurate information is likely to enhance it, and the government likely needs to play a role in allowing that, especially online, perhaps under rubric of a “Soul Sister.”
As an example of the overlap of psychiatry and religion, especially in terms of ethics and morality,5 tonight begins a joyous Jewish holiday, Purim—which provides a Biblical story where the truth is first hidden, then revealed, just in time to save the Jewish people. At first, Esther, following the advice of her cousin Mordecai, intentionally hides that she is Jewish when she marries the non-Jewish King of the time. Then, after their relationship is solidified, she reveals to him that she is Jewish and that the high-ranking officer, Haman, wants to destroy the Jewish people. Instead, the King becomes the judge and has Hamas killed, and the Jewish people are saved.
The verdict on telling the truth? It is apparently a hung jury because sometimes telling the truth is psychologically and morally indicated, and sometimes not. Perhaps how well we find and tell the truth is the most challenging trial of being a psychiatrist. Even more broadly, trying to best make the decision of when to tell the truth and how much of it, and when not to, is one of the biggest challenges of life. How well we do that as a society and as a species may help contribute to the fate of the world.
Dr Moffic is an award-winning psychiatrist who has specialized in the cultural and ethical aspects of psychiatry. A prolific writer and speaker, he received the one-time designation of Hero of Public Psychiatry from the Assembly of the American Psychiatric Association in 2002. He is an advocate for mental health issues related to climate instability, burnout, Islamophobia, and anti-Semitism for a better world. He serves on the Editorial Board of Psychiatric Times™.
1. Orwell G. 1984. Secker & Warburg; 1949.
2. Hassan S. Combating Cult Mind Control. Freedom of Mind Press; 2015.
3. Pies R. False flag conspiracy theories: psyche, society, and the internet. Psychiatric Times. January 11, 2023. https://www.psychiatrictimes.com/view/false-flag-conspiracy-theories-psyche-society-and-the-internet
4. Farber BA, Blanchard M, Love M. Secrets and Lies in Psychotherapy. American Psychological Association; 2019.
5. Moffic HS, Peteet J, Hankir A, Seeman MV. Anti-Semitism and Psychiatry. Springer; 2020.