Truth without consequence: reality and recall in refugees fleeing persecution.

Truth telling is one of the most fundamental tenets, not only of forensic psychiatry, but also of life in general. Within bioethics, deontological principles espouse truth telling, and in consequentialist approaches, truth telling is thought to foster respect and autonomy and ultimately to promote the greater social good. Paul Appelbaum writes of it as the first pillar of forensic ethics. Intuitively, it makes sense that the moral functioning of any individual (and by extension, society) is enhanced by truth. In forensic psychiatry, where so much rests on truth, it is imperative therefore that we take a good look at what truth might mean and what are the consequences. I have borrowed (with permission) the title of my essay from Alan Stone’s much-debated 1994 paper about revisiting the parable of the black sergeant. Although it was first written more than 25 years ago, the parable has become symbolic of the tension arising from forensic psychiatry’s manifest obsession with truth. Everyone who has ever practiced psychiatry in court has a story about a black sergeant. Appelbaum’s theory of truth telling as the primary concern of the forensic psychiatrist has been challenged by Stone in his 1994 essay. Griffith contributed to the debate by rightly pointing out the need for cultural connectedness and understanding the power of narrative. I do not have the hubris to even attempt to reconcile these three very different views of three noted scholars of our generation. I merely want to tell the reader the story of my black sergeant—sufferers of trauma, refugees, and victims of torture—when I get asked to comment on the truthfulness of a victim’s account and the credibility of his testimony. For something as pervasive as truth is, it is not so clearly defined. While one would think that there would be some uniformity in definition or etymology, it isn’t so. The concept of truth has fascinated philosophers since the time of Aristotle. Among the more widely held concepts of truth, we have metaphysical subjectivism that says that whether a proposition is true or false depends, at least partly, on what we believe. In contrast, metaphysical objectivism holds that truths are independent of our beliefs. It is thought that except for propositions that are actually about our beliefs or sensations, what is true or false is independent of what we believe to be true or false. Relative truths, on the other hand, are statements or propositions that are true only relative to some standard, convention, or point of view, such as that of one’s own culture. We all know that the truth or falsity of many statements is relative. That someone is to my left (or right) depends on where the observer stands. The doctrine of relativism says that all truths within a particular domain (say, morality or esthetics) are of this form, and therefore it follows that what is true varies across cultures and eras. An extension of this is moral relativism, which holds that a moral Dr. Sarkar is a forensic psychiatrist in private practice in London, UK. Address correspondence to: Sameer P. Sarkar, MD, PO Box 3544, Wokingham, RG40 9FA UK. E-mail: [email protected]