Truth in forensic psychiatry: a cultural response to Gutheil and colleagues.

It is clear in the preceding paper that Gutheil and his colleagues have framed an intriguing discussion about truth-telling by witnesses in court. The discourse at once arrests our attention and asks of us that we reflect seriously on the questions raised by the authors. This is but one of a distinguished series of papers that have appeared recently in this journal, authored by representatives from the Program in Psychiatry and the Law at the Massachusetts Mental Health Center and Harvard Medical School. Gutheil and his team have understandably focused their interest on expert witnesses in court. However, it is always worth the effort to remind ourselves that deliberating about the whole truth is a complicated exercise for all who participate in the justice system, not only the witnesses. All too often, we ignore the notion that law enforcement officers, attorneys, and even judges have their own struggles over truthtelling. A recent newspaper report about the infamous Central Park (New York City) jogger case is a relevant example. In that case, after repeated analysis of all the evidence, police and prosecutors differed significantly in their views of what happened during the attack. Gutheil et al. focused on a basic notion that deserves repeated emphasis: forensic psychiatrists do much of their work in the courtroom; they do not control the rituals that are fundamental to that culture. Consequently, we may want to tell the whole truth. However, the court’s rituals and unique customs may frustrate our most concentrated intentions. Despite that reality, Gutheil and his group would have us hold unflinchingly to the task of telling the whole truth, regardless of the oppositional elements that divert us from this concentrated effort. In addition, these authors buttressed their position by reminding us of Appelbaum’s claim that truthtelling is a characteristic of all ethical forensic psychiatrists. Two problems infiltrate the approach taken by Gutheil and his collaborators. There may, at times, be good reasons to circumscribe the whole-truthtelling of forensic psychiatrists. When those good reasons exist, the judicial system should not give in to the expert’s desire to tell the whole truth, even if the expert is experiencing ethics tensions. Secondly, the authors blithely ignored the problems framed for us some years ago by their own Harvard colleague, Professor Alan Stone, who stung us all with his profound narrative, the parable of the black sergeant. I shall return to the black sergeant later. In the authors’ first case example, about the expert witness’s dilemma, they did not provide us details of the abuse allegedly perpetrated by the father on his mentally retarded, adult son. But the authors also did not give us evidence to buttress the idea that the allegations of abuse should be aired in the courtroom. These abuse allegations were not the central basis of the court case. What the authors called excluded truth may in fact be no more than ideas, which if mentioned in court, would inexorably give rise to distorted reasoning. The result would be a patently evident miscarriage of justice. Not every fact, because it is true, should be mentioned in the course of a hearing. Dr. Griffith is Professor of Psychiatry and of African-American Studies, Yale University, New Haven, CT. Address correspondence to: Ezra E. H. Griffith, MD, Department of Psychiatry, Yale University School of Medicine, 25 Park Street, 6th Floor, New Haven, CT 06519.