For the past week or so I’ve been spending much of my time transcribing (or interpreting!) my research interview recordings for the first phase of my project. A lot of the material in these interviews has been about recollection, and interpretation, of past events, which has got me thinking about the idea of “Truth”.

This thinking has then been backed up by a couple of the other blog posts, newspaper articles and journal pieces that I’ve been reading. First off we have a post by Linda Gask on her personal blog, relating to the role of “assessment” in psychiatric practice. She was reflecting on the role of assessment and what this means in terms of current mental health service provision.

The second article I read was an editorial in the British Journal of Psychiatry looking at the role of psychopathology as the “basic science” of Psychiatry. The authors in this article make a more general argument for psychopathology than many previous pieces, and descriptions that I have read. Many of my textbooks refer to psychopathology as a somewhat static, dry, list of phenomena to be identified and catalogued in order to reach the “diagnosis”. However the authors in this piece want to highlight the role of phenomenology and its existence at the core of psychopathology – that is we are not interested merely in the presence of  phenomena, but also the meaning that an individual assigns to it. There is overlap here with a book that I read recently – Psychoanalysis in a New Light where the author, Gunnar Karlsson, outlines the idea of a science of psychoanalysis, informed by principles of a phenomenological approach. At first glance this is not an intuitive link – psychoanalysis focussing on un-conscious experiences and their impact on the self and phenomenology focussing on the conscious experience of reality, however the argument that Karlsson makes is that both approaches rely on an interpretative standpoint – that interoperation is an active process, which in therapy leads us to an act of “constructed reconstruction” where therapist and client work together to interpret experience and draw parallels between the past and the present.

The final piece of writing I wanted to link to in this, somewhat rambling, piece was an article published in the Guardian looking at the role of impartiality in journalism. The article argues that classically journalism has promoted itself as an impartial representative of fact, but that more recently high profile journalists who have emerged who present partial representations of events, but with an emphasis more on transparency and access for readers to source material. The author describes the emergence of a balanced journalism – that provides an impartial description with full access to the underlying source material.

So what do these random musings have to do with Truth? As a child I was raised by my parents with the belief that there was one form of Truth and that the scientific method – through its pursuit of objectivity represented the only proper means of accessing truth. This left me with a form of naiveté where I approached each form of authoritative document as a representation of absolute truth that brooked no discussion or consideration. This served me fine for most of my education until one day when I was presenting some findings from my Masters project during my Chemistry degree.

I was presenting the findings from a series of experiments I had been performing (2+2 cycloadditions under ultraviolet light if you are interested), I was following the methods laid out in an academic paper published in quite a respected Chemistry journal. The problem I had was that the authors in the paper were claiming that they were getting yields from their procedures of around 50% (i.e. half of what they put in was coming out as pure product). I couldn’t get yields above 25% no matter how many times I repeated the procedure, nor how painstakingly I approached the process. This was the emphasis of my presentation, asking the assembled great and good in my department basically what I was doing wrong and why I was so bad at my job.

Have you thought that they may be lying

This was the response from one learned Professor, rapidly approaching retirement.

This was a mind blowing experience for me. Up until this point I had believed that truth was absolute – and if this was presented in an academic journal, well that truth was beyond question…

Fast forward to the present day. Clinically I now work with clients who have often experienced tragic, but extensive, episodes of trauma. Similarly my research project involves individual interviews with people with extensive trauma in their past.

How does this affect the definition of truth and what is the overlap with journalism, psychiatric assessment and psychopathology as defined by the authors in the editorial above?

What I’m trying to argue is that truth is a subjective concept. When we work with clients in mental health care we are seeking to understand their interpretation of the past, and how this affects them.  Or at least we should be in my opinion. Obviously if we merely catalogue a series of objectively measured signs – auditory hallucinations, delusions and define these in the absence of context, to reach diagnoses that guide to perfect treatment paradigms then life is very nice and simple. Sadly I don’t think I’ve ever encountered a situation where this was appropriate, or in my opinion even ethical.

But this is where we reach the tension. For journalism it appears that there is an opinion that there is one truth that may be represented objectively, or impartially. But is this true? Journalists are presumably representing complex social phenomena – I would argue that there are many parallel possible narrative truths that exist in these phenomena?

And science? Well science claims that there is an objective reality to be discovered and measured through experiment. But is this true either? Possibly in the physical sciences, although I am not sure this is always the case – as represented partially by my anecdote above. In biomedical science? No I don’t think we can make any claim to this? Scientists are not impartial, and neither are their human subjects of study. Witness the need for randomisation and blinding in clinical trials in an effort to introduce this “objectivity”. But what then about the development and reporting of these interventions? The language used in the construction of descriptions of findings are deployed in order to represent the authors interpretation of truth. But may this be a biased interpretation? I suspect so, witness the way in which correlation is presented almost as causation, but only with brief acknowledgements of alternative explanations that that author does not support. In my opinion the neuroscience literature is rife with this manner of presentation, and I’m planning to discuss this in a future blog post.

And psychiatry? Psychiatry takes for its subject the study of human distress. Can it make claims to objectivity? I don’t believe so. I think that we work with distressed clients and try to make sense of their experience so far as is possible. But then mental health services are called on to define, through clinical assessment, who should receive care and what form that care should take. The result is that distressed people are frequently excluded as not displaying “major mental illness”, whatever that means.

I feel that we need to accept that an absolute definition of truth may not always be possible, and is probably not even desirable. I want to try and work with people within frameworks that they define and minimise their distress with whatever tools I have available. Unfortunately this is not always easy…

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