Truth, Effectiveness, and Mental Health: Part Three

Part Two of this series can be found here.

Why ask the question, Why bother with truthfulness?

Everybody's in favor of truthfulness, right?

Yeah, right.

A long, long time ago, as I left Nashville for New York, I asked my therapist to refer me to someone in New York. He pulled out the directory of an organization to which he belonged and began looking through it. "Some of these guys you really don't want to see," he said, "They've just found something that makes them feel secure, and they're busy socializing people into it."

A couple of years ago, I got a bit of "fan mail" from a graduate student who'd found "Cultures of Healing" helpful. She told me that she referred to it sometimes as she told her fellow students not to worry so much about choosing the "correct" theoretical orientation - just to choose one that matched their values. Yikes.

Our beliefs do a lot of things beyond informing us of what's what. They serve to direct our attention, interpret ambiguous or fragmentary data, manage emotions, estimate status, delineate responsibility, judge possibility, assess interests, plot strategies and tactics, plan for eventualities, prepare for action, protect the sense of self, and create things that never existed. Among other things.

Those various functions cohere rather than less than perfectly. Put differently, they don't necessarily play together nicely.

And in therapy, we're all too apt to care more about some functions than others, to overestimate the evidence for ideas that serve those functions, and to skew other functions of mind to fit our pleasing therapeutic notions.

We can believe things that help us manage our emotions, or support our sense of self, or estimate our status that also badly interfere with many other functions.

If you believe you have talents you do not have, your plans for the future will most assuredly go awry. If you think things really aren't your fault that really are, your estimation of your status will be badly off - again, with bad implications for your plans. Blinkered, optimism-inducing assessments of your interests can skew your attention, so you fail to notice important things.

There are at least three reasons why therapists and patients should be truthful. (Truthfulness, you may remember, I defined last time as "knowing the extent of your ignorance and the actual evidentiary weight of your beliefs - and never pretending to know more than you know.")

The first (which should be obvious) is that we minimize conflicts between the various functions of belief if we do our best to be truthful.

If we base our plans on sound knowledge, make our sense of self match up with what most astute people would perceive of us, manage our emotions not by what makes us feel good but by what corresponds with reality, and so forth, we're less likely to create for ourselves more conflicts than life forces upon us.

That's kind of like the reason for not lying: It's hard to keep your story straight once you start. Even so, it's hard to keep your various beliefs sound when you let some functions of mind play fast and loose with truth.

The second reason is that when we're honest about the evidentiary weight of our beliefs, and we're honest about our ignorance, we're less likely to get overly invested in unlikely ideas. That allows for maximum flexibility in light of further evidence - and in light of the mind's many tasks. Our mental health does not rest on maintaining unlikely beliefs.

If I'm overly invested in a particular story about myself, I'm likely to overlook or deny realities that conflict with my story - with consequences for all of the mind's other functions. If, however, I hold my story with tentativeness appropriate to the actual evidence, I can revise it as new facts come to light, or reconsider my story when new possibilities present themselves.

The third reason to prize truthfulness in therapy - as in life - has to do with the relationship between the clinician and the patient. If I mislead my patients - even to make them feel better - I have robbed them of the opportunity to face and choose between the things life actually offers them. I have arrogated to myself the right to cut them off from all possibilities, all plans and strategies, all assessments of their interests, and all perceptions of their status that have been hidden from them by my falsehood. I have misdirected their attention, induced skewed interpretations of data - and on and on.

Put more technically, I have screwed them out of a lot of choices, no matter what my intent.

Similarly, when a patient misleads me, he or she deprives me of the chance to consider the facts and make an informed choice of how to help. He or she undermines my right to position myself according to my best judgment.

"Effective" therapy based on unlikely beliefs is dangerous therapy.

It may ease our depression or anxiety, let us face life more optimistically, stir us to go forth more boldly, give us courage to ignore our critics, and so forth.

But it is likely to skew other functions of mind, fall prey to further developments, and rob us of many opportunities we would have seen if only we'd seen correctly. That seems to me a high price to pay for feeling better.