Pathology of Lying, Etc.

W >> William and Mary Healy >> Pathology of Lying, Etc.

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The differential diagnosis involves consideration of the
characteristics of the insane, defective, and epileptic. We
repeat that we agree that the mentally abnormal person may engage
in pathological lying quite apart from any expression of
delusions, and that during the course of such lying the insanity
may not be recognized. This occurred in many of the cases cited
in the foreign literature, and if the prior histories of many
individuals now in insane hospitals were known undoubtedly such
lying would be frequently noted. But once the person is
recognized as insane he need not be classified as a pathological
liar. This term should be reserved, as we stated previously, for
normal individuals who engage in pathological lying. Of course
other observers have noted such lying in people who could not be
designated as being mentally abnormal, but our material is
peculiarly rich in examples of this kind.

CORRELATIONS STUDIED FOR CAUSES

Heredity. We come now to a very interesting group of
facts--showing at once complete corroboration of previous
observers' statements that pathological liars are extraordinarily
``erbliche belastet.'' Taking our 19 mentally normal cases we
find the following:

Insanity in the direct family (four of these being a parent). .6
One or both parents severely alcoholic. . . . . . . . . . . . .6
Criminal or very dissolute parent . . . . . . . . . . . . . . .4
Suicide of parent . . . . . . . . . . . . . . . . . . . . . . .1
Extremely neuropathic parent. . . . . . . . . . . . . . . . . .1
Syphilitic parent . . . . . . . . . . . . . . . . . . . . . . .2
Epileptic parent. . . . . . . . . . . . . . . . . . . . . . . .1
Unsatisfactory data . . . . . . . . . . . . . . . . . . . . . .2
Reliable data showing normal family stock . . . . . . . . . . .2

Thus, out of the 19 cases there are only three or four which do
not come of stock showing striking defects. Now, as we go on to
show later that unfortunate conditions or experiences were often
causal factors, the total findings seem to show clearly that
these latter influences generally bore their unfortunate fruition
upon inherited instability.

The heredity in the border-line cases is, as might be expected,
even worse. These facts are easily discerned in their respective
case histories.

The question of inheritance of similar mental traits is, of
course, important. We have found absolutely no proof of the
trait of pathological lying, as such, being inherited. The
reader will note with interest particularly the facts in Cases 2
and 4, where we at first thought we had to deal with inheritance,
but later found there was no blood relationship between the
supposed parent and child. In those instances the lying of the
younger individual was much more likely to be the result of
psychic contagion, and this also may be largely the explanation
of Cases 6 and 8, where an older relative was well known to be a
prevaricator. The bad inheritance in these cases then turns out
to be, corroborating what we found in studying the general
problem of criminality,[25] a matter of coming from stock that
shows defects in various ways-all making, however, in the
offspring for moral instability.

[25]``Inheritance as a Factor in Criminality. A Study of a
Thousand Cases of Young Repeated Offenders.'' Edith R. Spaulding
and William Healy. pp. 24. Bulletin of the American Academy of
Medicine, Vol. XV. February 1914.

Developmental Physical Conditions. Inquiry into our 19 mentally
normal cases gave the following findings: Antenatal conditions
were defective in 2 cases on account of syphilis and in one case
from advanced age of the mother. The accident during pregnancy
to the mother in one case, the severe mental shock in another,
and the effect of illegitimacy in still another we can not
evaluate. In 2 cases there were operative births with, however,
no bad results known. One was a twin. Early severe disease of
the nervous system was experienced by one, and convulsions during
infancy by two others. Another suffered from some unknown very
severe early illness, and one from prolonged digestive
disturbance in infancy. Three had in early childhood several
severe illnesses, one had a long attack of ``chorea.'' Two
suffered from general nervousness, incited in one case by the
excessive use of tea and in the other by a similar use of coffee.
One was an habitual masturbator from childhood. Difficult
menstruation was reported in only one case. In 5 cases there was
a quite normal early developmental period, according to reliable
accounts. In 3 cases the early developmental histories are
completely unknown, and in 3 others uncertain. The data of
developmental history in the border-line types may be easily
noted in the case histories.

Previous Ailments. Ailments suffered from in our 19 cases after
the early developmental period amount to very little. The
several gynecological troubles have been mentioned above under
the head of Physical Conditions. In one other case there had
been urethritis previously. Head injuries, which play such a
significant part in the study of criminalistics, find no place in
our mentally normal series, but should always be kept in mind in
considering the border-line types. Epilepsy as a possible factor
in criminalistic problem cases is to be remembered.

Habits. We have already mentioned the effect upon nervous
conditions of excessive tea and coffee in two of our cases.
Masturbation, including its indirect effect, particularly upon
the psyche, appears to be a very important feature of these
cases. We should be far from considering that we have full data
on all of our cases and yet this stands out most strongly. We
have had positive reports from relatives or from the individual
showing this certainly to be a factor in 7 out of the 19 cases.
This is a very large finding, when it is considered that the data
are frequently unobtainable. Of course we are not speaking here
of masturbation per se, but only of the fact of its ascertained
relationship to the pathological lying. This is only part of the
whole matter of sex experience which, we find upon gathering our
material together, plays such an enormous role.

Age of Onset. It is very easy to see that the tendency to
pathological lying begins in the early formative years.
Common-sense observation of general character building would tend
to make us readily believe that if an individual got through the
formative years of life with a normal hold upon veracity he would
never become a pathological liar. We can see definite beginnings
at certain critically formative periods, as in Case 6 and perhaps
in Case 3, but our material shows that most cases demonstrate
more gradually insidious beginnings. (Case 21 is in this respect
in a class by itself.) As we stated in our introduction, it is
clear from the previous studies of older individuals that the
nature of the beginnings were not learned because it was too
late. Our material offers unusual opportunities in this
direction and shows the fact of genesis in childhood most
clearly. For specific and often most interesting details we
refer the reader to our various case histories.

Sex. Our findings show only 1 male out of 19 mentally normal
cases. A general observation by practical students of conduct,
namely, that females tend to deviate from the truth more readily
than males, is more than thoroughly borne out here. There are
certainly several social and psychological reasons for this, but
they need not be gone into here. If our figures seem not to be
corroborated by the findings of previous students it is only
because the figures are not comparable-- the latter have mixed
the mentally abnormal with the pathological liars proper. It
will be noted that in our examples of border-line cases 5 out of
the 8 are males. Cases of pathological swindling by mentally
abnormal individuals, such as we have avoided, make up much of
the foreign literature. We can easily see that the social
opportunities for swindling are vastly greater for males than
those offered to the opposite sex. Sex differences, as in many
instances, must not be taken here too seriously because social
environment, differing so greatly for the sexes, is largely
responsible for the behavior which we superficially judge to be
entirely the expression of innate characteristics.

Environment. We are far from feeling that a mere enumeration of
material environmental conditions tells the story of
environmental influences important for our present subject. The
psyche is frequently most profoundly affected by environmental
conditions which even a trained observer would not detect. But
conditions in the total number of unselected cases show
something, and, for whatever it is worth, we offer the following
enumeration of environment in our 19 normal cases, who with much
more reason might be expected to be largely influenced by
surroundings than our group of border-line cases.

Reasonably good home from birth . . . . . . . . . . . . . . . .5
Defective home conditions through poverty . . . . . . . . . . .2
Very ignorant parents . . . . . . . . . . . . . . . . . . . . .2
Immoralities in home life . . . . . . . . . . . . . . . . . . .6
Marked defect in parental control . . . . . . . . . . . . . . .6
Very erratic home conditions-parent abnormal. . . . . . . . . .1

Early Mental Experiences. As will have been observed by the
reader in going over the case histories, the early mental
experiences of many of our group of mentally normal pathological
liars have been shockingly bad. Full appreciation of this can
only be gained through perusal of the text, but here we may call
attention to the fact that no less than 8 of the 19 have had very
early untoward sex experiences, that 5 were markedly under the
influence of bad companions, including even the influence in one
or two cases of vicious grown people. The sex experiences we
have just enumerated were received through others--we are not
here speaking of masturbation, which is discussed above.

Psychic Contagion. Direct contagion of the tendency to lie seems
more than likely to take place, at least during the more plastic
periods of life. It may be that this only develops when there is
some sort of predisposition to instability; our related findings
on defective heredity would seem to indicate the fact. It should
be noted that in 5 instances out of our 19 mentally normal (Cases
2, 4, 6, 8, 20) some other member of the household, we learned
from reliable sources, was known as a chronic prevaricator.

Mental Conflicts. The fact that several of our cases started
lying from the time when there occurred some experience
accompanied by a deep emotional context, and that this experience
and the emotion was repressed, seems to point clearly to the part
which repressed mental life may play in the genesis. That as
children they kept to themselves secrets of grave import and
dwelled long on them, shows in a large number of our cases.
Anything deeply upsetting, such as the discovery of the facts of
sex life or questions about family relationships, are the
incidents which cause the trouble. For students of modern
psychology nothing more need be said on this point--the concrete
issues are perceivable in the case histories.

Adolescence. Quite apart from the age of onset, we may consider
the physical and psychical instabilities of adolescence as
effective causes of pathological lying. Of course it is equally
true that many other tendencies to peculiarity are accentuated at
this period. It has been suggested that cases which have their
origin largely in the unstable reactions of adolescence have much
the better prognosis, but it seems that not enough evidence has
been accumulated as yet to justify us in this conclusion, which,
we acknowledge, may prove to be true.

Irritative Conditions. In the same way the various types of
irritative conditions, physical and mental, may be considered as
exciting moments. Individuals with a tendency to pathological
lying will no doubt show aggravation of the phenomenon at periods
of particular stress. We have heard it suggested in several
cases by relatives that the menstrual period, for instance,
brings about an access of tendency to prevarication. We would
grant the point without conceding this exciting factor to be a
fundamental cause. (Case 21, we may say again, illustrates a
special fact.) The periodicity which Stemmermann makes much of
may merely mean succumbing during a period of physiologic stress.
Social stress also may be met by pathological lying, in the same
way that the individual who finds himself in a tight place may
attempt to get out of it by running away. We have already spoken
of the likeness of social and physical stress as showing when the
weak individual is brought to bay. That pathological lying does
not run an even course, but shows remarkable fluctuations with
powerful exacerbations, is undoubtedly to be explained by changes
of inner and outer stress.

Habit Formation. The influence of habit in causing chronicity
must always be definitely reckoned with. It is hardly necessary
to say more than a word on this subject. Even the individual, as
in Cases 8, 9, and 10, comes to strongly realize it.
Particularly is this point to be estimated in considering the
possibilities of a rapid cure.

Special Mental Abilities. Once more, for the sake of
completeness in giving a category of causes, we should call
attention to the fact acknowledged by all thorough students of
this subject, namely, that, other things being equal, it is
particularly the individual who has linguistic abilities, who is
especially good at verbal composition, that seems to have most
incentive to dally with the truth. But beyond this we would
insist that a combination of verbal ability with proportionate
mental defects in other fields gives a make-up which finds the
paths of least resistance directly along the lines of
prevarication.

SOCIAL CORRELATIONS

The role played in society by the pathological liar is very
striking. The characteristic behavior in its unreasonableness is
quite beyond the ken of the ordinary observer. The fact that
here is a type of conduct regularly indulged in without seeming
pleasurable results, and frequently militating obviously against
the direct interests of the individual, makes a situation
inexplicable by the usual canons of inference. To a certain
extent the tendencies of each separate case must be viewed in
their environmental context to be well understood. For example,
the lying and swindling which center about the assumption of a
noble name and a corresponding station or affecting the life of a
cloister brother, such as we find in the cases cited by Longard,
show great differences from any material obtainable in our
country. In interpretation of this, one has to consider the
glamour thrown about the socially exalted or the life of the
recluse--a glamour which obtains readily among the simple-minded
people of rural Europe. Then, too, this very simple-mindedness,
with the great differences which exist between peasant and noble,
leads in itself to much opportunity for cheating.

With us, especially in the newer work of courts, which are
rapidly becoming in their various social endeavors more and more
intimately connected with many phases of life, the pathological
liar becomes of main interest in the role of accuser of others,
self-accuser, witness, and general social disturber.

Here again, we may call attention to the fact, which is of great
social importance, namely, that the person who is seemingly
normal in all other respects may be a pathological liar. It
might be naturally expected that the feebleminded, who frequently
have poor discernment of the relation of cause and effect,
including the phenomena of conduct, would often lie without
normal cause. As a matter of fact there is surprisingly little
of this among them, and one can find numerous mental defectives
who are faithful tellers of the truth, while even, as we have
found by other studies, some are good testifiers. Exaggerated
instances of the type represented by Case 12, where the
individual by the virtue of language ability endeavors to
maintain a place in the world which his abilities do not
otherwise justify, and where the very contradiction between
abilities and disabilities leads to the development of an
excessive habit of lying, are known in considerable number by us.
Many of these mentally defective verbalists do not even grade
high enough to come in our border-line cases, and yet frequently,
by virtue of their gift of language, the world in general
considers them fairly normal. They are really on a constant
social strain by virtue of this, and while they are not purely
pathological liars they often indulge in pathological lying, a
distinction we have endeavored to make clear in our introduction.

It stands out very clearly, both in previous studies of this
subject and in viewing our own material, that pathological lying
is very rarely the single offense of the pathological liar. The
characteristics of this lying show that it arises from a tendency
which might easily express itself in other forms of
misrepresentation. Swindling, sometimes stealing, sometimes
running away from home (assuming another character and perhaps
another name) may be the results of the same general causes in
the individual. The extent to which these other delinquencies
are carried on by a pathological liar depends again largely upon
environmental conditions--for instance, truancy is very difficult
in German cities; a long career of thieving, under the better
police surveillance of some European countries, is less possible
than with us; while swindling, for the reason given above, seems
easier there.

Running away from home and itineracy show in a wonderfully strong
correlation with pathological lying, both in previous studies and
in our own material. Several authors, particularly Stemmermann
in her survey of the subject, comment on this. This phenomenon,
not only on account of the numerical findings, but also from a
logical standpoint, is easily seen to be the expression, in
another form of conduct, of the essential tendencies of the
pathological liar. It is part of the general character
instability, the unwillingness to meet the realities of life, the
inclination to escape consequences. As a matter of fact,
frequently the pathological liar gets himself in a tight place by
lying, and then the easiest escape is by running away from the
scene. The delinquencies of our present group as given below can
with profit be compared with our previous statistics[26] on a
large group of offenders. We gathered the facts concerning a
series of 1000 carefully studied youthful repeated offenders. Of
694 male offenders, 261 were guilty of running away to the extent
that it made a more or less serious offense. Of 306 female
offenders, 76 committed the same type of offense. For comparison
with the present group it is to be remembered that 18 out of the
19 mentally normal pathological liars were females.

NORMAL BORDER-LINE
Running away . . . . . . . . . 12 6
Stealing. . . . . . . . . . . 7 6
Swindling . . . . . . . . . . 7 2
Vagrancy. . . . . . . . . . . 0 4
Attempt at suicide . . . . . . . 0 2
Sex offenses . . . . . . . . . 8 1
False accusations. . . . . . . . 10 4
Self-accusations . . . . . . . . 3 2
Abortion. . . . . . . . . . . 1 0

[26] P. 140 ff. William Healy. ``The Individual Delinquent.''
Pp. 830. Boston: Little, Brown, and Co. 1915.

We have given figures on false accusations here, including other
cases than were enumerated in our special chapter on the subject.
In that chapter the center of interest was on the false
accusations, but it is true that in certain other cases of
pathological lying false accusations were indulged in as a
somewhat minor offense. The 9 cases enumerated as swindlers
showed this offense in varying degrees, as might naturally be
expected by the differences in ages, which, if nothing else,
makes for variations in the evolution of social and character
tendencies. Perusal of the cases shows the small beginnings as
well as the flagrant offenses on this order. As we previously
have stated, we have avoided dealing with the older careers of
notorious swindlers. The nature of the sex offenses can be
learned from the case histories by those who wish to make special
inquiry. Masturbation we have regarded more as a causative
factor, and have spoken of it in a previous section. Truancy we
have not enumerated. It goes without saying that it had been
indulged in by practically all of the males and by a considerable
number of the females in our cases.

The observer of delinquents cannot help being constantly
impressed by the fact that the offense of lying seems to the
usual offender small in proportion to the commission of other
criminalistic deeds. Particularly does this come out when one
observes the chronic liar growing up in a household where grave
sex and other delinquencies are habitual occurrences. Should his
lying be compared with these major anti-social transactions?
Indeed, it might be a field for speculation as to whether, given
certain qualities of mind, imaginative powers, etc., pathological
lying may not play the part of a vicarious delinquency--being to
the delinquent apparently less pernicious than more objective
offenses. In our case histories may be seen some indications of
this.

PROGNOSIS. TREATMENT

In discussing prognosis and treatment we can eliminate at once
consideration of pathological lying by the insane. The outcome
there depends upon what can be done for the underlying psychosis.
We have avoided intimate discussion of these cases, but many
suggestions of the unalterableness of the full-fledged tendencies
among the insane are found in the European literature cited by
us. Even discussion of the outcome of the border-line cases,
such as we have given examples of, needs but short shrift.
Everyone knows the extreme difficulties of dealing with
constitutional inferiors; marked cases are socially fit only for
proper colonization. The epileptic, in default of cure of his
disease, is ever going to be prone to many peculiar mental states
which may involve pathological lying. The slight mental
confusion of chorea, which may lead to false accusation, as we
have seen in Case 23, is one of the most curable of all abnormal
mental states. With proper attention to diagnosis and treatment,
favorable outcome of cases of hysteria, such as that in Case 24,
is frequently seen. Another type which cannot be handled except
by permanent segregation is the thoroughly aberrational and
socially dangerous class represented by Case 25, however one
designates the type. Much more, undoubtedly, can be done for
such a border-line individual as Case 12, if there is sufficient
cooperation among educational and reformatory institutions and
the courts. It has seemed to us that the chief cause of failure
in this interesting case has been the fact that this young man
could go on ever entering new social situations and finding new
worlds for exploitation because no one had the means at hand for
securing facts concerning his past or for ascertaining what any
good diagnostician could easily perceive to be his limitations
and tendencies.

Very much more to the point is consideration of the actual and
possible outcome in cases of pathological lying by normal
individuals. Here, as in other matters where bodily, mental, and
social issues are blended, no prognosis or outlook can be
rationally offered without consideration of possible changes in
the circumstances peculiar to the given case. First and foremost
stands out the fact that cure of the tendency sometimes happens
even after long giving way to it. In this statement we are not
contradictory to some previous writers.

As Stemmermann says, out of the general literature there is not
much from which one can deduce any principles of prognosis. But,
again, we would insist that one of the great weaknesses has been
that earlier studies have not carefully distinguished between the
mentally normal and the abnormal cases of pseudologia
phantastica. When, for instance, Forel speaks of pathological
liars as being constitutionally abnormal individuals who are not
curable, he fails to differentiate where profitable
differentiation can be made. If our own work is of any practical
value it is in offering safer grounds for prognosis and
treatment. Stemmermann summarizes well her follow-up work done
upon cases seen years previously by other observers. Some of
these are still in institutions. After a period of well- doing
several of these have become backsliders and reverted again to
lying and swindling. Very few appear to have been cured, but yet
some of the facts of betterment are most convincing. This author
states that, at the most, one dares to ponder over the point as
to whether there are not cases which recover, particularly when
the pathological lying is a phenomenon of adolescence.

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