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.
Our own material is, in part, too recently studied to form anything like a generalization concerning prognosis. Many years have to elapse before one can be sure there is not going to be a recurrence. But one is not altogether certain that prognostic generalizations are of practical worth for this group of mentally normal pathological liars. So many incidental factors of physical, mental, and social life, with all of the complicated background of the same, come in to make the total result, that experiment and trial with the individual case, while hesitating to give an exact prognosis, is perhaps the only sane procedure.
What we do know definitely is the immensely favorable outcome in Cases 1, 4, 7, 19, and the promising betterment in several other instances--all in direct contradiction to what we had expected from survey of previous literature. In several of these cases the years have gone by with nothing but steady improvement. The difficulty in getting adequate treatment, either in home life or by the necessary individual attention elsewhere, makes it impossible to say that many of the others also could not have been favorably influenced. Frequently a total alteration of environmental conditions is necessary, and this, of course, is often very difficult to obtain. Also it is extremely rare that one can get the whole matter, and its sure social consequences, fairly and squarely met by anybody with influence over the individual. Until this can be done, little in the way of good results may ever be expected. The splendid attack made by relatives or others upon the situation in Cases 1, 4, 7, possibly 14, and 19 tells the story of the prime necessity for adequate handling of pathological lying.
Specific treatment of physical conditions should always be undertaken when necessary. It should go without saying that any individual who is open to the temptations of inner stress should be strengthened at all points possible and relieved from all sources of irritation. But, lest anyone should become too much persuaded of the efficacy of surgical or other treatment, it should be remembered that the psychical reactions, even where there is physical irritation, involve the definite wearing of neural paths, with habit formations, which bodily treatment can only slightly alter. An enticing problem to the gynecologist is always the relationship of pelvic, particularly sexual irritations, to conduct. We cannot confirm the idea of a prime causal connection in this particular, although we have evidence that betterment of the physical ailment may lead to less inclination towards the unfortunate behavior. In Case 1 the lying came long before pelvic disease was acquired, but very likely the irritation of the latter led to an accentuation of the psychical phenomena. In Case 6 the typical conduct was persisted in after remedy of the pelvic disorder; so also in Case 3 after relief of abdominal conditions, and in Case 21 after cessation of pregnancy. Other points bearing upon this may be read in our case histories. On the general problem of the possibility of physical treatment it will be noted that a considerable share of all our cases were in good general condition.
In discussing treatment great emphasis should be placed upon the primary necessity for directly meeting the pathological liar upon the level of the moral failures and making it plain that these are known and understood. It is very certain that frequently this type of prevaricator has very little conception of the social antagonism which his habit arouses. There is faulty apperception of how others feel towards the lying, and to what depths the practice of this habit leads. Appreciation of these facts may be the first step towards betterment. In several of the improved cases we have mentioned that it was largely the acquirement of social foresight which made the first step in a moral advance which finally won the day. In this whole matter the first ethical instruction may well be based upon the idea of self-preservation--after all the backbone of much of our morals.
When it comes to specific details of treatment these must be educational, alterative, and constructive. In Cases 1 and 3 under treatment we know that when the lying was discovered or suspected the individual was at once checked up and made to go over the ground and state the real facts. The pathological liar ordinarily reacts to the accusation of lying by prevaricating again in self-defense, but when with the therapeutist there has been the understanding that the tendency to lying is a habit which it is necessary to break, the barricade of self- defense may not be thrown up. An alterative measure of great value, then, is directly to meet the specific lie on the spot, as it were, when it is told.
Next, accuracy of report may well be practiced as a special discipline. In these normal cases we have seen that there could be little doubt about the individual having self-control enough to stick to the truth, if the will was properly directed.
Indeed, many of our cases were exceptionally bright individuals with many good powers of observation and memory. Had one the opportunity, there can be little doubt but that training in the power to do well on such a test as that afforded by the ''Aussage'' picture would have yielded good results. Indeed, there is some suggestion of this in our table of findings on this test, where we note that pathological liars, when left merely to themselves and their first often comparatively meagre report on the picture, give few incorrect details. The difference in their report as compared with other observers of the picture was found when they answered questions. Since this is the case, there can be little question that training in the power to respond accurately might be gained.
It may be of value in considering therapeutics of pathological lying to enumerate the general run of treatment which was carried out in those instances where we know that betterment took place.
Nearly always only a part of what we advised could be carried out, but, even so, a brief statement of the conditions under which betterment was accomplished seems worth much.
Case 1 was treated first in an institution for delinquents where every effort was made to cure her disease and where she was taught to employ herself in constructive work. It was found she had ability to design, and this was used to the utmost. Then her lying tendencies were checked by social disapprobation as much as possible. A special effort was made toward this. The girl was undoubtedly made more serious-minded by the after-effects of her experience and perhaps by her disease. She was later successfully handled at home by her sensible mother. Leaving the years of adolescent instability behind her was also undoubtedly a factor in betterment.
Case 4 was taken in hand by a sterling character who restrained very carefully the tendency to lying, and by firm methods showed her the social advantages of self-control in this respect. At the same time she was given a vastly better environment, particularly in the matter of her friends. However, there is little doubt that nothing would have been accomplished in this case without first a deep understanding of the girl's troubles and of her mental conflicts.
Case 7 was treated for her sex difficulties under the constant care of a vigorous mother, who first, naturally, had to gain an understanding of the case. With her bettered physical and mental conditions, the girl was able steadily to hold a position for which earlier she had no capacity.
Betterment in Case 14 came about mainly as the result of an understanding of the child's mental conflicts and somewhat through partially bettered environmental conditions. We learned lately that the severe visual defect had been neglected.