Pathology of Lying [32]
in such a place for long. We note she was sent back from one of these to the main hospital on account of having vomited the medicine she had been given. In fact, she has repeatedly been found resisting the treatment which had been prescribed.
The record of admission and treatment given in one hospital is of peculiar interest. She was received there four years ago and evidently had been unable just previously to take care of herself properly on account of roaming. Her clothing was dirty and her head unclean. She was found to have the old appendicitis scar, which contained a small sinus. She remained in bed after admission, complaining of much pain in her abdomen, not well localized however, and would lie moaning, crying, and rolling across the bed. She was then running a slight temperature. After a time an operation was decided upon and a hairpin was found in the abdominal wall, undoubtedly inserted through the scar by the patient herself. (The findings of the surgeon in Chicago, then, revealed a repeated performance.)
At another place the patient maintained she was unable to urinate, but at the same time strongly resisted catheterization. From the variability of her complaint it was found it could not be caused by a local condition, and examination showed no reason for the difficulty. Analysis of her symptoms undertaken at this time led to several stories, one about urethritis, which Inez claimed to have contracted from her brother at 3 years; an episode when she had received a great fright during micturition; an incident when she had seen a man exposed when she went to the toilet. (Of course, our experience with this type of case leads us to appreciate the difficulties of psychological analysis with extreme liars.)
On one occasion she entered a hospital, claiming to have been recently injured; she had been taken in a supposed fainting condition from a car. Then it was she maintained that she had been struck by an iron bar and that a spike had entered her back. She also claimed at this time to have had her toes frozen. Study of the case here, too, showed no signs of injury or frost bite. On another occasion she told of having been dropped by a nurse while being lifted from a bed. Altogether her stories and her simulations have been convincing enough to get for her on many occasions good attention during at least a few days.
We can get no account of true hysterical signs being discovered by any one. There has been no showing of anything but that she is a liar and a simulator. In the hospital records the portions devoted to previous history are thoroughly vitiated by her untruthfulness, and they contain statements which offer great contradictions, one to the other.
Inez has been observed, then, for two long periods by psychiatrists. While at the end of neither period were the observers willing to state that the young woman was compos mentis, still their verdict in this matter had to be made up from considerations of her social behavior rather than from what they were able to discern by direct observation of her mental processes. From one case-record we read that ``The patient was quiet, pleasant, and agreeable, replied promptly and intelligently to questions, and talked spontaneously of her affairs. She was quite clear as to the environment, had apparently a satisfactory memory, with the exception of a recent period preceding admission. Her statements, too, were probably not altogether truthful, but frequently a reason for the untruthfulness was made out. She thought that her mind was all right, but complained of having occasional difficulty in thinking.''
Another prolonged study of her mental status was made four years ago. From the record we learn that there were no apparent reactions to hallucinations. Consciousness was clear and the patient was completely oriented for time, place, and persons. The train of thought was coherent and relevant. Questions were readily answered and attention easily held. Memory was fair for most events. School knowledge was reasonably well retained.
The record of admission and treatment given in one hospital is of peculiar interest. She was received there four years ago and evidently had been unable just previously to take care of herself properly on account of roaming. Her clothing was dirty and her head unclean. She was found to have the old appendicitis scar, which contained a small sinus. She remained in bed after admission, complaining of much pain in her abdomen, not well localized however, and would lie moaning, crying, and rolling across the bed. She was then running a slight temperature. After a time an operation was decided upon and a hairpin was found in the abdominal wall, undoubtedly inserted through the scar by the patient herself. (The findings of the surgeon in Chicago, then, revealed a repeated performance.)
At another place the patient maintained she was unable to urinate, but at the same time strongly resisted catheterization. From the variability of her complaint it was found it could not be caused by a local condition, and examination showed no reason for the difficulty. Analysis of her symptoms undertaken at this time led to several stories, one about urethritis, which Inez claimed to have contracted from her brother at 3 years; an episode when she had received a great fright during micturition; an incident when she had seen a man exposed when she went to the toilet. (Of course, our experience with this type of case leads us to appreciate the difficulties of psychological analysis with extreme liars.)
On one occasion she entered a hospital, claiming to have been recently injured; she had been taken in a supposed fainting condition from a car. Then it was she maintained that she had been struck by an iron bar and that a spike had entered her back. She also claimed at this time to have had her toes frozen. Study of the case here, too, showed no signs of injury or frost bite. On another occasion she told of having been dropped by a nurse while being lifted from a bed. Altogether her stories and her simulations have been convincing enough to get for her on many occasions good attention during at least a few days.
We can get no account of true hysterical signs being discovered by any one. There has been no showing of anything but that she is a liar and a simulator. In the hospital records the portions devoted to previous history are thoroughly vitiated by her untruthfulness, and they contain statements which offer great contradictions, one to the other.
Inez has been observed, then, for two long periods by psychiatrists. While at the end of neither period were the observers willing to state that the young woman was compos mentis, still their verdict in this matter had to be made up from considerations of her social behavior rather than from what they were able to discern by direct observation of her mental processes. From one case-record we read that ``The patient was quiet, pleasant, and agreeable, replied promptly and intelligently to questions, and talked spontaneously of her affairs. She was quite clear as to the environment, had apparently a satisfactory memory, with the exception of a recent period preceding admission. Her statements, too, were probably not altogether truthful, but frequently a reason for the untruthfulness was made out. She thought that her mind was all right, but complained of having occasional difficulty in thinking.''
Another prolonged study of her mental status was made four years ago. From the record we learn that there were no apparent reactions to hallucinations. Consciousness was clear and the patient was completely oriented for time, place, and persons. The train of thought was coherent and relevant. Questions were readily answered and attention easily held. Memory was fair for most events. School knowledge was reasonably well retained.