A Biological Cause For Lying?

I saw him at a public clinic back in the days when I usually just took care of renewing people’s prescriptions.  He seemed rather average for someone in his forties who lived on the streets and looked like he did. But he seemed to want me to know that he was “special,” that there was more for him than just coming in for a prescription refill.

He told me that he was related to a well-known television star currently starring in a popular series.  This was Southern California, after all, and I have been involved in more than one case where these relations were real.  Sometimes I even get phone calls from celebrities to confirm relations, although more often, I get to see signed pictures.  This patient did not have any.  I admitted that I had never heard of either the star or the series, which caused this patient a bit of distress.

He started telling me about horrible things his dentist had done to him.  Given the state of his dentition, it was likely that he had never had so much as a check-up or teeth-cleaning in his life.

He kept talking, although the stories he told had nothing to do with anything we needed to talk about.  From my point of view, he was telling me things I did not need to know.  They would have no impact on what I would do for him.

He gave a history that was consistent with some bipolar (manic-depressive) illness, in the past.  There is no specific blood test for this illness.  There may be a couple of tests, like the chromosome smear, that may be able to objectify the diagnosis in some way.  But this is the type of thing we shrinks do the old-fashioned way.  We observe and interview, take a history and match the findings against criteria in DSM-IV to come up with a diagnosis.  There is no way county clinics could ever be convinced to pay for expensive genetic tests.

He had some blood work, the medicines were not hurting him, so I renewed his ‘scrip and sent him on his way.  I greatly doubt that he ever had the dental work that he told me about, and I doubt even more that his relative was on the television show.  I even doubt that he is a bipolar II – a form of manic depressive that alternates from hypomanic (slightly manic) to depressed.  In other words, while still requiring medication, he might not be quite as wild-and-crazy as a full-blown manic.  In addition to pills I offered him psychotherapy, which he declined.

I had a feeling he was a pathological liar.

Psychiatry with its rich systems of classification can say a lot about liars.  I have actually had a couple I would call “pathological liar,” which is NOT something nicely described in the Diagnostic and Statistical manual, nor is it something the biological underpinnings of which are known to us, nor is it something anybody actually knows how to treat.

The antisocial personality disorders, or “sociopaths,” can end up in jail, and/or can somehow be confronted with the consequences of their actions.  There are even a few studies on how they do in psychotherapy.  Maybe about 50% turn around.

The lying seems tied to personal gain and a general disdain for the rights of others.  Lying can certainly be found in other kinds of psychiatric problems.  It is just that they are “different.”  There is a kind of lie you lie when you have no memory and you are trying to cover up for that.  There is another kind of lie you lie when you are trying to pretend you (or someone close to you) has a dread disease and you are trying to fool the doctor.

Here, I will never know if the patient was really bipolar.  I do know he was getting no pension from this diagnosis, and was actually working in what sounded to me like a low-level sales job.  I asked him how he was doing with his boss.  He said the boss did not like that he always seemed to be telling people strange things about the history of the store or what else they had sold, which seemed strange.

The hallmark, then, of the lying we call “pathological lying” is that the person doing the lying does not seem to be getting anything out of it — not love nor money.  It just seems as if these persons cannot relate to someone else for more than the shortest period of time without lying.  And nobody seems to know why.

A few people have tried to treat this with medication and tried to see it as biologic.  The evidence is thin, but may give us some clues.  I am totally tempted by the idea that there is excess white matter in the brains of those who lie.  I am also intrigued by the idea that people somehow become “better” liars somewhere around age 10, and there is indeed some “myelination,” some increase of white stuff, in the brain around that age. This means that there may actually be a biological key.

I have actually had some success with some patients who have this kind of problem, but it happens in private practice, where resources are available.  I have used teaching and retraining.  It is not simple.  As always, putting people in a group, especially here a group that people are not even sure exists, is absolutely not the way to get this done.  It is imperative to look at each individual, and to see if he or she has any of the known conditions that include lying; even small or partial forms of them.  It may be necessary to try a couple of different methods before finding one that helps.

This is where it is necessary to have a personal doctor, who helps only you.  This is where you need someone to never give up and never surrender.