Carroll’s 5th Law of Psychiatry: Anybody who says “I’ll be honest with you,” isn’t. Anybody who asks, “Why would I do that?” did that.

One thing I found hard to digest when I was starting out is that people lie to you. Well, not just people. Patients. People I’m trying to help.

I suspect I get lied to with the approximate frequency of a judge, but less than a cop. I have statistical evidence to back that up in the form of many anecdotes. I will share one with you now.

(At some point I will write a post about how anecdotes are stories of things that never happen. Ignore that, it only applies to other people’s anecdotes. Mine are entirely true, widely generalizable, and say something very important about the human condition. Promise.)

Once upon a time in Baltimore or its near environs there was a psychiatrist. He (or she – could have been anybody, really) was in a meeting where an absolutely real patient who is not at all abstracted from dozens of identical encounters was talking to him.

ARPWINAAAFDIE (Arpie for short): I am being treated horribly unfairly!

Dr. C. (not his real name, I’m sure): In what way?

Arpie: I keep getting put into all these groups. It’s just too much, I can’t get to all of them.

Dr. C. : Is there some reason for this?

Arpie: I keep coming up positive for weed! (“Coming up positive” means testing positive for a drug. Oddly enough, almost nobody ever says “I used.” One “comes up positive” as though there is a lottery for such things.)

Dr. C. : That can happen sometimes. There are false positives. So you have to go to some extra groups for a week?

Arpie: No!

Dr. C. : No?

Arpie: I’ve been in groups for six weeks!

Dr. C : For a single positive urine test?

Arpie: No. I’ve been positive for six weeks!

Dr. C. : And why do you think that is?

Arpie: I was around some people who were smoking. My cousin does it in the house all the time with his friends.

Dr. C. : I see. You ever have a problem with marijuana?

Arpie: Used to.

Dr. C. : I see. So you previously had a problem with marijuana, and you have been in a house with several people who are smoking constantly, and you have been positive on urine testing for weeks, but you have not been smoking?

Arpie: Right. I mean, I have been doing great in this program. It saved my life. Why would I do anything to jeopardize that?“

And there it was. The “Why would I do that?” Notice she did not say “I did not do that.” In fact she never flat out denied it.

The practiced eye will also note that Dr. C. never said whether or not he believed her.

From this exchange, we can conclude one very, very important thing. Arpie is probably not a raging psychopath. We’ll get back to that.

Most people really, really suck at lying. The main reason people really, really suck at lying (and I have evidence to back this up in the form of expert opinion, because I am an expert) is that we are wired for consistency. Saying one thing and believing another produces an internal tension that psychologists give a catchy name, “cognitive dissonance.” People act to minimize this. One way people minimize this is they re-align their beliefs to fit what they say. As one student of mine once said, “You remember when you were a kid and you were acting sick to get out of school, and after a while, you started kinda feeling sick?” That sort of thing.

When lying, people often minimize dissonance by half-a%%ing it. They try to get away with saying something that is as little untrue as possible. They fudge details but leave the main story intact, they talk around the lie without ever flat-out lying. This, in terms of prevarication, is a terrible mistake. Because this almost always produces an internally inconsistent narrative.

You can get away with that if your listener doesn’t care much about the answer.

Compare and contrast:

Friend: “How are you?”

Depressed person who hasn’t smiled in a month: “Fine.”

Friend: “Did you hear about what happened at that picnic?”

and:

Doctor: “How are you?”

Depressed person: “Fine.”

Doctor: “OK, now that we’ve got that out of the way, how are you?”

Depressed person: Dissolves into tears.

In the first, the question is a social nicety and nobody particularly pays attention to the answer. In the second, when somebody notices the disconnect between what is seen and what is said, and asks for real; the truth comes out.

So, if your listener is paying attention and knows what she’s doing, you’re probably screwed. If she’s good at this, she’ll be calm and nonjudgmental, so you don’t have any excuse to act angry and throw up a smokescreen. She’ll watch how uncomfortable you are. She will never commit to either disbelief or belief. Either way would let you off the hook. She will never accuse you, nor give you an excuse to attack her and discharge all that pent up tension.

She’ll also be watching to see how hard you are working not to say something. That something will be the lie. She could toss out some not-quite-neutral comment about how she’s open to believing you, like how “false positives do happen. ” She might alternate that with pushing you right into a corner repeatedly, giving you a choice between telling the lie and making up some new detail, to increase the dissonance. I was taught by one of the great masters of this, who advocated the Columbo Technique – adopting a non-threatening, bemused manner from which you can endlessly ask about “just one more thing.”

Eventually, dear liar, you’re going to be feeling quite squirmy, and she’s going to be calmly sitting across from you with one more bland, open-ended question ready to ask. A good interviewer on the scent of a lie is a lovely and terrible thing to watch.

Really, the way to lie is to go bawlz-out and tell a whopper. (Apologies for the gendered reference, but the opposite is equally vulgar and a bit too serial killer.) You can make up the details as you go, and there are no conflicts, as long as you don’t go on too long. The Nazis, vile bastards that they were, were right on that one.

Which brings us back to a point above. Arpie is not a psychopath. Psychopathy is, roughly speaking, lack of a conscience – a sort of wired-in incapacity to treat anyone else as more than a means to your own ends. People who are highly psychopathic will look at such an interaction as a game to be played for a win, and the win is getting what they want; or getting away with it once they have it. They will have no qualms about telling great big lies, even to someone who cares about them. That internal dissonance wouldn’t be there, because to such a person, lying is a matter of strategy and tactics, not morality.

So, to sum up, in order to lie effectively:

1. Lie to someone who isn’t paying attention (Usually easy).
2. Tell a whopper (Hard if you’re not a psychopath, so . . . ).
3. Be a psychopath.

Under ordinary circumstances, only number 1 applies, which is the only reason most people get away with the lie.

Now this is short term. This is all about whether the lie is internally consistent – meaning somebody can pick it apart right there. The main reason I’m not nearly so bugged by lies nowadays is that I’ve learned that what works in the short term, is pretty much dead opposite to what works in the long term. 

To give a concrete example, once upon a time there was a patient who had a habit of coming into the ED in distress because various family members died in terrible ways. Everybody took him at face value, until he had gone through more grandmothers than a cat has lives.

Big ol’ whopper? Yup. Inattentive listener? Well, maybe that’s unfair, but the pace of most EDs is not conducive to deep curiosity. Yet, eventually, the big lie gets too big to fit in with the rest of reality.

The psychopath thing? The very thing psychopaths have going for them in the short run fails them in the long run. No matter how superficially disarming they are, they show their colors. Then nobody believes them. Even when they tell the truth.

So to make a lie work in the long run:

1. Keep it simple, with the deception trivial, so that most details will fit reality and not lead anybody to be too curious.
2. Don’t be a psychopath.

Lies mostly amuse me, now. This is not to say I haven’t swallowed some in my time, and I will no doubt swallow many more before I’m done. I don’t take it personally. The best goalie on earth is still going to let some through. I do take a certain delight in the game of detecting them. If I don’t catch it at first, though, usually all I have to do is wait and watch. The truth finds a way. 

Back to poor Arpie, squirming internally while trying to hold onto this program that really has made a world of difference in her life, staring right down the barrel of losing it because she’s in too deep. What is her way out, though? To admit she’s doing exactly what may cost her that program? 

And what about this Dr. C. character? There he sits, knowing the truth, but still going through this ritual. Isn’t it a little uncomfortably cat-and-mouse? Wouldn’t it be kinder to just come out and call bull#$@t, or even just drop the hammer and throw her out?

You’re right to wonder about him. He certainly does, from time to time. Maybe we should pick up this story later. Could be, there’s redemption to be had for all. That always makes for a better story.