1. Deception L.V.Hettiarachchi Consultant Forensic Psychiatrist
National Institute of Mental Health

2. Purposeful misleading of another
“To have a thought, and, by words or other means of expression, to convey another one”
Purposeful misleading of another
I have done that- says memory
I could not have done that- says my pride
The end remains exorable
Eventually memory gives in
(Neitzche 1886)

3. Psychiatric Implications

4. Malingering
DSM-5:
“intentional production of false or grossly exaggerated physical or psychological symptoms motivated by external incentives”
a. avoiding military duty
b. avoiding work
c. obtaining financial compensation
d. evading criminal prosecution
e. obtaining drugs

5. Feigning:
Deliberate fabrication or gross exaggeration of psychological or physical symptoms without any assumptions about its goals
Ganser’s syndrome:
Approximate answers (pathognomonic) 
Clouding of consciousness
Somatic conversion (particularly sensory symptoms)
Hallucinations

6. Voluntary production of symptoms to assume the sick role
Factitious disorder:
Voluntary production of symptoms to assume the sick role
No other obvious secondary gain
Munchausan’s syndrome
Suspect effort:
Suggests the examinee is not applying his or her best effort to do well on the task.
Intentional or non-intentional.
Also referred to as suboptimal effort, incomplete effort, or submaximal effort

7. Prevalence of Malingering
13% of patients were suspected or considered to be malingering mental illness in emergency department
Worker’s compensation or disability claims- between 25-30% of probable symptom exaggeration
30% of neuro-psychiatry presentation suspected of malingering

8. Other points fascinating Psychiatrists

9. Could there be unconscious motives ?? substituting
Usually
Consciousness of falsity
Intent to deceive
Preconceived goal or purpose
Could there be unconscious motives ??
substituting
day dreaming
denial
self deception

10. Close relation to malingering
Pathological falsification
Dissociation

11. Pathological Falsification
Confabulation
Psudologia fantastica
Abnormal illness behavior

12. Confabulation Falsification of memory In clear consciousness
Associated with organically driven amnesia(amnestic disorders)
No insight

13. Pseudologia Fantastica
Extensive gross fabrications
Content and extent disproportionate to discernible or personal advantage
Not just matter of fact but attempt to create new and false identity
Caught up in own fabrication and eventually seems to believe
Central and persistent feature of persons life

14. Pseudo …… Attention seekers
Sometimes difficult to distinguish from delusional systems
Frequently found in courts
Often give up when counterfeit
Types
Common fantasist
Professional impersonator
Swindler pretending to be wealthy
Outraged woman alleging sexual assault
False confessor

15. Abnormal illness behavior
Ways in which symptoms may be differentially perceived, evaluated and acted upon ( or not acted) by different kind of persons (Mechanic)
Shaped by socio-cultural and socio-psychological factors
Abnormal illness behavior ? DD of malingering

16. Dissociative Disorders
Dissociation
Psychogenic non-epileptic seizures
Dissociative amnesia
Fugue states
Trans and possession disorders

17. Dissociation Hysteria, conversion Separation or splitting
One part of mind doesn't pay attention to another or unaware
Partial or complete loss of
Normal integration of memories of the past
Awareness of identity
Immediate sensation
Control of bodily movement
Onset and termination are sudden

18. Dissociative Amnesia Loss of memory of important recent events
Not due to organic causes
Too extensive than ordinary forgetfulness
Usually of a traumatic event
Partial and selective

19. Fugue State Apparent purposeful journey away Associated with amnesia
Self-care maintained
New identity may assumed
Few days

20. Trance and Possession Disorders
Temporary loss of sense and personal identity
Loss of awareness of surrounding
Selective attention and awareness to selected part of immediate environment
Repeated set of movements, postures and utterances

21. Multiple personality disorder
Psychogenic epilepsy
Dissociative motor disorders(paralysis, aphonia)
Dissociative stupor
Somatization

22. Most common suspicious presentations in medico-legal context
Psychosis
Amnesia
Depression
PTSD

23. Famous studies… Rosenthan 1973 ‘ being sane on insane places’
16 pseudo patients gained secret admission to psychiatric hospitals
Conclusion- “ distinguishing sane from insane in psychiatric hospitals is very difficult”
Lot of criticism on conclusion afterwards
Psychiatrist do not diagnose pseudo-patients when they are not looking for them
Andreason et al (1959) in Australia
18 psychology students were asked to feign mental illnesses
Findings- non of the presented pictures resembled well defined psychiatric disorders
Conclusion
1. it is so difficult to simulate mental illness
2 ………………

24. ??????
? Is there science behind deception? ? Are there certain biological processes directly involved in deception? ? Is there a way to detect these biological/physiological parameters?

25. Lie Detection ??? Pseudoscience
Police investigation
In recent past
Medical
Legal
Business

26. Methods of lie detection
Physiological
person who is lying exhibits involuntary physiological responses such as increased blood pressure, perspiration, breathing, and heartbeat
Polygraph
Voice stress analyzer
EEG
fMRI
Psychological assessments

27. Polygraph Autonomic response in relevant versus irrelevant questions
Skin conduction
Blood pressure
Respiratory rate
Peripheral vasomotor activity

29. Pitfalls
Invasive
Counter measures
Poor predictive value

30. Voice stress analyzer
Measure stress resulting from monitoring vocal activity
Adv-
No sensors
No sensor induces artificial arousal

32. Are we really detecting liars or deception?

33. EEG Statistical tests developed for lie detection Input EEG sample
Preprocessing Feature extraction
classification
Output EEG signal with message (True or false).

34. Prefrontal parietal network
fMRI
Measure haemodynamic response- or the Blood Oxygen Dependent Level (BOLD)
BOLD signal can tell most active areas of the brain neurons in response to various experiences, motor commands
Create maps of the brain in action as it process thoughts, sensations, memories
Brain that are most active during deception
inferior frontal gurus
inferior parietal lobe
bilateral frontal cortices
amygdala
Prefrontal parietal network

36. Adv. and Disadv. Insufficient data Accuracy Reproducibility issues
Ethics (Neuro-ethics)
Potential privacy violations(cognitive freedom)
Legitimacy of using MRI for legal purposes
Judges/jurors may influenced
For
Non-invasive
Fully cooperative and conscious subject

37. First case of neuroscience as evidence
India in 2008
Judge Shalini Phansalkar-Joshi
Angela Saini convicted of murder of ex-fiance` Udith Bharath
Neuro-experiential knowledge
Life sentence
“I am innocent and have not committed any crime”

38. Legal implications
"Is There Science Underlying Truth Detection?" University of Pennsylvania
Judge Jed Rakoff “I will never allow a fMRI scan as evidence for deception”
Lie detectors may take away from the jury its role as fact-finder
"mechanization," or dehumanizing of deception detection
Legally relevant neuroscience must begin with behavior, not with a picture of blood flows in the brain

39. Clinical Assessments Observation MSE Psychometrics Specific tests
Adjuvant tests

40. Clinical issues detecting malingering
Understanding real symptoms underlies distinguishing typical from atypical symptoms

41. Magnificent seven Rare Symptoms Improbable symptoms
Symptom combinations
Symptom severity
Indiscriminate symptom endorsement
Subtle vs. obvious symptoms
Reported vs. observed symptoms

42. Observation 1. Direct observation ?? Body language
Body and face become stiffer
Hand-to-face touching increased, especially nose rubbing and mouth covering
Face and hands become a bit paler as blood is withheld from extremities. (A sign of high stress.)
Nostrils may open wider ('flare')
Breathing deeper and maybe audible
Lips become thinner and tighter
Shoulders pulled up, and elbows pulled into sides more. Body takes up less space
Forehead tightens up a little in the area between the eyebrows
Eye contact breaks away from you and eyes may squint or close
Hand palms turned down or closed, and not revealed to you
2. Indirect observation/observe unobserved

43. Psychometrics Floor effect Symptom validity testing (SVT)
incorporation of extremely easy questions or tasks
involve over-learned information or simple skills that are easily retained, with limited intellectual functioning
Symptom validity testing (SVT)
asking person to choose one of two items relevant to their complaint
Test of memory malingering (TOMM)
Morel emotional numbering test (MENT)
Unusual pattern of test methods
Self reported tests
Minnesota multiphasic personality inventory(MMPI)
Personality assessment inventory (PAI)

44. Unusual pattern tests Frequently used
Evaluate if the examinee is providing atypical responses to questions about mental health symptoms
Structured inventory of malingered symptomatology (SIMS)
Structured interview of reported symptoms (SIRS)
Miller forensic assessments of symptoms test(M-FAST)

45. Adjuvant tests Intelligence assessments Personality assessments
PCL-R
Risk assessments
HCR-20

46. Summary Deception Malingering Dissociation Lie detection
Medical and legal aspect of lie detection

47. Thnak yuo