His third patient as a boy appeared normal both mentally and physically. In his youth he went through the gymnasium and then studied theology. He spent money very freely on clothing and books, but at this period neither stole nor lied. After finishing his theological studies, he preached in his home town and was regarded as a young man of great promise. Then came a change; he began to write strange letters, telling of some positions offered him, he borrowed money freely from relatives and friends who were willing to give because they believed in his coming career. When studied, it was concluded by Delbruck that this was a case of constitutional psychosis, hysteria, moral insanity, and psychopathy—all of these forms being interrelated. Outside of masturbation, begun in early childhood and indulged in excessively at times, no causal factors were discovered. He considered that this case offered a good illustration of the peculiar coexistence of real lies and delusions in the same individual.
His fourth case was that of an artful, deceitful, arrogant, selfish boy, always clever in excuses, who had stolen from the age of twelve, often stolen things that he threw away. Though of Protestant family, he delighted to draw Catholic insignia and embroider religious characters. He finally entered the university, always lying and stealing. At the end of three months he was taken home in debt 2000 marks. He later became a Catholic. Outside of normal expense he had cost his father 28,000 marks. By the time he was studied he had already taken opium for four years, having started because of neuralgia. There had been a severe operation on account of some trouble with the teeth. It was discovered that there was contrary sexual feeling in this case also. The patient had a great inclination for doing woman's handwork. Delbruck again considered the early appearance of character anomalies and perverted sex feeling to prove a deep-seated abnormality of nervous constitution. He diagnosed it as a case of constitutional psychosis; the extent of the abnormalities showing the individual to be irresponsible.
His last patient was an alcoholic adventurer, early life unknown, who had an idiotic sister. He had lived long in America and returned to Germany full of stories of his wonderful achievements over seas. This case does not concern us except to emphasize the influence of alcohol in the development of such cases.
This outline is sufficient to show the justification of his conclusion, namely, that just as in healthy people a mixing of lies and mistakes may occur, so the same combination may reach a pathological height, and one can diagnose a mixture of lies with delusions or false memories.
These studies focus our attention on the following points which are valuable to emphasize for the purpose of this monograph: the complexity of details to be examined in the life of any one patient in whose delinquencies pathological lying is a factor, the variety of cases in which this factor may occur, hence the difficulties in the way of determining the extent to which the patient is responsible for his deeds and whether he belongs in a reformatory or an insane hospital. From the standpoint of society Delbruck's work has great use, since it reveals so plainly the menace that these liars are to their families and to the community as a whole, their unscrupulousness in financial dealings, their tendencies to bring false accusations involving families and friends alike in useless expense and litigation.
German studies on pseudologia phantastica since Delbruck's time have followed the line of amplification of his views and clarification of the subject by the addition of new types.
Koppen[9] attempted to differentiate sharply and to analyze more accurately the conception of the pathological lie. He found it impossible to make an absolute separation between pathological lies and normal lies. The lies of the mentally diseased are seldom pathological. They lie, but their lies do not differ from those of the mentally sound. We cannot call the results delusional lies. Among imbeciles we find a peculiar disposition to lying, especially among those of criminal inclination. Their lies do not separate themselves either in content or in relation to the rest of their ideas from the lies of the mentally diseased. Here follows his positive contribution to the conception; the pathological lie is active in character, a whole sequence of experiences is fabricated and the products of fancy brought forward with a certainty that is astonishing. The possibility that the untruth may be at any minute demolished does not abash the liar in the least. Remonstrances against the lies make no impression. On closer inspection we find that the liar is no longer free, he has ceased to be master of his own lies, the lie has won power over him, it has the worth of a real experience. In the final stage of the evolution of the pathological lie, it cannot be differentiated from delusion. Pathological lies have long been credited to hystericals, they are now known to arise in alcoholics, imbeciles, degenerates. All pathological liars have a purpose, i.e., to decorate their own person, to tell something interesting, and an ego motive is always present. They all lie about something they wish to possess or be.
[9] ``Ueber die pathologische Lugner,'' Charite-Annalen, 8, 1898. Pp. 674-719.
Koppen offers three case studies: I. A man who had suffered from many epileptic seizures came from a family in which there was insanity. He gave himself many false titles, and from his childhood pathological lying had been a prominent symptom. As an example, when he married against his father's will, he at the wedding read a false dispatch, pretending it to be congratulations from his family. Koppen suggests that this individual was incapable of meeting life as it really was and he therefore wove a mass of phantasies. II. A young man charged with grave falsifications. He had come from an epileptic family and himself had slight attacks in childhood. He bore various pathological stigmata. Koppen considered that the patient believed his own stories about his rather superior education and that in general his lies became delusions which influenced his actions. He diagnosed the case as psychotic; insane in a legal sense. III. A young man undoubtedly insane brought forward his pathological lies with such force that Koppen was persuaded that the patient believed in them.
Bernard Risch[10] has seen many cases of delinquents with more or less marked psychopathic signs in which pathological lying was the focal point. He reports five cases at great length, in all of whom the inclination to fabricate stories, ``der Hang zum fabulieren,'' is irresistible and apparently not to be repressed by efforts of the will. Risch's main points, built up from study of his cases, are worthy of close consideration: 1. Mental processes similar to those forming the basis of the impulse to literary creation in normal people lie at the foundation of the morbid romances and fancies of those afflicted with pseudologia phantastica. The coercive impulse for self-expression, with an accompanying feeling of desire and dissatisfaction, plays a similar part in both. That the making up of tales is an end in itself for the abnormal swindler, just as it is for the normal author, seems clear to Risch. 2. The morbid impulse which forces ``zum fabulieren'' is bound up with the desire to play the role of the person depicted. Fiction and real life are not separated as in the mind of the normal author. 3. The bent of thought is egocentric, the morbid liar and swindler can think of nothing but himself. 4. There is a reduction of the powers of attention in these cases; only upon supposition that this faculty is disturbed can we account for the discrepancies in the statements of patients. One has the impression that their memory for their delinquencies is not clear. Careful investigation proves that they do not like to remember them and this dislike has to be overcome. 5. There is a special weakness in judgment, which for general purposes is sound. The train of thought is logical, but in ethical discernment the lack appears. The pathological liar does not face openly the question of whether his lies can be seen through.