Magazine article Clinical Psychiatry News

Fink! Still at Large: An Internet-Based Survey Suggests That a Large Percentage of Patients with Depression Lie to Their Doctors. Have You Been Misled by Patients? If So, How Has This Compromised Therapy?

Magazine article Clinical Psychiatry News

Fink! Still at Large: An Internet-Based Survey Suggests That a Large Percentage of Patients with Depression Lie to Their Doctors. Have You Been Misled by Patients? If So, How Has This Compromised Therapy?

Article excerpt

The survey, conducted in Japan, opens an important subject in psychiatry. In a large study of 2,020 patients, Dr. Norifusa Sawada and colleagues reported that patients who had received treatment for depression within the past year, a full 70.2% had lied at least once during the treatment (Clinical Psychiatry News, October 2011, p. 16).

I did not find this statistic to be shocking. Although we implore our patients to be honest with full disclosure in order for psychotherapy or psychoanalysis to work, without the patient fully trusting the doctor, the patients still have much difficulty revealing their fantasies and dreams - as well as the facts of their lives.

First of all, trust does not occur magically from the moment the patient enters the office. It takes time and a great deal of work on the part of the therapist. The doctor has to be smart (impress), charming (entice), and sensitive (sees some things about the patient that the patient doesn't know).

This last point is critical. The patient is relatively naive about mental functioning. He might not even realize that he is lying. He comes to the office indicating that he is suffering, has symptoms, and wants help. It seems so counterintuitive and stupid to lie. Nevertheless, patients have other motives for covering up some facts and modifying some stories as they reveal themselves during the intake interview. There are numerous reasons for patients to run from the truth.

First of all, there is the reality that most patients don't want to see the psychiatrist. They come either because of coercion, serious pain and suffering, or fear of worse symptomatology.

Patients have to come to the therapist's office at great expense to say: "There's nothing wrong with me," no matter how bad the circumstances that led to their coming. Even in cases of attempted suicide, where patients can't deny the facts, they often will concoct some other explanation for the number of empty pill bottles on the bed to exonerate themselves from responsibility in their actions. So it's imperative that we keep a high level of suspicion to be the guardians of reality when we hear what is clearly "bull@&!$" coming from the patient.

Shame is our biggest enemy. Patients are shamed and revert to using phrases referring to mental illness like they're "nuts," "mentally crippled" etc. So, they are not going to cooperate very easily Patients do not want to be bad or "found out." The authors tell us that men are far more likely to be dishonest about the use of alcohol and illicit drugs, and women lie about whether they are taking their drugs as prescribed. Drug and alcohol use is frowned upon, and the patient does not want the doctor to have bad judgments about him - unless he is psychopathic or antisocial.

Lies of Different Types

I once had a patient who talked about his mother's use of alcohol and how cruel she was when she was drunk. I was most distressed that when he said he tried to get from the front door to his room when he came home from school before his mother came out of her bedroom. The drama in this case came when I got a call from a local drug and alcohol rehab hospital telling me that the patient had just been admitted. I had no idea after months of "therapy" that the patient faced these challenges. I never saw him again. That was clearly an omission on his part and a failure on mine.

Another patient swore that he was taking his lithium - four pills a day. When his blood level came back very low, I immediately confronted him about the lie. He earnestly claimed again that he was taking the pills. But the next blood level that came back was 1.1 (mmol/L), so my confrontation worked.

Along with the shame comes the guilt - guilt over having a breakdown, getting depressed, crying, and feeling suicidal. They know it's not normal. Yet, the disease takes over, and they try to run away from it. The average patient has no idea that he has an unconscious mind, that there are secrets hidden inside of him that he doesn't remember. …

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