Whopper, do you think a good history is better at determining the future prognosis of an individual? I mean, taking an individual, putting him or her in his or her environment and then asking yourself, what would typically be expected in that environment? I feel like using context to problem solve tends to be a good way for me to read situations. If I read a microexpression, then that tends to be more icing on the cake. But I agree. Lie detection...I don't think there is any good tool out there.
Psychiatrists per the study cannot tell if someone is lying better than a layman.
Don't exactly let that box you into a corner and think that you now can't touch that at all.
Lying is different than malingering. In malingering the person is feigning or exaggerating an illness for a gain other than attention. In that regard we are better than layman because we are better trained in diagnosing illness. There are also printed articles and presentations at professional societies on detecting malingering. So if a guy is holding a card and tells us it's an ace of spades, our ability to tell if he's lying of course will be no better than a layman, but after a thorough evaluation with a guy claiming to be suicidal due to depression we should have an upper hand.
In the case of malingering detection simply follow the professional guidelines often times brought in at AAPL, some of them are printed in Current Psychiatry. For example:
1-Do the signs match the sx (Patient alleges to be depressed but on the unit appears fine when he is not being directly interviewed by you, claims to not have an appetite but eats full meals, etc.).
2-Does the patient's disease course match the known science (e.g. patient claims he has hallucinations that started at age 45 with no history of drug abuse).
3-Can you identify any potential things the person has to gain by faking or exaggerating mental illness? (Is the person homeless and it's cold outside? Is he seeking disability?)
4-Are the patient's sx atypical? E.g. hearing auditory hallucinations in a foreign language, hearing them on only one side of the head, etc.
You could do malingering testing. I'd recommend an M-FAST in a clinical scenario but if it's serious I'd do a SIRS.
Here's some bombs I throw on suspected malingerers...
1-Throw a question that lets them believe they won't get what they're after. In a case where a plaintiff claimed the police bludgeoned his head and he was suing for millions due to memory problems," "Sir if your memory is truly as bad as you claim it is, you will not have the capacity to control the money you win in a lawsuit and will be assigned a guardian. What are your thoughts on this?"
2-Try a medication at a sub-therapeutic dosage first. E.g. Risperdal 0.5 mg daily for a patient alleging to be psychotic. If the patient completely clears up, your suspicion of malingering should light up.
3-Put the suspected malingering with a roommate that you just blabs about everything or is just real real real annoying. E.g. a patient that acted completely disorganized after a day with being with a very manic patient as a roommate, in a very organized manner, demanded to be put in a different room. We allowed him to argue why he needed a roommate showing he had a linear and organized throught process and could advocate for himself.
4-Offer the suspected malinger really fun things to do that someone with his alleged condition could not benefit from. E.g. a very disorganized patient starts playing boardgames in a very organized manner with other patients.
And getting back to laymen, even laymen have an ability to tell if someone is lying. If you obtain enough data, even a layman using such data could catch the liar.
