The Deceptive Brain
The Deceptive Brain
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欺骗性的大脑
DOI：
10.1177/014107680409700133
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发表时间：
2004
期刊：
影响因子：
--
通讯作者：
S. Spence
中科院分区：
文献类型：
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作者：
S. Spence
为什么欺骗会引起临床读者的兴趣？难道这不是一个道德问题，更相关的法律的或神学话语？我们如何科学地判断另一个人是否在对我们撒谎？我们应该这么做吗？
所有这些问题的答案可能取决于所设想的临床环境。关于坚持治疗的谎言的重要性将取决于该治疗的临床必要性。在法庭竞技场上，一个关于未来行为计划的谎言可能会产生深远的后果：恋童癖者会避开游乐场吗？在精神病学、神经病学、法医学实践以及其他医学领域，医生都被要求判断病人陈述的真实性（即使这可能并不明确）。医生通常在他们使用的术语中暗示真实性。
考虑一下假装的身体症状（“装病”）和归因于转换障碍的症状（“歇斯底里”）之间的区别。这两种诊断有着截然不同的含义，但有什么客观依据来区分它们呢？[1]尽管有脑成像实验的发现，[2]但从现象学上看，似乎没有什么客观证据支持一个人优于另一个人，而达到的诊断可能会受到环境因素和医生对患者个性或背景的看法的影响。此外，用于引起歇斯底里运动不一致的微妙“技巧”（例如，“瘫痪”肢体的无意识运动）也可能被用来指示欺骗。1，3关键不在于这些障碍是等同的，而在于它们缺乏客观的区分。然而，在记录这些诊断时，医生暗示病人是否值得相信。
医生是否特别擅长发现欺骗？这似乎不太可能。当心理学家研究了不同的群体，试图确定其他人是否对他们撒谎时，医生们在概率水平上进行了研究; 4，5除了安全人员之外，假定的“测谎仪”是法官，警察还是医生似乎没有什么区别。
然而，当人类行为被概念化为更高级的执行控制过程时，欺骗就出现了一个更微妙的方面。因为欺骗的“表现”似乎是一种技能--一种必须努力的技能，需要注意的技能，疲劳可能会导致不一致或无意的忏悔。
说谎是否依赖于高级大脑系统的问题很重要，因为这些系统在神经精神疾病中可能受到不同的影响。在精神科医生与之互动的一些最困难的病人（如“精神病患者”和性犯罪者）的情况下，欺骗可能是这种互动的一个特征。一个善于说谎的精神病患者可能表现出保留的，或者可能是上级的大脑执行功能。这可能对我们理解责任和减轻影响产生深远影响。
Why might deception be of interest to a clinical readership? Is it not a moral issue, more relevant to legal or theological discourse? How can we determine, scientifically, whether another human being is lying to us? Should we want to?
The answers to all of these questions might depend on the clinical setting envisaged. The significance of a lie about adherence to a treatment will depend on the clinical necessity of that treatment. In the forensic arena, a lie about plans for future conduct might have profound consequences: will the paedophile avoid playgrounds? In psychiatry, neurology, medicolegal practice and perhaps certain other areas of medicine, doctors are called upon to judge the veracity of their patient’s account (even though this may not be made explicit). Doctors commonly imply veracity in the terms that they use.
Consider the distinction between feigned physical symptoms (‘malingering’) and those ascribed to conversion disorder (‘hysteria’). These diagnoses have very different meanings, yet what objective grounds are there for differentiating between them?1 Notwithstanding the findings of brain imaging experiments,2 it would seem that, phenomenologically, there is little objective evidence that would favour one above the other, and the diagnosis reached may be influenced by circumstantial factors and the physician’s opinion of the patient’s personality or background. Also, the subtle ‘tricks’ used to elicit hysterical motor inconsistency (e.g. the unintentional movement of the ‘paralysed’ limb) might just as well be used to indicate deception.1,3 The point is not that these disorders are equivalent, rather that they lack objective differentiation. Yet, when recording these diagnoses, the physician implies whether the patient is to be believed.1
Are doctors especially good at detecting deception? This seems unlikely. When psychologists have studied various groups trying to decide whether others are lying to them, doctors have performed at the level of chance;4,5 with the possible exception of security personnel, it seems to make little difference whether the putative ‘lie detector’ is a judge, a police officer or a doctor.
However, there is a more subtle aspect to deception that emerges when human behaviour is conceptualized in terms of its higher, executive, control processes. For it would appear that deception ‘behaves’ as if it is a skill—something that must be worked at, for which attention is required, and in which fatigue may lead to inconsistency or unintended confession.5
The question of whether lying relies upon higher brain systems is important because such systems may be differentially affected in neuropsychiatric disorders. In the case of some of the most difficult patients with whom psychiatrists interact (such as ‘psychopaths’ and sex offenders), deception may be a feature of that interaction. A psychopath who is a skilled liar may be demonstrating preserved, or possibly superior, executive brain function. This may have profound implications for our understanding of responsibility and mitigation.