As Stemmermann says, out of the general literature there is not much from which one can deduce any principles of prognosis. But, again, we would insist that one of the great weaknesses has been that earlier studies have not carefully distinguished between the mentally normal and the abnormal cases of pseudologia phantastica. When, for instance, Forel speaks of pathological liars as being constitutionally abnormal individuals who are not curable, he fails to differentiate where profitable differentiation can be made. If our own work is of any practical value it is in offering safer grounds for prognosis and treatment. Stemmermann summarizes well her follow-up work done upon cases seen years previously by other observers. Some of these are still in institutions. After a period of well- doing several of these have become backsliders and reverted again to lying and swindling. Very few appear to have been cured, but yet some of the facts of betterment are most convincing. This author states that, at the most, one dares to ponder over the point as to whether there are not cases which recover, particularly when the pathological lying is a phenomenon of adolescence.

Our own material is, in part, too recently studied to form anything like a generalization concerning prognosis. Many years have to elapse before one can be sure there is not going to be a recurrence. But one is not altogether certain that prognostic generalizations are of practical worth for this group of mentally normal pathological liars. So many incidental factors of physical, mental, and social life, with all of the complicated background of the same, come in to make the total result, that experiment and trial with the individual case, while hesitating to give an exact prognosis, is perhaps the only sane procedure. What we do know definitely is the immensely favorable outcome in Cases 1, 4, 7, 19, and the promising betterment in several other instances--all in direct contradiction to what we had expected from survey of previous literature. In several of these cases the years have gone by with nothing but steady improvement. The difficulty in getting adequate treatment, either in home life or by the necessary individual attention elsewhere, makes it impossible to say that many of the others also could not have been favorably influenced. Frequently a total alteration of environmental conditions is necessary, and this, of course, is often very difficult to obtain. Also it is extremely rare that one can get the whole matter, and its sure social consequences, fairly and squarely met by anybody with influence over the individual. Until this can be done, little in the way of good results may ever be expected. The splendid attack made by relatives or others upon the situation in Cases 1, 4, 7, possibly 14, and 19 tells the story of the prime necessity for adequate handling of pathological lying.

Specific treatment of physical conditions should always be undertaken when necessary. It should go without saying that any individual who is open to the temptations of inner stress should be strengthened at all points possible and relieved from all sources of irritation. But, lest anyone should become too much persuaded of the efficacy of surgical or other treatment, it should be remembered that the psychical reactions, even where there is physical irritation, involve the definite wearing of neural paths, with habit formations, which bodily treatment can only slightly alter. An enticing problem to the gynecologist is always the relationship of pelvic, particularly sexual irritations, to conduct. We cannot confirm the idea of a prime causal connection in this particular, although we have evidence that betterment of the physical ailment may lead to less inclination towards the unfortunate behavior. In Case 1 the lying came long before pelvic disease was acquired, but very likely the irritation of the latter led to an accentuation of the psychical phenomena. In Case 6 the typical conduct was persisted in after remedy of the pelvic disorder; so also in Case 3 after relief of abdominal conditions, and in Case 21 after cessation of pregnancy. Other points bearing upon this may be read in our case histories. On the general problem of the possibility of physical treatment it will be noted that a considerable share of all our cases were in good general condition.

In discussing treatment great emphasis should be placed upon the primary necessity for directly meeting the pathological liar upon the level of the moral failures and making it plain that these are known and understood. It is very certain that frequently this type of prevaricator has very little conception of the social antagonism which his habit arouses. There is faulty apperception of how others feel towards the lying, and to what depths the practice of this habit leads. Appreciation of these facts may be the first step towards betterment. In several of the improved cases we have mentioned that it was largely the acquirement of social foresight which made the first step in a moral advance which finally won the day. In this whole matter the first ethical instruction may well be based upon the idea of self-preservation--after all the backbone of much of our morals. When it comes to specific details of treatment these must be educational, alterative, and constructive. In Cases 1 and 3 under treatment we know that when the lying was discovered or suspected the individual was at once checked up and made to go over the ground and state the real facts. The pathological liar ordinarily reacts to the accusation of lying by prevaricating again in self-defense, but when with the therapeutist there has been the understanding that the tendency to lying is a habit which it is necessary to break, the barricade of self- defense may not be thrown up. An alterative measure of great value, then, is directly to meet the specific lie on the spot, as it were, when it is told.

Next, accuracy of report may well be practiced as a special discipline. In these normal cases we have seen that there could be little doubt about the individual having self-control enough to stick to the truth, if the will was properly directed. Indeed, many of our cases were exceptionally bright individuals with many good powers of observation and memory. Had one the opportunity, there can be little doubt but that training in the power to do well on such a test as that afforded by the ``Aussage'' picture would have yielded good results. Indeed, there is some suggestion of this in our table of findings on this test, where we note that pathological liars, when left merely to themselves and their first often comparatively meagre report on the picture, give few incorrect details. The difference in their report as compared with other observers of the picture was found when they answered questions. Since this is the case, there can be little question that training in the power to respond accurately might be gained.

It may be of value in considering therapeutics of pathological lying to enumerate the general run of treatment which was carried out in those instances where we know that betterment took place. Nearly always only a part of what we advised could be carried out, but, even so, a brief statement of the conditions under which betterment was accomplished seems worth much.

Case 1 was treated first in an institution for delinquents where every effort was made to cure her disease and where she was taught to employ herself in constructive work. It was found she had ability to design, and this was used to the utmost. Then her lying tendencies were checked by social disapprobation as much as possible. A special effort was made toward this. The girl was undoubtedly made more serious-minded by the after-effects of her experience and perhaps by her disease. She was later successfully handled at home by her sensible mother. Leaving the years of adolescent instability behind her was also undoubtedly a factor in betterment.

Case 4 was taken in hand by a sterling character who restrained very carefully the tendency to lying, and by firm methods showed her the social advantages of self-control in this respect. At the same time she was given a vastly better environment, particularly in the matter of her friends. However, there is little doubt that nothing would have been accomplished in this case without first a deep understanding of the girl's troubles and of her mental conflicts.