Mutism, malingering, and competency to stand trial.

Mutism and mental illness have had a long-standing historical relationship with regard to the issue of competence to stand trial. This article reports a defendant who remained mute for 10 months and describes his use of the symptom of mutism in his malingering. Although mutism is frequently used by defendants for malingering, clinicians must have a high index of suspicion for the possibility. We recommend a comprehensive evaluation including neurologic workup, repeat interviews, observation of the defendant at unsuspected times for communicative speech with other inmates, study of handwriting sample, collateral nursing documentation, and, if necessary, Pentothal interviews to establish authenticity of mutism. The authors review the historical background and legal considerations of the relationship between mutism and malingering.