Distinguishing lies from jokes: theory of mind deficits and discourse interpretation in right hemisphere brain-damaged patients.

Right-hemisphere brain damaged (RHD) patients and a normal control group were tested for their ability to infer first- and second-order mental states and to understand the communicative intentions underlying ironic jokes and lies. Subjects listened to stories involving a character who had either a true or a false belief about another character's knowledge. Stories ended either with an ironic joke or a lie by this character. In the joke stories, the speaker knew that the listener knew the truth (a true second-order belief) and did not expect the listener to believe what was said; in the lie stories, the speaker did not know that the listener actually knew the truth (a false second-order belief) and thus did expect the listener to believe what was said. RHD patients performed significantly worse than control subjects on one of two measures of second-order belief, which suggests that the ability to make second-order mental state attributions is fragile and unreliable following right-hemisphere damage. RHD patients in addition performed worse than controls when asked to distinguish lies from jokes, confirming their known difficulties with discourse interpretation. For both groups, the ability to distinguish lies from jokes was strongly correlated with two measures of the ability to attribute correctly second-order beliefs. These results suggest that the fragility of RHD patients' understanding of second-order mental states underlies a portion of their difficulties in discourse comprehension, but that the underlying impairment is not restricted to right hemisphere dysfunction.