A historical sketch and fuller description of the syndrome will help in clarifying this notion. Ganser first reported his observations on prisoners in 1897 at a conference and published them a year later [1]. Much of the early literature on Ganser’s syndrome focused on convicted individuals awaiting trial, raising the notion that it was a “prison psychosis” related to the psychological consequences of confinement, guilt and stressful uncertainty about one’s predicament. The beginning of Ganser’s report offers a classical illustration of the syndrome that will ultimately bear his name:

Now, on the face of it, such behavior was strongly suggestive of intentional deception: the patients seemed to make mistakes on purpose. Ganser indeed readily admitted that “we cannot fail to recognize how in the choice of answers the patient appears to pass over deliberately the indicated correct answer and to select a false one, which any child could easily recognize as such” ([3], p 121). Yet, he was adamant that his patients were not malingering: “I come now to the question whether the peculiar manner of response which they showed is to be regarded in itself as malingering or as a genuine symptom. I must say that I never had the impression that these patients sought to deceive me. They never made any spontaneous absurd remarks; only when questioned did any such answers appear, and often they showed how troublesome to them these repeated examinations were. They appeared unwilling to have anyone think of their answers as false and simple-minded, and of themselves as ignorant and foolish, whereas they appeared convinced that whatever they said was correct” ([3], p 125). Because he classified right away the condition as hysterical, Ganser also duly reminded his audience that hysterical symptoms by themselves had always been (and still are) related to suspicions of malingering, yet equally frequently distinguished from intentional and conscious deceptions.

Furthermore, he felt that his patients presented with “a combination of manifestations of illness, which are well-known and whose simulation by people unfamiliar with psychiatry is improbable to the highest degree” ([3], p 126). This “combination” was what made, in Ganser’s mind, the disorder so specific and unlikely to be merely the product of fabrication or role-playing, calling it eventually a “peculiar hysterical twilight state.” In addition to giving approximate answers – a behavior dubbed “Vorbeigehen” (“to pass over,” “to pass by”) by Ganser, which appears in the text only once in the passive form “vorbeigegangen,” but oftentimes referred to as “Vorbeireden” (“to talk at cross-purposes”) in the literature –, other features were considered highly significant. These were: the presence of hallucinations (mostly visual and auditory, sometimes labelled pseudo-hallucinations when their authentic perceptual nature is in doubt); somatoform disorders in the form of hysterical stigmata (somatic complaints and movement and sensory disturbances not explained by organic factors); clouding of consciousness (a state of perplexity and bewilderment with attention deficits and seeming dissociation from the self and surroundings); sudden and “astonishing” recovery for all symptoms (although with occasional signs of partial relapse); subsequent amnesia for the episode; and the presence of a triggering factor aside from the crimino-legal context, including psychosocial difficulties such as financial worries or bitter distress, and organic elements such as typhus or head trauma.

This full picture must be kept in mind when considering the approximate answers these patients provide. To get a fuller sense of this behavior, it is worth quoting again Ganser on another of his patients:

On the clinical and scientific front, however, much debate and confusion has surrounded this “peculiar hysterical twilight state” and its characteristically approximate responses. Allen and Postel [2,5] go as far as to talk of a “repressed” chapter of the “history of hysteria” and, somewhat hyperbolically, deplore the “feast” of “successive layers of silence and falsification” that followed Ganser’s initial observations and the slipshod or mindlessly anhistoric nature of most research on the topic. On a side note, there is a curious and ironic uncertainty in Ganser’s 1898 original report. Al...