Three of the patients were suffering from major mental disorders, and their statements about committing murder were interpreted clinically as confirmations of their illnesses, rather than authentic confessions. Psychiatric staff failed to determine whether the reported offenses had actually occurred, or whether their patients could have been responsible for those crimes. The real facts were discovered, and the initial confessions verified, only after the patients eventually reported their murders to the police. In the fourth case, a patient, who had a deceitful and disturbed personality, told his therapist about murders he had committed and was planning to commit. Although the police were notified, they dismissed his claims, and only arrested the man when he was attempting to carry out another homicide. The article explores relationships between psychopathological syndromes and confessions of crime, examines how truthful confessions are sometimes overshadowed by coexisting psychopathology, and provides recommendations to help clinicians differentiate between true and false confessions. 26 references