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"Let’s be honest": That expression is entirely overused. Time was, any person using that phrase either followed it or preceded it with a lie. These days, it seems to indicate: "I really want you to pay especially close attention to what I’m going to say, because it is unvarnished by today’s intense scrutiny on all things uttered."

The concept of truth experiences generational convulsions, especially among academic types. For my purposes, honesty means the accurate answering of subjective realities to reasonable queries. Of course, to be truthful in a psychiatric setting can be perilous if emerging emotions are painful to experience.   

The ability to lie is a developmental milestone for a toddler. It is self-realization that what occurs in the head can be protected and accessed only by the young individual. It is then incumbent upon parents to instruct the child about the consequences of mendacity and the high importance of honest dealings. Those who develop comfort with lying come to assume such a standard in all their dealings, just as an honest person expects the same in others.  

Obviously, there are many layers of deception, from the harmless "white lie" to the most egregious cons. For our discussion, we have the luxury of acknowledging the broad continuum of reasonable dealings with each other. Sometimes we fib to protect feelings, to hold fast to private information, to limit personal shame. Regardless, the greater the departure from what we accept as truth, the more difficult it can be to keep track of disparities. There are a select few who will lie even when the truth will do.  

In a prison-setting, accuracy is rarely achieved through the subjective reporting of a single person. Most inmates develop a code of survival preceding their incarceration, and it only strengthens through the prison experience. For someone struggling to survive, the truth is whatever perceived reality will incur the least distress or garner the most reward. Trust is in exceptionally short supply behind bars, where one slip can lead to disastrous results for an inmate. Developing doctor-patient rapport inside is particularly challenging. 

An important distinction needs to be made between honesty and openness. In a game of poker, each player covers his/her cards. To reveal one’s hand is to commit game suicide. Likewise, in life, there are those who’ve earned our revelations—family, close friends, and the rest who do not deserve our protected information. Learning to draw distinctions between honesty and openness is an important psychological development with which many of us struggle. It’s usually coupled with an intense difficulty saying "no" to others. Curiously, many of us feel the pull to answer any question posed to us, no matter the source. A gifted salesperson recognizes this human foible (the difficulty in refusing a query) and takes copious advantage.  

When encountering a serial liar, the first reaction of an honest person will be puzzlement: S/he will suspect something’s awry, but won’t believe the depth of another’s mendacity. Repeated offenses will inevitably lead the victim to recognize patterns of inconsistency and to the unpleasant realization: "I’m dealing with a liar." Direct confrontation rarely leads to tearful confessions. Usually the opposite—denials and reversed accusations. The old adage "once a liar, always a liar" can often instruct, especially if the liar is an advanced age where change is rare and painful. Sadly, in many cases, the only recourse is to cut off contact, though such a course of action is highly dependent on the nature and intensity of the connection between parties.