Malingering in Mental Health Care
Though it may seem obvious to some people that a person has a mental illness, many who suffer from a mental health disorder do not show outward signs. We go about our lives, mingling with the public on a day to day basis, never sure of who is sharing our seat on a coach or is in front of us in a shop queue. We know what these people look like or how they appear to us, but we have no idea if they have a mental illness or not.
The fact is that mental illness can appear invisible but it can also be very apparent. When you visualize a mental health patient, you probably think of:
- Loud and intimidating people
- Extremely quite and introverted people
- Wild eyes, staring eyes
- Unpredictable verbal or physical outbursts
- Dirty or mismatched clothing
- Strange facial expressions
- Alcoholics or drug addicts
A considerable proportion of mentally ill people do not fit those descriptions, but with media encouragement, we have been led to believe that having a mental illness is akin to “madness”. We know well of our image of a “mad” or “deranged” person. If a picture of being mentally ill is so obvious in our eyes, then it is fair to say that there must be a universal image we all relate to. We may have read books, newspaper articles or seen films that depict the persona or outer appearance of people who have a mental health disorder. The problem is that a person with mental illness often doesn’t fit the picture that we paint.
In the late 1800s a journalist actually faked mental illness to do some investigative journalism into mental asylums. She could fake it. (See book on the right).
The shocking but truth is that that some people actually fake mental illness for their own good. Whether it is born from a preconceived image of, or textbook information about mental disorders, these people are willing to pretend they have everything, from an anxiety disorder or depression to schizophrenia. The act is purely intentional and people who feign mental illness are known as malingerers.
What is Malingering?
Malingering is the act of faking illness or exaggerating it, with intent to use the illness for personal gain. It is seen in different circumstances but tends to be for one of the following reasons:
- To avoid responsibility – work, family, criminal activity
- To get out of the armed forces
- To claim insurance
- To claim disabled benefits
- To get drugs
It may be that a person has had a bout of depression that has been treated in the past, but they claim that the depression keeps coming back when it doesn’t. They may exaggerate an existing anxiety problem and say that they also have agoraphobia, obsessional behavior or many other anxiety related conditions. As we can’t always see depression visually, or determine someone’s anxiety level throughout the day, we tend to believe them. These mental health issues are easier to fake or exaggerate.
There are some people who fake the more serious mental illnesses such as schizophrenia, and claim to have auditory and visual hallucinations. These kinds of disorders are more difficult to fake, but if these people are desperate, they will attempt to convince the people they need to that they are seriously mentally ill.
Work, Disablement Benefits and Malingering
Many people who have a diagnosed mental illness actually work, and to some degree manage quite well. I have known scores of people that have a diagnosis of depression, anxiety disorders, personality disorders, and even some of the more severe mental illnesses who manage to hold down a job. It is still however, not unusual to have to take time off work or not work at all for any mental illness.
What if you don’t like your job any more, or feel under pressure at work? Many people in these circumstances may pretend to be clinically depressed. They go along to their practitioner, say they have a few symptoms related to depression and are signed off sick. This can then develop with a few more feigned symptoms such as anxiety and phobic behavior (anxiety and depression are often seen together). The grand finale is that they are unable to work at all, are discharged from work on medical grounds and then in receipt of long term disablement benefits.
There are also those who recover from mental illness, who pretend to still be suffering with the same symptoms. This kind of exaggeration is often born out of a fear of losing benefits, or a fear of having to work after many years of illness.
Crime and Malingering
The insanity defense brought about by the McNaughton Rules, question a person’s mental competence after a crime has been committed such as murder. A person is deemed liable for the crime committed, if they knew what they were doing at the time, and if they knew that the act was legally wrong. As you can imagine, the insanity plea has been abused terribly over the years.
A famous example of the lengths people will go to in trying to avoid prosecution is that of Mafia mobster Vincent Gigante. Because he was in fear of prosecution, he walked the streets in his pajamas and slippers whilst apparently talking to himself, as though suffering from schizophrenia. This worked for ten years and he was deemed mentally unfit to stand trial. He was caught out in the end however!
This is not an isolated case of course, as many criminals from petty thieves to murderers will sometimes try to fake mental illness to avoid the responsibility for their crime. Crime, especially serious crime, can be generally perceived as being closely connected to an underlying mental illness in the eyes of the masses, and this is why it may be considered an easy option for the criminal. We all tend to ask the question “mad or bad” when trying to understand criminal behavior.
Those who are in prison may fake mental illness to receive more lenient care and for attention. Prison life might be considered a little easier with a few drugs thrown in for a mental disorder too! Psychotropic drugs often help calm a person and induce better sleep. A criminal may actually have a drug problem and this is another way to handle that aspect.
Claiming Insurance and Malingering
The most obvious physical illness insurance claim that springs to mind is that of faked or exaggerated whiplash injury after a traffic accident. People do however; fake mental illness after a trauma of any kind. We hear more and more about post traumatic stress disorder (PTSD), and this is an illness that many will try and fake. This is often more about exaggerating the effect that a traumatic event has had on a person. They may indeed be affected, but not to the extent that it interferes with their lives. An exaggeration of PTSD brings with it an attention from professionals and a much needed diagnosis letter for an insurance claim.
The emotions are strongly connected to mental illness and we can not see someone’s emotions; how they truly feel. If a person tells a doctor that he keeps reliving the traumatic event, is anxious, irritable and having a hard time sleeping, it is highly likely that a PTSD diagnosis will be considered, and this is classed as mental illness. This diagnosis will push up insurance claims considerably higher.
Daily Mail Article on Celebrity Mental Illness and Children
- Mind games: How celebrities have sparked alarming teenage trend for faking mental illness | Mail Onl
Those who have faked conditions claim they have been influenced by stars who speak openly about their problems, such as Kerry Katona and Britney Spears.
Celebrity Mental Illness and Young People
Although it sounds unbelievable, it has been found that some children and adolescents can fake mental illness purely because they know of a celebrity that has a disorder. There has been much media coverage of the mental illness of such stars as Britney Spears and Kerry Katona for instance. Faking depression and self harming for example have become “cool” for some children. This could have far reaching consequences for those children, and shows us how little they truly understand about the seriousness of having a mental health disorder. Some of these children may well enter into the psychiatric care services, and be given strong medications to deal with a fictitious mental illness.
Diagnosis of Malingerers in Mental Health Care
Faking or exaggerating mental illness because one actually wants to be mentally ill is recognized as a problem that needs help, but this can be hard to define. Munchausen syndrome is one such factitious disorder that is recognized by mental health professionals. A person with Munchausen syndrome will go to great lengths to assume a sick role because they want to be sick, but there will be no signs of such things as monetary gain or an impending court case. This implies that the person has an emotional problem that is unresolved and is seeking a way to resolve the inner emotional turmoil. Munchausen syndrome can happen within the mental health care service, but is more usually seen first in the medical setting as an attention seeking role. Perhaps this is because it is simply harder to keep up the pretence of a behavior, as opposed to pain.
If a psychiatrist is presented with a suspected malingerer, it is the faker’s purpose or goal that is paramount in diagnosis. There is no internal mental conflict with a true malingerer, and he is faking purely out of a need to gain something such as mentioned above. Many malingerers have not done their homework thoroughly enough, if at all! This is where we come back to how the layman defines the picture of mental illness, and that picture is just not as accurate as we think! A psychiatrist may suspect malingering when:
Would you be prepared to anonymously expose a malingerer?
- The person has an impending court case
- The person has an impending insurance claim
- The person has an addiction to drugs
- The person talks in a blatant text book fashion about his feigned illness (facts many of us wouldn’t know at the onset of severe mental illness or be in a position to explain)
- Changing symptoms from time to time
- The person claims to be confused and behaves irrationally, but has apparent spells of being completely lucid
- The behavior changes when the person is alone
- The person has no previous history of any symptoms of mental illness
It can sometimes prove to be a difficult call for psychiatrists and there is always the chance of getting it wrong. In these instances the people who are not faking will not get the treatment they need which is of great concern.
There are sure to be some malingerers that slip through the diagnostic net, but often people will get found out in the end. The impact of malingers on the benefit system, the cost to the health service and the bogus insurance claims, all have an effect on the rest of society. Resources for mental health care are already stretched and this kind of behavior takes valuable services away from those who legitimately need it.