Malingering
The picture was for your attention!
I found the discussion our group had on malingering very interesting. I had brought up the movie Primal Fear and many classmates discussed real cases they knew about in relation to feigning a mental illness in regards to the Criminal Justice system. Since I was so intrigued by the real cases mentioned, I wanted to read more about them. However I ended up stumbling on this really interesting article titled, Faking it: How to detect malingered psychosis. I wanted to highlight some of the more interesting points the article made.
According to the article, malingering is “the intentional production of false or grossly exaggerated physical or psychological symptoms, motivated by external incentives.” (Resnick & Knoll, 2005, p. 14) Even the smartest of psychiatrists and criminal justice officials can be duped by cunning criminals. So how can they limit the potential of this happening? How can they act as a human lie detector test when some of these criminals are so highly manipulative and sophisticated? I think it is safe to say there is no full proof way to detect if someone is faking a mental illness; however this article identified some helpful tips in recognizing some of the lies, and provided some insight into the idea of malingering.
Malingering is typically used for two purposes – avoiding pain, or seeking pleasure. Avoiding pain could be feigning illness to get out of jail and be housed in a mental hospital for a shorter period of time, or even to miss some days of work (as seen in the cartoon above). Malingering is also used to seek pleasure; this could come in the form of controlled substances, or even workers compensation benefits. There are three types of malingering: pure, partial and false imputation. Pure is when they straight up fake a nonexistent disorder, partial is when they exaggerate real symptoms, and false imputation is when they “ascribe real symptoms to a cause the individual knows is an unrelated to the symptom.” (Resnick & Knoll, 2005, p. 14)
The article provides some tips and tricks for identifying malingering when conducting an interview. For example, it states that if you suspect the person is faking, do not let on that you are suspicious. Proceed with an objective interview. This way they will not become defensive and be put on guard. This will make it harder for you to make a determination. You should also ask open-ended questions. Subjects should describe their symptoms in their own words and should not be led to an answer. Then once they identify their symptoms, you can get more specific and detailed with the questions.
Some more advice given – try to make the interviews long. Malingerers have difficulty maintaining fake symptoms for longer periods. When possible, the authors recommended monitoring them in an inpatient facility during the assessment phase because faking psychosis is difficult to do 24 hours a day. Also helpful and perhaps, critical, is to review collateral data and information associated with these cases. This could be previous interviews, evaluations, personnel files, depositions, police reports, etc. These are items that can help corroborate or disprove the fact they are faking.
Another interesting finding is when a subject’s language use when they claim to have hallucinations. The authors noted two examples they witnessed firsthand. First, a person who was charged with rape told the officers that voices told him to “go commit a sex offense” and another example was of a robber who claimed voices kept telling him to yell “stick up, stick up, stick up.” This specific language was identified as “stilted or implausible.” The article did not really identify what would have been a more “logical” language that would have suggested a crime was truly committed by a sick person, but my assumption is that it was almost too perfect of an excuse.
Malingerers may also claim to have active auditory and visual hallucinations but do not show signs of being distracted. They may act confused in the presence of a doctor, but are excellent chess players when they play against other patents in a facility. They also may say they “don’t know” when asked detailed questions about psychotic symptoms. A person with honest psychotic symptoms would be able to provide an answer. I found some of these tips as common sense, but a lot were rather interesting and something I may not have thought of (i.e. the hallucination language example).
These fakers typically trip up in certain areas. There are some obvious clues like when they completely contradict themselves, and then there are the slightly nuanced lies that can be picked up on by professionals. They may overact and think that the more bizarre they behave, the more convincing they are. In reality they would be more effective if they don’t engage in unusual or odd symptoms, but rather play it more low-key. Malingerers are noted to almost flaunt their illness and chat about it, whereas patients with true schizophrenia, for example, are reluctant to admit it or discuss it further.
Popular and validated tests to detect malingering include assessments like Structured Interview of Reported Symptoms (SIRS), Minnesota Multiphasic Personality Inventory, Revised (MMPI-2) and the Miller Forensic Assessment of Symptoms Test (M-Fast). The article gives a slight overview of each test.
Worth noting, as I think we have all have mentioned in some discussions posts (throughout our BU CJ journey) is the “CSI effect.” With classes like ours and articles like this, we all get better and more educated and aware, but so do the criminals. On a semi related note, in watching the Netflix show “Unbelievable” which was based on a true story centered on a serial rapist who learned how to clean crime scenes by reading a textbook (basically a “playbook” of sorts, although not at all its intention). So I do struggle with articles such as these that make the good guys more intelligent, but can also benefit the bad guys. Overall, this was a really interesting article. I recommend reading it if you have a chance as it covered some other details I did not touch upon for this post.
Reference:
Resnick, P. & Knoll, J. (2005). Faking it. Current Psychiatry. Retrieved from: https://mdedge-files-live.s3.us-east-2.amazonaws.com/files/s3fs-public/Document/September-2017/0411CP_Article1.pdf