May 25

Malingering: When Psychiatric Conditions are Faked

Malingering involves the intentional production or display of false or grossly exaggerated physical or psychological symptoms, with the goal of receiving a specific benefit or reward such as money, an insurance settlement, disability status, evasion of legal consequences or release from incarceration, or avoidance of work, jury duty, the military, or other types of service. Psychologytoday.com

Some cases of malingering are relatively easy to detect, but some can be especially tricky for mental health professionals (and/or physicians) to identify. Such cases of malingering can lead to abuse of the system, with unnecessary tests and interviews being performed and time taken away from other clients and patients.

Malingering is a condition not listed in the DSM-5. However, “It is similar to, but distinct from, factitious disorder, in which an individual fakes symptoms of physical or mental illness but without a concrete motive or expectation of reward. Malingering is also distinct from somatic symptom disorder, in which someone experiences actual psychological distress due to imagined or exaggerated symptoms” (psychologytoday.com).

It may go without saying that individuals who do have ulterior motives for showing up at your therapy door don’t really want or need your help of the therapy kind; what they want is to manipulate you so that they get something else—something they presumably feel they can’t get otherwise.

A couple examples from pop culture: 1) Corporal Max Klinger (actor Jamie Farr) on the old TV show M*A*S*H (1972-83). His plan for getting out of the Army involved trying to prove that he was psychologically unfit. He couldn’t achieve his goal, though, and eventually gave up.

2) Liz Lemon, played by Tina Fey on the more recent TV sitcom 30 Rock. Her goal was to escape jury duty. See below:

A malingerer presenting at a mental health setting could also be driven by such motives as getting out of work, obtaining disability insurance, and seeking drugs.

Reportedly, research has shown, though, that a person who fakes symptoms of mental illness can actually start to believe the illness is real (Scientific American). Put into action, this means Klinger would start to really believe, for example, that he can fly (in his pink bathrobe and slippers), while Liz Lemon would settle into the delusion that she’s a Star Wars character.

On a more positive note, psychologist Elizabeth Loftus is quoted in the above-cited article as envisioning “therapeutic potential in the new study”…

…musing on a hypothetical strategy she calls ‘feigning good,’ which could motivate patients by helping them believe in improved cognitive skills and diminished symptoms of illness. ‘Should clinicians be prescribing a form of feigning? You wouldn’t want patients to feign anxiety, but maybe they could feign the opposite. Maybe they could feign crystal clear concentration.’

Dec 13

“The Art of Misdiagnosis”: Investigating a Mom’s Suicide

All I can really do is write my own misdiagnosis of your life. Gayle Brandeis, author of The Art of Misdiagnosis

So states Gayle Brandeis, author of The Art of Misdiagnosis: Surviving My Mother’s Suicide, in this brief trailer to her new book:

The book’s title takes its name from the documentary Brandeis’s 70-year-old mother Arlene was working on “about the rare illnesses she thought ravaged her family: porphyria and Ehlers-Danlos syndrome.”

“Whether they were psychosomatically induced or not,” states Kirkus Reviews, “Arlene attested that the illnesses had been repeatedly dismissed or misdiagnosed by the medical community; even the author herself admits to suffering, as a teenager, from a combination of malingering and factitious disorder.”

In an interview with Mutha Magazine, Brandeis states the following about the origins of her book The Art of Misdiagnosis:

My therapist suggested writing a letter to my mom (such great advice!) and that became a thread of the book. The time around her suicide begged to be told in present tense. And as I dug through our old emails and files and the like, certain pieces jumped out at me as needing to be part of the narrative. It took a lot of time and finessing to fit the puzzle pieces together, but the pieces revealed themselves to me with bells on.

What was going on for Brandeis when she lost her mom? Melissa Wuske, Foreword Reviews:

Brandeis’s mother committed suicide one week after Brandeis had a baby. Those deeply contrasting experiences set the scene for the opening of this memoir: a daughter going through her mother’s things, trying to make sense of her death.

And this quest winds up involving a “compulsive, contagious need to know her mother and herself.”

As author Nick Flynn writes in his review: “John Cassavetes offers this: ‘When a character can’t find his way home, that’s where the story begins…’ Gayle Brandeis begins her story where it ends, then slowly—thoughtfully, painfully, lovingly—works her way back. It all circles around a handful of days, where everything happens—birth, death, truth, transformation.”

More about the overall process Brandeis experienced, from Kirkus Reviews:

Desperate for answers, she and her sister fruitlessly scoured their mother’s bedroom, which, much like the woman herself, appeared ‘lovely and elegant on the surface, total chaos underneath.’ The author’s reality soon became even more complex: she wrestled with the grief of her mother’s sudden death, processed her complicated history of paranoia, suspicion, and delusions, and nurtured her newborn. This frustration bleeds into the text as Brandeis recounts episodes where her mother’s inexplicable accusations wreaked havoc on her pregnancy and her marriage. The author then reveals her mother’s history of psychosis, which seemed to stem from the author’s pregnancies, with which Arlene became obsessed.

Author Caroline Leavitt‘s review:

Deeply compassionate, and breathtakingly brave, Brandeis’ memoir is a raw, unflinching trip down a rabbit hole, unspooling both the chaotic life of her mentally unbalanced mother, and how her mother’s obsession with physical illness crash-landed Brandeis’ own life—and health—from girlhood to marriage and motherhood. About the stories we desperately need to make of our lives in order to survive, and how the body sometimes speaks what the mind dare not, this is also an extraordinarily moving portrait of a troubled mother, and of the daughter who fearlessly, poetically, writes her way into discovering her truest self. Truthfully, I am in awe.

On her website Brandeis provides resources for others dealing with suicide.