Friday, July 12, 2013

Revealing malingering

Though I am a forensic psychiatrist, I usually engage in clinical practice.
The other day, I was asked by a medical student how to identify the person that he was malingering.

It is not so easy task for a practitioner, because we always perform clinical practice on the assumption of the honesty of the patients. If I suspect the patient tell a lie about his or her mental status, I cannot establish a therapeutic alliance with the patient. It causes us so many troubles that I hardly offer a good care. Therefore, it is rational that both the patient and the therapist trust each other.

Some patients do not want to get recovered. To be deemed as a patient is often beneficial, so called 'second gain'.  The reasons are various. Some patients want to avoid their own duty. Others want to revenge to their family. To distinguish the second gain is important in treating the patients with some kinds of mental disorders such as conversion.

However, patients with second gain are truly patients, not malingering.

Actually, malingering occurs in other than clinical situation.
I have seen a defendant who pretended to be suffering from auditory hallucinations. He claimed that he was commanded to peep a public bath of women by the God.

My grand boss was completely deceived by a criminal who had committed a murder. The criminal pretended to be schizophrenic to be deemed as not guilty for the reason of insanity. His attempt had almost completed but was finally revealed.

I replied to my student that there are three types of malingering we sometimes encounter.

(1) Drug abuse
(2) Insurance
(3) Lawsuit

All of them are associated with the trouble of money.
After all, we have to be cautious with money.

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