MALINGERING AND ILLNESS DECEPTION

Abstract

MALINGERING AND ILLNESS DECEPTION Edited by Peter Halligan, Christopher Bass and David Oakley 2003. Oxford: Oxford University Press Price £35.00 (paperback). ISBN 0–19–851554–5 In a recent television drama, a defendant charged with killing a mother and her two children while driving was compelled to appear in court against the wishes of his counsel. He was mute and unresponsive throughout the preliminary proceedings to determine his fitness to plead, but was finally provoked into ‘normal’ response mode following a recommendation that he should be detained in a special psychiatric hospital ‘at Her Majesty’s pleasure’. The presiding judge had an instinct from the outset that this was malingering (even without seeing the individual concerned)—and was correct. Luckily, few in the medical profession have to make this sort of decision—witnesses to the fact and expert witnesses, yes, but the buck stops with the legal process. Indeed, we are repeatedly reminded in this book that malingering is not a disease or a valid diagnosis (in contrast to deliberate self‐harm) and that its unmasking is a task for the legal process rather than the medical one. Why, therefore, should neurologists, psychiatrists and clinical psychologists be interested in this topic? Well, they are often (with others) the last port of call for patients with medically unexplained symptoms, with subconsciously driven symptoms and signs (hysteria) or with ‘the intentional production of false or exaggerated symptoms motivated by external incentives’ (to use one of the many related definitions of malingering in the book). In the role of investigating and caring for an individual with symptoms and signs, the clinician …