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You fooled 'em Chief. You fooled 'em all.
July 9, 2013 8:12 AM   Subscribe

How easy is it to fake mental illness?

Marjorie Wallace, head of mental health charity Sane, says "the difficulty lies in the lack of precision in diagnosis". She notes Moors Murderer Ian Brady's case as a particularly vexing example.

"As seems the case with Brady, the mental illness is compounded by severe personality disorder, which can make a person highly devious and convincing."

Roger Graef, a visiting professor at the Mannheim Centre for Criminology agrees. Whilst feigning mental illness is extremely difficult for most, "really smart people understand the game and play it", he says.


Previously: James Holmes and the Insanity Defense; Revisiting Dr. Rosenhan
posted by not_the_water (44 comments total) 13 users marked this as a favorite

 
You fooled 'em chief.
posted by not_the_water at 8:13 AM on July 9, 2013 [1 favorite]


When they ask you to draw a clock, look at them like they're nuts, and draw the clock with the numbers and hands all on one side.
posted by infinitewindow at 8:17 AM on July 9, 2013 [14 favorites]


I'm a lot more interested in the question of how easy it is to fake normal.

I suspect a lot more people are putting a lot more effort into that, than the other way around.
posted by mhoye at 8:25 AM on July 9, 2013 [82 favorites]


...numbers and hands all on one side.

NO No no, gotta be on the OTHER side.
posted by sammyo at 8:30 AM on July 9, 2013 [2 favorites]


What's a tortoise?
posted by Mister_A at 8:33 AM on July 9, 2013 [8 favorites]


"Doctors will find it hard not to be a little mortified by the book's exposition of their clinical frailty: we are bad both at recognizing malingerers and at categorizing them. We may even be guilty of the sin decried by Thomas Szasz —the medicalization of social woes to suit our own ends. In defence of the hapless clinician, one might add that most doctors are neither trusting naïfs nor unredeemed narcissists but simple pragmatists. Every neurologist, for instance, will have a complement of 'tricks' to expose factitious complaints, but such manoeuvres, when they must be employed, occasion no frisson of triumph or exasperation; like testing the visual fields or tapping the reflexes, they are (or should be) simply a means to a diagnostic end. Whatever our existential reservations, a patient still presents a problem to be solved, and most of us would prefer to grant the benefit of the doubt. Human motivation is at best a murky subject; and doctors make bad policemen. It is surely no accident that the lawyers here endorse a similarly pragmatic approach, in their own contribution to the debate."
posted by Teakettle at 8:39 AM on July 9, 2013 [5 favorites]


Probably as easy as it is to fake mental clarity. Think of how many seemingly sane people on the outside are truly bonkers.

So the answer is easy. VERY easy. You just have to be committed.
posted by mrgrimm at 8:43 AM on July 9, 2013 [4 favorites]


severe personality disorder, which can make a person highly devious and convincing

Of course, we would NEVER consider THAT a 'mental illness', that's just being an evil person.
posted by oneswellfoop at 8:44 AM on July 9, 2013 [4 favorites]


I'm ok with people faking as long as it means people who need care get care. If we care about people faking, it will inevitably lead to care getting even harder to get.
posted by bleep at 8:44 AM on July 9, 2013 [12 favorites]


How easy is it to fake mental illness?

Exceedingly. Undercover journalists have been committing themselves to institutions and writing exposes about rampant abuses in psychiatric hospitalization since the 19th century. It's a lot less easy to fake normal and get out -- once you're in, no one trusts a word that comes out of your mouth, particularly after they've started force-medicating you with sedatives.

See also: Nellie Bly's Ten Days in a Mad-House (1887), Julius Chambers' A Mad World and Its Inhabitants (1876), Norah Vincent's Voluntary Madness (2008), and David Rosenhan's experiment On Being Sane in Insane Places (1973).

The last of these begins its conclusion with the following:
It is clear that we cannot distinguish the sane from the insane in psychiatric hospitals. The hospital itself imposes a special environment in which the meaning of behavior can easily be misunderstood. The consequences to patients hospitalized in such an environment -- the powerlessness, depersonalization, segregation, mortification, and self-labeling -- seem undoubtedly counter-therapeutic.
Seems like common sense to me.
posted by divined by radio at 8:44 AM on July 9, 2013 [36 favorites]


Mental illness is not legal insanity. Legal insanity is not mental illness. It would be extremely easy to fake the latter. The former is so meaningless that I'm not entirely sure that it's possible to fake it. People with real, severe mental illnesses are found to be legally sane all the time. So, y'know, why not the opposite?

Okay, well, that's in the US, I suppose it could be different in the UK.
posted by Sequence at 8:45 AM on July 9, 2013 [7 favorites]


To add another layer of confusion, a lot of normal behavior is fakery, manipulation and malingering. Keeping it overly real is the hallmark of the mentally problematic.
posted by Teakettle at 8:53 AM on July 9, 2013 [7 favorites]


You know what a turtle is, Mister_A?

Same thing.
posted by coachfortner at 9:02 AM on July 9, 2013 [6 favorites]


What sane person would want to fake mental illness?
posted by murphy slaw at 9:06 AM on July 9, 2013 [1 favorite]


What sane person would want to fake mental illness?

Exactly! A person faking mental illness really is ill. So a person faking mental health really is healthy!
posted by RussHy at 9:08 AM on July 9, 2013 [6 favorites]


What sane person would want to fake mental illness?

Exactly! A person faking mental illness really is ill. So a person faking mental health really is healthy!


Dammit Yossarian!
posted by sparklemotion at 9:11 AM on July 9, 2013 [33 favorites]


it will inevitably lead to care getting even harder to get.

It can be made harder?? I'm being partially mocking here, but as someone who has issues that need help, it's one of the hardest to get good care for, not just from doctors (who've i've noticed always seem to assume the person is lying) but from crappy insurance. I needed a therapist after a suicide attempt, and the doctor who saw me gave me a sheet of therapists in the "area" (up to an hour away) and told me to ask my insurance which they would "let" me see. Out of ten or so names, only one was covered, and they were the farthest.

I have mixed feelings on people who fake it. It's not fun to have or interesting, it makes life hell. Fakers get the benefit of being able to live normally, while not really facing the bad of having them. But i'd also rather we help all than just assume so many are faking it. Sort of like those who falsely claim being raped, don't just assume it's a lie (but also don't ruin lives while checking it out) in case you can help someone.

People with real, severe mental illnesses are found to be legally sane all the time.

Yeah, so few people seem to get this. I've seen so many facebook posts like "Of course Dahmer was insane, he ate people, but should still be punished!" replacing various people. Legally insane is so rare it's almost bigfoot. You basically are beyond what most people consider crazy, you don't know the year, president, who you are, what is going on, etc. Even then, it's not a sure thing. Plus, once you get back to "normal", you go from hospital to prison.

What sane person would want to fake mental illness?

More than you'd imagine. Just look at how many people among the geek group that self diagnoses as having asperger. Not to mention all the Dexter, Joker and Hannibal Lector type characters that romanticize it, not how they also all seem to be in control of it. They want to claim something else is making them feel or do bad things, but not face they are just crap people.
posted by usagizero at 9:12 AM on July 9, 2013 [11 favorites]


Sure, malingering is a problem to be on the lookout for. But think about this: what kind of person would actively fake a mental illness?

A crazy person, that's who!
posted by grubi at 9:13 AM on July 9, 2013 [1 favorite]


You know what a turtle is, Mister_A?

Clearly you have not seen The Godfather.
posted by xmutex at 9:17 AM on July 9, 2013 [1 favorite]


More than you'd imagine. Just look at how many people among the geek group that self diagnoses as having asperger. Not to mention all the Dexter, Joker and Hannibal Lector type characters that romanticize it, not how they also all seem to be in control of it. They want to claim something else is making them feel or do bad things, but not face they are just crap people.


Sure, I see a lot of people who self-identify as OCD or ADHD or manic-depressive or whatever in order to seem more interesting at parties, but how many of those people actively seek treatment?

I speak from experience when I say getting treatment for mental illness involves wrestling with bureaucracy at best and is demeaning and dehumanizing at worst. Why would anyone do it if they didn't genuinely need help?
posted by murphy slaw at 9:20 AM on July 9, 2013 [4 favorites]


It can be made harder?? I'm being partially mocking here, but as someone who has issues that need help, it's one of the hardest to get good care for, not just from doctors (who've i've noticed always seem to assume the person is lying) but from crappy insurance.

I almost added something like "if it's possible for it to get harder" but I couldn't phrase it right. But yeah they will make it harder if they can find any excuse, and lots of talk about faking will be a perfectly fine one. But I feel like anyone who's faking it has to be suffering as much as anyone who's not faking it, so give them whatever they're entitled to if it means actual suffering people aren't thrown under the bus.
posted by bleep at 9:21 AM on July 9, 2013


Jon Ronson did a TED talk concerning tests for psychopathy, , the gray areas between the 'sane' and 'insane', and the DSM-IV-TR.

"I wonder if I've got any of the 374 mental disorders," I thought.

I opened the manual again.

And I instantly diagnosed myself with twelve different ones."

It turns out, it is also significantly more difficult to prove you are not insane, post diagnosis, compared to the relative ease of claiming insanity.

ex: "Nurse, have you seen my copy of Scientific American, there is a remarkable article about the language of bees."
Nurse scribbles on notepad "Patient believes bees can talk."
posted by aretesophist at 9:26 AM on July 9, 2013 [5 favorites]


When they ask you to draw a clock, look at them like they're nuts, and draw the clock with the numbers and hands all on one side.


That's right hemisphere brain injury, yo.
posted by Ideal Impulse at 9:27 AM on July 9, 2013 [2 favorites]


When they ask you to draw a clock, look at them like they're nuts, and draw the clock with the numbers and hands all on one side.

This also works if they ask you to draw a cock.
posted by TheWhiteSkull at 9:37 AM on July 9, 2013


Get me two pencils and a pair of underpants and I'll show how easy it is.
posted by comealongpole at 9:46 AM on July 9, 2013 [4 favorites]


I have known one spectacular malingerer (faked a fatal illness, told stories of ritual abuse as a child, etc.), and the conclusion I came to is that even if she did not have the illness(es) she claimed to have, she was not living high on anyone's hog. She still lived in squalor, she still clearly felt extremely incapable of relating to people in honest ways, she had committed herself to some serious lies just to get people to be her friends (lies she had to keep track of) she had faked seizures, etc...she did not appear to be having a particularly good time. She was definitely a manipulator, but a pitiful one. I wouldn't give her money or believe anything she says, knowing what I know, but I agree with other posters that malingering is, in itself, a possible symptom of a person who is Not Well.
posted by emjaybee at 9:48 AM on July 9, 2013 [10 favorites]


severe personality disorder, which can make a person highly devious and convincing

So ... being a successful politician or CEO is now considered a mental illness?
posted by ZenMasterThis at 9:49 AM on July 9, 2013 [1 favorite]


RussHy: "What sane person would want to fake mental illness?

Exactly! A person faking mental illness really is ill. So a person faking mental health really is healthy!
"

That's some catch.
posted by Mister_A at 9:55 AM on July 9, 2013 [2 favorites]


oneswellfoop: severe personality disorder, which can make a person highly devious and convincing

Of course, we would NEVER consider THAT a 'mental illness', that's just being an evil person.
Not clear on your point, since it is recognized as a mental illness (no scare quotes needed).
posted by IAmBroom at 10:03 AM on July 9, 2013


usagizero: Plus, once you get back to "normal", you go from hospital to prison.
I think you got most of the rest of the description right, with some hyperbole (knowing who's POTUS has nothing to do with criminal insanity tests, but you know that), but "Not Guilty by Reason of Insanity" does not default at any point in the future to "Guilty". Cite. Cite.
posted by IAmBroom at 10:13 AM on July 9, 2013 [1 favorite]


I did this once.

I'm not proud of it all -- the counselor in question was a nice enough guy and was earnestly trying to help me, but at the time I was going through a lot, I was deeply frustrated with the guy's naivety and obvious lack of real emotional experience, and I was nineteen years old.

Anyway, my idea was to lead him through several diagnoses and then deliver the reveal that I had planned this whole thing out beforehand, thus making plain the fact that he wasn't qualified to help me with my problems. I had a few things going for me in terms of pulling this off: one, like the article mentions, I had seen people go through psychotic episodes before; two, this guy was just a counselor for the university's student health services, not some master clinician; and three, my mom was a screenwriter and former actor who had given me (not always voluntary) "acting lessons" throughout my childhood that involved her standing in the kitchen doorway, making a frame with her hands that was meant to be the camera and which I was not to look at as I acted out my prompt.

The first stage went off without a hitch -- for the first few weeks it was depression, and then I revealed some more alarming details that made borderline personality disorder seem like the likely candidate, and then from there reframed things a bit to make Asperger's the diagnosis du jour, making sure throughout the whole thing that I never got too hammy with the act. I never did deliver the master stroke, though, since I wasn't in any state to really have any conviction in it. Instead, I just stopped going, which is sort of crappy in its own way.

Looking back on this episode, I want to say that this might be pretty common: I'm sure other people have had the same impulse that I did, and not every clinician is going to have the expertise to realize what's going on. What I'm pretty sure of, though, is that people who are engaging in that type of charade really do need help of some kind, even if they're kind of being dicks in the process of pursuing it like I was.
posted by invitapriore at 10:15 AM on July 9, 2013 [1 favorite]


Get me two pencils and a pair of underpants and I'll show how easy it is.

Bibble.
posted by The Underpants Monster at 10:22 AM on July 9, 2013 [3 favorites]


Psychiatry has a lot of entanglements with authoritarian outlooks; Bruce Levine harps on about that a lot (I swear I had a much more direct article bookmarked; something by Szasz? but my Google Fu has wilted). In a relationship where one person is seen as the infallible expert and the other person is seen as weak, helpless and confused, it's extremely easy to fake mental illness. All kinds of not-mental-illness behaviors get misinterpreted as mental illness either because the Mental Illness context requires all behavior to be read as Mental Illness or because the patient doesn't align with the psychiatrist's preconceptions and must therefore, y'know, have something wrong with them (homosexuality being the good and obvious historic example).

Psychiatry is done by people, and based entirely on clusters of symptoms. Naturally, it's a bit of a mess. This is a great article I've always loved about all the Catch 22s and mental finger traps inherent in psychiatric treatment. This article touches somewhat on one of the double-binds mentioned; that viewing someone in terms of a disease limits our empathy for them.

It's very easy for everything you do to be perceived as symptoms of illness when everyone walks into the situation automatically seeing you as "wrong"/"Other"/etc.
posted by byanyothername at 10:26 AM on July 9, 2013 [4 favorites]


I was nineteen years old.

For some of us, nineteen years old is a mental disorder. I know it was for me.
posted by grubi at 11:28 AM on July 9, 2013 [4 favorites]


I'm a lot more interested in the question of how easy it is to fake normal.

Easy. Been doing it my whole life.
posted by Mental Wimp at 11:38 AM on July 9, 2013 [1 favorite]


I'm a lot more interested in the question of how easy it is to fake normal.

They have changed this policy in recent years, but for several years the seminary I attended (mis-)used psychological tests to assess the mental health of its students. It's an understandable impulse, as religious training attracts a greater-than-average share of troubled people trying to work through their own issues. But general population screening is emphatically not what things like the MMPI were designed for, and testing dozens of students each year generated a fair amount of false positives. Like me.

I sat down with my advisor in the spring of my first year, and he explained that, according to the tests, I was depressed, antisocial, likely bipolar, possibly suicidal. I was none of these, and told him so, but once "diagnosed," normal actions were reinterpreted as symptoms of my disorder.

"I see you in the hall laughing and joking with your friends, but one on one with me you are somber and talk about the difficulties you are going through. That sounds bipolar to me."

"No, it sounds like public conversations with friends are a different context than private conversations with advisors."

But he wasn't buying it. I got a gently phrased ultimatum that amounted to "follow up on this or be kicked out." We agreed that I would go see the head of the university counseling center for four sessions, and follow his recommendation.

At the end of four weeks, the counselor told me that he wasn't sure if I was healthy or not. "Outwardly, everything seems fine, and you present as stable, but you are also test very high on abstract thinking and on empathy, which are just the qualities you would need to convincingly fake normalcy."

"Look," I said, "if my grades are good, I have meaningful relationships, there are no complaints about my behavior and I have no concerns, what difference does it make whether I'm faking it or not? Wouldn't that kind of faking be an adequate self-management skill all by itself?"

So I got to register for year two, although my interest in that particular school had dissipated substantially.

I'm pretty sure I'm perfectly healthy, but you might be Internet pals with a deeply troubled person who is the world's best normalcy-faker. Not sure how to word that on my résumé, though.
posted by Pater Aletheias at 12:29 PM on July 9, 2013 [20 favorites]


Mental Wimp: "I'm a lot more interested in the question of how easy it is to fake normal.

Easy. Been doing it my whole life.
"

Yeah, I'm always amazed that people can look at me and not see the cracks. (One of the more baffling things I've been told was from a coworker I admitted my depression to. She looked confused, "But you're so cheerful!")
posted by Karmakaze at 12:30 PM on July 9, 2013 [5 favorites]


One of the more baffling things I've been told was from a coworker I admitted my depression to. She looked confused, "But you're so cheerful!"

Speaking as someone diagnosed with (and treated for) both ADHD and depression, I have to explain to people that they're confusing a coping mechanism (or a side effect) with actual mental health. Lots of depressives are funny, outgoing people. We've learned to be so, if only as a defensive mechanism. Or if they minimize the condition. "SOmetimes I get sad too!" There's a difference between feeling depressed and constantly BEING depressed. It's the difference between a sprained ankle and having no foot. Both are indicated by limping, but one of 'em is permanent.

Same with my ADHD. "How can you be ADHD? You're always so big on staying focused!" Yeah, because I *have* to -- staying focused takes meds, counseling, and a strong conscious effort, unlike those folks without this condition. "Sometimes I space out, too!" Yeah, well, there's a difference between occasional spacing out and constantly being unable to dictate when and where I focus normally.

Very little of this stuff is what it seems on the surface.
posted by grubi at 12:42 PM on July 9, 2013 [2 favorites]


once you're in, no one trusts a word that comes out of your mouth, particularly after they've started force-medicating you with sedatives.

Go on.
posted by Twang at 1:13 PM on July 9, 2013 [1 favorite]


murphy slaw: "I speak from experience when I say getting treatment for mental illness involves wrestling with bureaucracy at best and is demeaning and dehumanizing at worst. Why would anyone do it if they didn't genuinely need help?"

And this is tantamount to torture. It can often be difficult to convince people who clearly need help to even consider that it might be necessary. (convince isn't really the right word, but it's the best I can do right now) Combine this with the fact that many illnesses make it nearly impossible to develop the motivation to navigate all the roadblocks and very few people who need help end up getting it.

It's almost so bad I would say that people who manage to get to the point of getting treatment (other than a "go away" script from a GP, anyway) have proven they don't actually need it. It's not actually that bad, but sometimes it seems close.
posted by wierdo at 1:36 PM on July 9, 2013


Since I saw the episode 'Tweedledum' from the TV series Colditz as a 10 year old, this whole setup still haunts me at times. I found the episode online, but I'm not sure if I'm going to watch it again.
posted by ouke at 1:37 PM on July 9, 2013 [1 favorite]


Mental health versus disorder is a challenge the differentiate; had an interesting conversation recently with someone whose depression is being successfully treated - the issue came up that he thought he might no longer have the diagnosis of depression (it's REALLY successfully being treated) and I pointed out that it was being treated, it hadn't disappeared. If the treatment stopped, the depression would very likely re-occur, which isn't a cure, it's a treatment.

One problem is we don't differentiate mental illness like we do other illness. A cold is different from the flu is different from diabetes is different from cancer, both in how they are treated, the intensity of treatment, and how "cure" is defined, but people try to teach mental illness as if it were all the same thing instead of a clustering of very diverse disorders which have the added bonus of many of them being responses to the environment the person is in.
posted by Deoridhe at 1:55 PM on July 9, 2013


Since I saw the episode 'Tweedledum' from the TV series Colditz as a 10 year old, this whole setup still haunts me at times. I found the episode online , but I'm not sure if I'm going to watch it again.
posted by ouke at 9:37 PM on July 9


Came to post about this. Glad someone else remembers it, because it had a big effect on me too, when I saw it as a child. I certainly will watch it again.
posted by Decani at 3:09 PM on July 9, 2013


I have a friend who, tragically, believes that he is faking his mental illness and that he is going to get caught and go to jail. He says he is constantly being followed by black helicopters and government agents, and that he was implanted with top secret technology that controls his mind. He claims he talked his way into a psychiatric ward in order to hide from the government and get a few weeks break from the stress of being followed everywhere, but now feels guilty for "faking" it, and is scared the secret agents on his tail are going to use evidence of him faking mental illness in order to send him to prison for fraud.

Listening to him talk about it, the irony makes me want to cry.
posted by lollusc at 1:33 AM on July 10, 2013 [1 favorite]


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