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Concept
Malingering
Summary
Malingering is the fabrication, feigning, or exaggeration of physical or psychological symptoms designed to achieve a desired outcome, such as relief from duty or work, avoiding arrest, receiving medication, and mitigating prison sentencing.
Although malingering is not a medical diagnosis, it may be recorded as a "focus of clinical attention" or a "reason for contact with health services". It is coded by both the ICD-10 and DSM-5. The intent of malingerers vary. For example, the homeless may fake a mental illness to gain hospital admission. Impacts of failure to detect malingering are extensive, impacting insurance industries, healthcare systems, public safety, and veterans’ disability benefits. Malingered behaviour typically ends as soon as the external goal is obtained.
Malingering is established as separate from similar forms of excessive illness behaviour, such as somatization disorder, wherein symptoms are not deliberately falsified. Another disorder is factitious disorder, which lacks a desire for secondary, external gain. Both of these are recognised as diagnosable by the DSM-5. However, not all medical professionals are in agreement with these distinctions.
According to 1 Samuel in the Old Testament, King David feigned madness to Achish, the king of the Philistines. Some scholars believe this was not feigned but real epilepsy, and phrasing in the Septuagint supports that position.
Odysseus was said to have feigned insanity to avoid participating in the Trojan War.
Malingering was recorded in Roman times by the physician Galen, who reported two cases: one patient simulated colic to avoid a public meeting, and another feigned an injured knee to avoid accompanying his master on a long journey.
In 1595, a treatise on feigned diseases was published in Milan by Giambattista Silvatico.
Various phases of malingering (les gueux contrefaits) are represented in the etchings and engravings of Jacques Callot (1592–1635).
In his Elizabethan-era social-climbing manual, George Puttenham recommends a would-be courtier to have "sickness in his sleeve, thereby to shake off other importunities of greater consequence".
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