Vedika Puri
In ‘The Sinner’, Cora Tannetti, fatally stabbed a man during a family outing but received a reduced sentence and a transfer to a psychiatric facility due to extreme emotional disturbance. In ‘One Flew Over the Cuckoo’s Nest’, Randle McMurphy, guilty of battery, gambling and statutory rape is transferred to a mental institution on the basis of insanity. What sets them apart is that one is feigning psychological symptoms and the other is not.
The DSM-5 defines malingering as the “intentional production of false or grossly exaggerated physical or psychological symptoms motivated by external incentives such as avoiding military duty, avoiding work, obtaining financial compensation, evading criminal prosecution, or obtaining drugs.” (Carr 2015)
The assessment and identification of malingering is a pervading problem as it highly likely for some patients to successfully feign mental disorders and other genuine patients to be incorrectly identified as malingerers. That is why, malingering needs to be assessed carefully and sensitively as the situation can quickly escalate and lead to backlash.
Therefore, the assessment of malingering is a long process that starts with a thorough clinical interview and behavioral observations. A clinical interview is useful in gaining information about the client’s psychiatric history, developmental issues, medical conditions, substance abuse history, education and employment background, family and interpersonal relationships, spiritual and cultural background, legal history, and much more (Carr 2015). Asking open-ended questions, reviewing collateral information, and conducting long discussions help find inconsistencies during interviews. Simultaneously, the behavior of the client in front of the clinician, their interaction with other patients and the description of their own condition can reveal many observed inconsistencies. The clinician should specifically look out for any rare symptoms, unlikely symptom combinations, overplayed improbable symptoms, and extreme symptom severity that the client describes (Scott 2016).
The great amount of information gathered from interviews and behavioral observations cannot be used in legal situations because of their subjective nature and the possibility of the clinician’s biases. That is why, objective psychometric measures are used for further assessing psychiatric malingering (Carr 2015).
Therefore, the second step in the process of malingering assessment is the use of malingering-specific self-report screenings. M-Test, Structured Inventory of Malingered Symptomatology (SIMS), Miller Forensic Assessment of Symptoms Test (M-FAST) and Assessment of Depression Inventory (ADI) are some screenings that are valid and reliable and can be used for the detection of malingering. Before deciding which screener to give, the clinician must consider the symptoms presented, the setting in which the test would be conducted and the method of administration. Most of these screening measurements can be completed within 15 minutes and are very useful in helping a clinician decide whether further assessment of malingering needs to be conducted or not (Duffy 2011).
The third step in the malingering assessment process is using comprehensive psychometric tests for the successful and accurate identification of malingerers. The Personality Assessment Inventory (PAI), Minnesota Multiphasic Personality Inventory-2 (MMPI-2), and Structured Interview of Reported Symptoms (SIRS-2) are some intensive tests that can be used. Amongst these, the personality tests have several validity scales that can help in detecting whether a client is presenting a genuine or a false image of himself/herself, while the SIRS is a specialized structured interview designed particularly to detect malingering (Duffy 2011). SIRS is a valid, reliable and the most widely used assessment for the detection of feigned psychological symptoms. Often described as the “gold standard” in psychiatric malingering assessment, SIRS is a 172-item interview with eight primary and five supplementary scales that categorizes clients into Genuine Responding, Probable and Definite malingerers (Carr 2015).
All of these tests have their own strengths and weaknesses and overall help in identifying malingerers. Despite this, these tests cannot identify the external gains that are leading the patients to malinger and so the complex process of malingering often remains incomplete (Carr 2015). That is why; the clinician has to consider all explanations of a patient’s test results and behavior so as to avoid an incorrect accusation. Sometimes, due to a lack of evidence of secondary gain, malingering can go undetected and present its own negative consequences. Denial of treatment, disrupted therapeutic relationship, legal sanctions and stigmatizations are all problems that come with malingering (Duffy 2011).
Therefore, although much research has gone in assessing malingering, issues such as when and how to initiate a malingering assessment, accounting for cultural differences on malingering and how to differentiate between malingering and other deception-centered conditions remain unresolved. Inspite of there being many such topics to be explored, the existing research on the tools of assessment and identification of malingering should be properly utilized so as to avoid any personal and societal repercussions.
Works Cited
Carr, C. M. K. (2015, September). TheScholarsRepository@LLU: Digital Archive of Research, Scholarship & Creative Works. Retrieved October 1, 2019, from https://scholarsrepository.llu.edu/cgi/viewcontent.cgi?article=1234&context=etd.
Duffy, S. (2011). Semantic Scholar. Retrieved October 3, 2019, from https://pdfs.semanticscholar.org/c438/83edb8c320bcc9d28b4b2d4012d3e163de37.pdf.
Iii, H. W. L. (2007, April 15). Malingering: Key Points in Assessment. Retrieved October 2, 2019, from https://www.psychiatrictimes.com/forensic-psychiatry/malingering-key-points-assessment.
NBCUniversal Television Distribution. (2017). The Sinner.
Scott, C. L. (2016, March 16). fmhac. Retrieved October 3, 2019, from https://www.fmhac.org/uploads/1/2/3/9/123913996/scott_malingering_handout.pdf.
Tylicki, J. L. (2016). Retrieved from https://pdfs.semanticscholar.org/e96c/0f96411639d670eacfcb3b3a4b5ba11437dc.pdf
United Artists. (1975). One Flew Over the Cuckoo's Nest.
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