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Malingering and illness deception
  1. S Fleminger

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    Edited by Peter Halligan, Christopher Bass, David Oakley. Published by Oxford University Press, Oxford, 2003, £35.00, pp 362. ISBN 0-19-851554-5

    This excellent book gets off to a cracking start. The introductory chapter by the editors lays out the evidence that many of our patients may be deceiving us, and that much of this deception may be conscious. We are introduced to several major themes of the book, including the debate as to whether or not malingering should be identified as a psychiatric disorder, a disorder of free will, or simple criminal behaviour. What is one to make of the evidence of high rates of fraud within society? We are introduced to the difficulty of detecting deception and therefore the problem of known unknowns—everybody finds it difficult to answer the question “how many times have you failed to detect a lie?” Simon Wessely then takes us on a delightful tour of the history of malingering—perhaps it all stems from legislation passed in Imperial Germany in the late 1800s!

    This book consists of a fascinating collection of essays covering an enormous breadth of animal and human study. The editors seem content to let the authors express their own views; the views expressed in one chapter may be contrary to those expressed elsewhere in the book. This is a strength—we see the matter being debated by specialists with very different backgrounds. Chapters include: “Can monkeys malinger?”; “Law, lies and videotape: malingering as legal phenomenon”; “The misadventures of wanderers and victims of trauma”; and “The contemporary cultural context for deception and malingering in Britain.”

    The chapters written by the lawyers came out pretty well—they were clear thinking and pragmatic. On the other hand, the occasional chapter seemed to be over-concerned about dissecting out the minutiae of differences between various “models” that needed to be considered. For example, in the chapter on illness deception in disability assessment a range of conceptual models is considered ending up perhaps unsurprisingly with a biopsychosocial model. I was not convinced that this got very far in helping the physician tasked with weeding out those who were claiming insurance fraudulently.

    So, having read this book are we going to be any better at detecting malingerers? I suspect not despite guidance offered in the final chapter on ways to detect deceit by analysis of vocal and non-vocal characteristics. I suspect that most sensible doctors will continue to accept that they don’t know whether or not they are being duped. In the mean time, if they have read this book they will, however, have been entertained and educated.