Simulated Insanity
Apr 7th, 2008 by admin
In this chapter, Ray talks about the concept of simulating mental illness to avoid legal consequences.
The workings of an insane mind — such as attract the popular notice — are apparently so confused and discordant, so wild and unnatural, as to have given rise to the notion as prevalent as it is unfounded that insanity may be easily imitated.
He goes on to note: (more after the jump)
The grand fault committed by impostors is tat, in their anxiety to produce an imitation that shall deceive, they overdo the character and present nothing but a clumsy caricature. […] The really mad are, generally speaking, not readily recognized as such by a stranger, and they retain so much of the rational as to require an effort to detect the impairment of their faculties. In feigned cases all this is very different; the person is determined that his derangement shall not be overlooked for want of numerous and obvious manifestations of its existence.
He states that one of the most over-acted impairments is that of memory. Ray observes that a person attempting to feign mental illness is far more likely to assert that they do not remember people, places, and events (particularly those salient to a trial) than an individual with an illness.
I’m not sure how further research has changed the understanding of consistency from Ray’s time. Ray states that consistency of delusional ideas is also a hallmark of malingering. This point seems potentially contentious. The overall character of the discussion, however, is that although some points are more suspicious than others the whole is greater than the sum of the parts. That is, the whole mental status exam is important for the pattern. Forgetting friends and family while being able to perform more advanced cognitive tasks easily is not in and of itself conclusive, but it’s certainly very suspicious. Another key point is a good history and good collateral information. Symptoms that begin only after incarceration are, of course, highly predictive of malingering.
Ray also goes on to describe suspicion of wrongdoing by friends and family as more characteristic of true illness, while those who harbor suspicions about a person with whom they had a prior disagreement are more likely malingering. That is, if the crime has a rational motive and clear gain then that is more likely the product of a sound mind. Also noted is the impossibility of imitating the insomnia of a true manic episode; a person who is unfatigued after more than 72 hours of exertion has a very high probability of true mental illness. The converse is not as compelling, as an absence of insomnia provides far less information.
While there’s plenty more in there, perhaps that’s enough to start a discussion.