In this blog the Resource entitled Simulation of Illness addresses the most common hazard to diagnosis, the faking of complaint. In hysteria and malingering the simulation of complaints give the false impression of illness. A succesful fake brings gain. The malingerer fakes deliberately, but in a manner that usually makes detection impossible. If detected, the gain sought becomes obvious. The hysteric produces complaints that are readily recognised by the alert skilled expert, but in a manner that conceals the motivation and the gain being sought. Although both states are “all in the mind”, the malingerer rarely reveals his thoughts and the hysteric rarely has enough insight. Consequently persisting doubt attends either diagnosis and a full understanding is rarely attained.
The immense range of possible complaints gives simulation an unlimited potential for variety, but at any particular time fashion sets the common presentation. A number of the posts touch on recent fashions (pseudo-illnesses in Fostering Victim Mentality and What is the Loony Bin?, Iatrogenic pain, and the panic state due to hyperventilation). The medical focus on complaint such as pain invokes the fatal flaw of descriptive diagnosis (see the Elephantanopia series). Reasoning based on the effect cannot reliably identify the cause of illness. The simulation of illness creates an enormous burden on the community, inflating the cost of social services, wasting valuable court time and imposing so much unnecessary effort on health services that its prevention would bring their budgets back to the tolerable. No less importantly, for every person saved from the temptation of simulation for gain comes emotional relief for their families and in the long run a better life for themselves. Malingerers, hysterics and victims of epidemic pseudo-illness do not feature among the successful or happy members of the community.