The natural concern of doctors for those who suffer has its downside. When they cannot distinguish fake from fact or self-defeating from resolvable conduct, empathy governs their reason. Objective criteria should guide diagnosis. Doctors (and judges for that matter) distinguish exaggerated, imagined and false complaint from the genuine at no better than chance level. We fail equally at recognising deceit. Only those who have learned from their own success at faking do better at picking another faker. But few let facts deter belief. Unjustified confidence leads whole societies into error. Sympathy for the self-dubbed victim costs society a great deal in epidemics of pseudo-illnesss such as RSI, chemical sensitivity, sick building syndrome, video screen sickness, chronic PTSD, fibromyalgia and a host of other chronic pain syndromes without definable cause (see post Iatrogenic Pain and for details see the Resource “Pain”).

Although each pseudo-illness has its day and passes, on any one day every western community hosts a number of them in epidemic proportions. All involved, helpers, complainers and their gullible audience, put aside the common sense perspective of reality. Given a scale of suffering, the person in victim mode sets it at the extreme well, above the settings chosen by sufferers of major illness such as paraplegia or terminal cancer. And they get away with it. Not just the doctors who support their claims, but the courts which award them compensation accept the implausible. Communities could afford modern medicine far better were its gatekeepers, doctors and the courts, not also the naive promoters of pseudo-illnesses. Accepting exaggerated or imagined complaints at their face value gives simulators the opportunity to manipulate us, not necessarily to their benefit. It encourages them to take their flight into illness rather than work for resilience. Few who retreat into the sick role obtain satisfaction even when it brings them a bag of money. Those who view themselves as victims nourish bitter blame and resentment. They make their own misery.