Person Under Investigation: Detecting Malingering and a Diagnostics of Suspicion in Fin-de-Siècle Britain

Author:

Krishnan Lakshmi

Abstract

AbstractIn 1889, The British Medical Journal published a piece titled, “Detective Medicine,” which describes feats of medical detection performed by physicians attending malingering prisoners. Though simulating illness had a long history, the medicalization of malingering at the fin de siècle led to a proliferation of such case histories and cheerful records of pathological feigners thwarted.

Publisher

Cambridge University Press (CUP)

Subject

Health Policy,General Medicine,Issues, ethics and legal aspects

Reference69 articles.

1. 7. There is a continuous thread through the late nineteenth-century to early twenty-first century diagnostic literature, concentrated around particular entities: occupational injury, disability and social security assessments, military medicine, traumatic brain injury, neuropsychiatric disorders, pain, forensic trauma, post-traumatic stress disorder, and illness deception (malingering/factitious disorder/Munchhausen's Syndrome) itself. Yet little has been written specifically about the epistemologies of malingering detection and diagnostic reasoning more generally, physician professionalization/identity formation, and medico-disciplinary power. The late twentieth-century and early twenty-first century clinical database reflects the empirical impulse, with a growing number of validated instruments and quantification tools: see Young, G. , "Toward a Gold Standard in Malingering and Related Determinations," in Malingering, Feigning, and Response Bias in Psychiatric/Psychological Injury (Dordrecht: Springer, 2014): 53-87

2. R. Rogers, et al., "Standardized Assessment of Malingering: Validation of the Structured Interview of Reported Symptoms," Psychological Assessment: A Journal of Consulting and Clinical Psychology 3, no. 1 (1991): 89. Secondary literature reveals a tension between sociolegal and biomedical analyses of malingering. For example, in their introduction to Malingering as Illness Deception (Oxford, 2003): 3-31, Peter Halligan, Christopher Bass, and David Oakley contest the prominent role that medicine and the biomedical model continue to play in "shaping and defining current discussions of illness deception," as this facilitates a merging of the "language of medicine" and the "language of morality." They reframe illness deception as a "volitional act" that can be conceptualized within a sociolegal framework, rather than a deterministic disease model, therefore foregrounding the human capacity for free will. Though their intervention attempts to free "illness deception" from its diagnostic and clinical moorings and physicians from their roles as gatekeepers, embedding malingering further in sociolegal and social responsibility frameworks still yokes the detection of malingering to morality. Though there is a small body of ethics scholarship addressing the clinician's duties in cases of suspected malingering (via a bioethics/informed consent framework, cf. P. J. Candilis, "Ethics, Malingering, and a Lie-Detector at the Bedside," Journal of Forensic Science 43, no. 3 (1998): 609-612

3. J. D. Seward and D. J. Connor, "Ethical Issues in Assigning (or Withholding) a Diagnosis of Malingering," Neuropsychology of Malingering Casebook (New York: Psychology Press, 2008): 535-547, the necessary critique frequently comes from the humanities and social sciences, including C. E. Rosenberg, "The Tyranny of Diagnosis: Specific Entities and Individual Experience," The Milbank Quarterly 80, no. 2 (2002): 237-260 and L. Grubbs, "Lauren Slater and the Experts: Malingering, Masquerade, and the Disciplinary Control of Diagnosis," Literature and Medicine 33, no. 1 (2015): 23-51, and Ian Hacking's discussion in Mad Travelers (Cambridge: Harvard, 1998) on the politics of assigning diagnoses (distinguishing between hysteria and epilepsy in Charcot's time). Clearly the health humanities has something to say about this intersection of medical jurisprudence, diagnosis, power, and critique.

4. The Principles and Practice of Narrative Medicine

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