Pretending To Be Sick: The Signature Diagnosis Of Psychiatry
Submitted by Rick Giombetti:Last week I was involved in a healthy subject clinical drug study that required us test rats to undergo a couple of invasive procedures for 48 consecutive hours. One of the procedures was to have an IV inserted into a vein in one of our arms. This was for the purpose of injecting the drug into us intravenously. The other invasive procedure was the most discomforting I have experienced in my career of selling my body to medical science. We were required to have a small nose tube inserted down our noses and into our stomachs for the purpose of having a PH probe monitoring our PH levels in our stomachs. This is why the study paid us $250 for each overnight stay we did, which were four, or $1,000. It was the highest paying study for me in terms of the value of an overnight stay (My highest overall was worth $2450).
We had the nose tubes inserted into us the morning after I our first over night stay. My tube ended up staying in for eleven hours that day. This insertion of the tube was used as kind of a test run for the PH monitors we would be using for 48 straight hours and give us the option of withdrawing from the study if we decided we didn't want to endure it. One of the study subjects, a talkative and loud middle aged man told me the night before the insertion of the nose tube for 2 straight days that he didn't want to go through with it. He was going to sleep over for an additional $250 and withdraw himself. It was with little surprise that I observed this particular subject withdrawing from the study by claiming that he "had a headache." He was pretending he was sick.
Why did the subject withdraw himself from the study in this manner, especially since it is made clear to us that we can withdraw from a study at any time and for any reason? Why didn't he just say, "I'm dreading the thought of having that awful nose tube inserted down my nose again for two straight days and I don't want to do it"? Saying you "have a headache" is one of the most common cop outs I've heard for people not wanting to go to school or go work on a particular day. It's a socially acceptable way for an individual to excuse him/herself from an activity or situation he/she seeks to avoid.
The issue of the headache is a point of contention a psychiatrist I correspond with, who happens to think psychiatric diagnosis is a lot of bunk, has raised regarding the issue of what exactly a disease is. My psychiatrist pen pal points out to me that things we regard as real medical problems, like epilepsy and headaches, present no known physical abnormalities in a patient's brain. This is her rebuttal to the "no physical abnormality, no disease," argument put forward by retired child neurologist Fred Baughman.
Fair enough. Perhaps we don't necessarily need a demonstrable lesion or other physical abnormality for somebody to be sick, but we do need somebody to at least be complaining of some kind of physical discomfort in order for the person to be considered sick. That said, we all know that people can pretend to be sick, whether they "have a headache" or fake seizures, and that they do it for a variety of reasons. This is where psychiatry steps into the picture and helps muddy things up, as it always does. What does a psychiatrist see when they see a person pretending to be sick? The answer to this question demonstrates what distinguishes psychiatry from the rest of medicine.
According to the American Psychiatric Association's (APA) Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision (DSM-IV-TR), there are two forms of pretending to be sick: Factitious Disorder and Malingering. On page 513 of the DSM-IV-TR, "Factitious Disorders are characterized by physical or psychological symptoms that are intentionally produced or feigned in order to assume the sick role." Also, "Factitious Disorders are distinguished from acts of Malingering. In Malingering, the individual also produces symptoms intentionally, but has a goal that is obviously recognizable when the environmental circumstances are known. For example, the intentional production of symptoms to avoid jury duty, standing trial, or conscription into the military would be classified as Malingering." The malingerer could also be attempting to achieve a financial goal, like obtaining an insurance payout of some kind. Finally, "Malingering may be considered to be adaptive under certain circumstances (e.g., in hostage situations), but by definition a diagnosis of a Factitious Disorder always implies psychopathology (Author's emphasis)."
In other words, the test subject I described above is "sick" according to the APA, even though he clearly is not sick. The actions and words of a person are what determines his/her diagnosis, not any physical symptoms or abnormalities. This is what distinguishes psychiatry from other medical specialties, and makes the case that psychiatry shouldn't be considered a medical specialty. While psychiatric evangelists, like E. Fuller Torrey, author of "The Invisible Plague," and their fellow intellectual travelers, like Edward Shorter at the University of Toronto, author of "A History of Psychiatry," argue the signature diagnosis of psychiatry is schizophrenia, the reality is pretending to be sick is.
Indeed, when the jig appears to be up and psychiatrists are being exposed publicly as the quacks they are, they can always be counted on to pull the schizophrenia diagnosis out of their magic hats and use it to claim they are real doctors. This phenomenon inspired Thomas Szasz to write a book on the subject titled "Schizophrenia: The Sacred Symbol of Psychiatry," which was published in 1976. Szasz wrote the book at a time when the psychiatric enterprise was experiencing a period of intense public criticisms of its practices, and he noted at the time how psychiatrists were reflexively defending their professional turf by pointing to the schizophrenia diagnosis.
Of course, the reality is that the schizophrenia diagnosis revolves around diagnosis on the basis of a person's actions and words, such as erroneous beliefs, "delusion," and claiming to hear the voices of others, "hallucinations," just like with pretending to be sick. A homeless man holding a sign protesting his eviction from his apartment, and claiming he is Jesus, at the corner of Sixth and Pine in downtown Seattle isn't any sicker than a malingerer, because he protests in a manner that polite Seattle society disagrees with. I am not speaking of an imaginary person, but Cuban immigrant Juan, my favorite street protester of all time. And, yes, I admit I am a "Devil Communist," as Juan would no doubt accuse me.
Next time you hear somebody excusing him/herself from an activity they don't want to partake in, and you're sure he/she is faking it, remember you are observing the signature diagnosis of psychiatry in action.
