Malingering At Its Finest

Malingering And Substance Abuse

Psychiatric patients who malinger do not necessarily have any psychiatric issues to begin with. Often times, they have a history of antisocial behavior such as criminality, spending time in the prison system, homelessness and getting involved with heavy substance use. They may have a history of psychiatric-like features, but even then, they’re often secondary to substance abuse or malingering for the sake of secondary gain.

What is secondary gain? This is when a malingerer wants to obtain something of personal interest, such as spending time in the hospital in order to avoid upcoming court dates. Malingerers are street smart; they know what to say and how to act in the emergency room in order to earn themselves a night or two in the hospital.

The problem with malingerers is that if they tell a psychiatrist in the emergency room that if they do no get admitted, they will cut their throat, jump off the bridge or OD on substances, it puts the psychiatrist in a corner; this corner often leads to the psychiatrist admitting the patient for the sake of the patient’s life.

Even though you may suspect someone to be a malingerer does not mean that the person won’t actually try to kill themselves. For instance, if as a psychiatrist you decide not to admit the malingerer to the hospital and they go and jump in front of a train, there can be potential liability if their family pursues a legal investigation.

That’s because anyone that actually shows up to an emergency room and talks about depression and suicidal ideations is already in a state of mind that is not considered normal. Unfortunately, you have people who abuse the system such as those who are homeless and want a bed to sleep and food to eat when it’s 10 degrees outside.

It’s very difficult as a psychiatrist to accept or deny malingerers into a hospital. Accepting them is difficult because you suspect that they are playing you for a fool, but you also don’t want to take a chance with legal liabilities and them actually harming themselves. Denying them is also difficult because you are now taking a chance that they won’t actually kill themselves.

Believe it or not, even after a malingerer obtains a hospital admission, they may decide to cut their hospitalization short due to getting annoyed over something such as “cold food.” So even though they have a place to sleep, food, psychiatric medications and round the clock care and comfort, they may ask for a discharge the very next day for reasons not even worth further mentioning.

Unfortunately, malingerers are part of the healthcare system and they have to be dealt with. But even for them I feel bad because at the end of the day we are all human beings!

Are you Ready? (This is Defeating Stigma Mindfully)


4 Replies to “Malingering At Its Finest”

  1. Hence the whole though shall not judge unless you can clearly prove whatever.

    Some people have whatever mental issues and/or other outside issues which cause them to seek assistance from various sources.

    Same with addiction in allot of cases, when they are younger I am all for pushing more don’t do these substances approach but once they are past a certain age?

    It’s actually better to just give them enough to live and get high in whatever safe space while monitored like pets in a zoo.

    They might even slow down and change themselves after many stressors are eliminated which yes including the big one, the need for more drugs and alcohol plus how to get that money etc etc which then branches into whatever routes from legal options to illegal ones.

    You wanna help people but you also wanna maintain order and like society has learned after dealing with me for many years?

    It costs them more having me do criminal acts and paying police plus government to track and find, let alone charge me, let alone jail me, that’s already like 100K in the first year which is then 67+K for each year in jail compared to just handing someone a basic income supplement of say like 16k per year plus making a deal on housing/apartment.

    Even many cops are getting tired of it these days because while they are being called out to chase some guy who stole 50 bucks from an atm for cocaine?

    Real crimes like rape and murder are happening and/or not being focused on in terms of cases piling up.

    Society needs to really rethink the whole situation and pick their battles better.

    Generations in the future may be all healthy and no drunks and junkies let alone criminals but you have to let the present ones who are past the points of no return just die off peacefully in whatever ways.

    Not to mention they can still be valuable to society in other ways via being studied and used as examples to prevent others from falling into the holes we fell in, have them create art and write stories since they are already high and in creative mode anyways many times.

    Like that white stripes song rag and bone, we can still use them, we can make something out of them…

    It just goes against many of the traditional things many are taught in society which will ultimately be the hardest hurdle.

    “Rewiring their brains” to not be all reefer madness scared of us.

    Liked by 1 person

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