“Can You Fake Mental Illness?”

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The Story

“Can You Fake Mental Illness?”
http://www.slate.com/articles/health_and_science/science/2012/08/faking_insanity_forensic_psychologists_detect_signs_of_malingering_.html
by Douglas Starr
Slate, August 7, 2012

The Pitch

Dear Laura,

With the receipt of James Holmses’s notebook at the University of Colorado detailing his plans for a mass execution and reports of his strange behavior in prison, people have begun speculating whether he is mentally ill or simply laying the groundwork for an insanity defense. Such conjecture often takes place when someone commits a horrific, inexplicable crime. It leads to the question – can a criminal get away with faking insanity?

Experts have been debating that question since the creation of insanity defense in the mid-19th century. Criminals of the era would do anything to avoid the noose or the guillotine, and would fake symptoms from the then-emerging field of psychology. Over the years a rich literature grew, as criminal psychologists wrote case histories and studies on how detect those “malingerers.” Most techniques relied on the investigators’ experience and powers of observation — looking for inconstancies in symptoms, waiting until the suspect grew tired of the game, or simply catching a telltale look in his eye. As the Austrian criminologist Hans Gross wrote: “The shammer, when he thinks no one is looking, casts a swift and scrutinizing glance on the Investigating Officer to see whether or not he believes him.”

Today’s forensic psychologists equally worry about malingering. Of the roughly 60,000 Competency to Stand Trial referrals every year, anywhere from 10% to 17% are found to be faking it. Today’s experts, like their forbearers, observe the suspects with a practiced clinical eye to see if the symptoms match those of well-studied pathologies and if the symptoms remain consistent over time. They also use a battery of vetted psychological tests. One, called M-FAST, poses a series of 25 questions and gives a numerical score to the suspect’s sense of reality. A skilled psychologist using this test can make a preliminary assessment in less than 15 minutes. Other exams involve highly structured interviews that produce additional scores for the subject’s memory and claims of psychosis.

Those tests, combined with the psychologists’ abilities to categorize symptoms, have produced an enviable track record in screening malingerers. Yet a master-faker will occasionally pass through. For decades the mafia chieftain Vincent Gigante, dubbed “Oddfather” by the New York press, shuffled about Little Italy in his pajamas, slobbering and muttering in order to show he was mentally incompetent. During his trial in 1997 he fooled half a dozen leading psychologists – even Richard Rogers, who wrote the definitive textbook on malingering. It wasn’t until 2003 when officials who tapped his phone heard him speaking quite coherently to his wife, that Gigante admitted it had all been an sham. That, as well as other anecdotes and information, could make a fascinating article about the phenomenon of malingering and its detection.

My credentials: I’m co-director of the graduate program in Science Journalism at Boston University and a veteran journalist specializing in science and science policy, especially in regards to the legal system. I’ve published two award-winning books with Knopf, the most recent of which explores the birth of forensics and criminology. My articles and commentaries have appeared in a variety of media, including The New Republic, Wired, Science, Smithsonian, Public Television, National Public Radio, The Los Angeles Times, and the Boston Sunday Globe Magazine. (For more information see: douglasstarr.com/bio.)

Would your readers be interested? Regards,
Doug Starr

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