A PROBLEMATICAL CASE

Abstract

The simulation of mental disease is rare, but cases of suspected or alleged malingering are met with, especially in medico-legal work associated with capital crimes. It is a rather common fallacy among the laity and the general medical profession that feigned insanity is of fairly frequent occurrence. Actual instances, however, are unusual and some psychiatrists may never see a single case. The difficulties of simulation, alone, would seem to preclude, in most cases, the possibility of malingering. One will readily admit that neurotic symptoms may be assumed, those of a subjective nature, the evidence of existence of which depends largely upon the statement of the patient. Even such instances are less frequent than commonly believed. Single symptoms may be simulated or exaggerated, in the traumatic neuroses existing physical abnormalities may be falsely ascribed to the injury, suggestible hysterical individuals may imitate others and, as found in military life, a mentally diseased person may endeavor to simulate recovery in order to resume active duty. Insanity, however, as a prolonged departure from the patient’s usual mode of thinking, acting and feeling is quite a different proposition. When the intensity of the excitement, the unceasing, restless activity, the prolonged period of sleeplessness and other characteristic signs of a manic condition, the deep and lasting depression with the diagnostic facies of a depressed state, the mannerisms, absolute change of personality, emotional deterioration or fixed delusions of a pr2ecox, or the physical evidences of an organic condition, are considered, it seems doubtful that any of these could even be momentarily assumed without prompt detection by experienced psychiatrists. Among the so-called prison psychoses, however, there are certain reactive disturbances of which the mode of onset, the symp-