You can “malinger” — fake — virtually any mental disorder, because mental illness is defined by symptom lists that are self-reported. That is, you tell the doctor or therapist the symptoms you’re experiencing, and they simply go down the list and figure out which disorder the symptoms best fit into. Since the symptoms are self-reported, you can easily make up the symptoms to qualify for whatever diagnosis you want.
In medicine, things are a bit different. Although doctors might use your self-reported symptoms as a starting point on how to diagnose the medical problem you present with, they can usually followup by ordering a series of laboratory tests to confirm their diagnosis. There is no equivalent for mental health concerns (although there are many paper-and-pencil psychological tests have very good validity when it comes to differential diagnoses; these, however, are rarely used in daily practice).
So when I come across an article like this Associated Press one — talking about how some soldiers may be faking post-traumatic stress syndrome (PTSD) in order to gain benefits — it makes me cringe a little.
Are there people who try and game the system? Sure, there will always be such people. But they exist in any population. The real questions to be asked by such an article should be: Are more doing it now than before? If so, why? And what can be done to stop it?
No one knows the full extent of PTSD fraud. But there have been some hints.
A 1990 law allows the Veterans Benefits Administration to crosscheck its rosters with federal tax and Social Security databases to find “unemployable” veterans reporting work-related income. In 2004, this program identified 8,846 such veterans who reported at least $6,000 in earnings, including 289 with income of $50,000 or more.
Hints are nice, but data are even better. Are these people “unemployable” because of physical disability, or mental disability? An important distinction, given this article is apparently about how “easy” it is to fake PTSD. The article doesn’t say.
This sounds more like an accounting oversight issue than anything else — How come the government isn’t asking these 8,846 veterans about this income and how it was earned when they were supposedly “unemployable”? That’s the real question and the only answer is “lack of resources and personnel to do so.” Right. We have resources to track down tax cheats, so why not these folks?
The article is surprisingly pretty thin on any actual research data, but full of those juicy anecdotes that make for good story-telling. We love a good story as much as the next person, but when it comes to implicating an entire population — U.S. soldiers who serve their country — we’d like to see a little more hard data and a little less of those juicy stories that make it sound like this is an out-of-control problem amongst veterans.
Already, VA officials are legally bound to resolve “any reasonable doubt” in the veteran’s favor. And Rogers, the retired claims specialist, and others say the system is vulnerable to fraud because of the way it was designed: Doctors make diagnoses without fact-checking the veteran’s story, and once that diagnosis is made, claims raters’ hands are essentially tied.
Since when did a doctor become an investigator, responsible for fact-checking a soldier’s story? That hardly seems an appropriate responsibility for a doctor in the VA system. It also seems silly that when evidence shows the soldier to be lying, nothing can be done. A dishonorable soldier who has no trouble lying would seem to be one you wouldn’t want to be honoring with unearned income.
The system is clearly broken. But this article does little to help us understand this problem in context. Out of the 1.6 million troops who served, we’re talking about a known 8,846 problem individuals — or 0.55 percent. Is this an epidemic? Who knows, again, the article gives little clue as to whether these are numbers are cause for serious concern or not.
Malingering is hard to detect, even by well-trained professionals. Malingering is always going to be an issue when you tie a monetary reward to a specific diagnosis. If you disconnect the direct monetary incentive from the diagnosis, I suspect you’ll find far less malingering going on. And there needs to be an intermediary step of fact-checking in there, as well as serious repercussions for lying about one’s symptoms.
Read the full article: In tide of new PTSD cases, fear of growing fraud