Politcal correctness gone awry

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Creating and fostering an environment of free speech, free thought and tolerance for varying points of view is presumed to be a tangible construct, one that we can see and experience in our everyday lives. Lately, this idea has lost its presence in the moment and has been relegated to the abstract- something that is said and thought of, yet rarely practiced. There has been a lot of attention placed on the current state of political correctness in our society. Every other day, a new topic is being prohibited, shunned and pushed aside because of its perceived inappropriateness, offensiveness and sensitivity.

As you probably read or have been a witness to, the newest “trend” on college campuses is the phenomena known as “micro-aggressions.” For those of you who have been able to dodge the micro-aggression,” you should know the definition according to psychologytoday.com. According to the website, micro aggressions “are the everyday verbal, nonverbal, and environmental slights, snubs, or insults, whether intentional or unintentional, which communicate hostile, derogatory, or negative messages to target persons based solely upon their marginalized group membership.” If this sounds vague in nature, it is, because it has led to a movement where sharing one’s own history, reading literature and  discussing unpleasant  social events are now being called into question.

My own experience in graduate school was mixed, as I often found myself unwilling and more importantly, unable to provide feedback in an open discussion regarding interpersonal relationships, human behavior, sexuality and social norms. While the society at large sees me, a white male, as a non-marginalized individual, I in fact was scrutinized for views that did not fit the current political correctness mold. We preach and encourage a diversity of ideas, but what I have begun to see is we preach and tolerate diversity in the context of a homogenous group of people and views.

This does significant harm when working in the mental health field, as “micro aggressions” are used to explain subjective life experiences. As a matter of fact, I am unwilling to discuss rape, racism or any form of discrimantion for fear of being misunderstood, overgeneralized and attacked. This should not be the case in 2015. Universities, classrooms and policy-makers need to be honest when discussing these areas of one’s life experience. Honesty is not synonymous  with bluntness and it is certainly not mutually exclusive from empathy, compassion and care.

Those who hold views that run counter to  the current state of feminism, gender issues, religion and sexuality should not be ostracized,  ridiculed and asked to step aside. Rather, these individuals should be brought into the discussion and welcomed, as true debate and the fostering of open ideas requires a diversity of ideas that are uncomfortable. That is life. We all face harsh realities, developmental milestones and internal conflicts that can be unpleasant. We should stop ignoring them, repressing them and blaming society.

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Complacency in an age of apathy

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As we all know by now, Baltimore has been the epicenter of cultural, political, economic, social and psychological conflict over the past few weeks. With the death of Freddie Gray, light has begun to shine on some of the underlying problems we face in our cultural and social DNA. In addition to this event, which has left many heartbroken, angry, confused and saddened, another tragedy took place in New York City, with the brutal murder of a social service shelter manager. Her murderer, a former resident of the shelter she managed, stalked her, followed her to her car, attempted to rape her and as she was able to bravely escape, he gunned her down in the middle of the street.

As more horrific events like these become common, I wonder if we have become numb or complacent to the breakdown in our social contract. We have learned to accept and disregard the effects of unemployment, low wages, income inequality and mental illness. Collectively, we have failed to seriously address the pressing issues of our time that have led to the manifestation of racial tensions, mistrust between authority and citizen and above all else, a sense of apathy for action…real action.

Light has been shined on the broken neighborhoods of Baltimore, where drug dealing and gang violence have replaced work and education. Several politicians, many of them at the state level, have cited the amount of money that has been poured into poor neighborhoods for community centers and parks. While this is nice, it is a misappropriation of funds. As someone who works with the homeless, the addicted, the poor and the disenfranchised, I will be the first to tell you that the real issue lies in the disincentives to work. We have created more barriers, such as back-to-work programs, that do virtually nothing. We assume that the disparaged cannot work and must receive government assistance. This is wrong.

We need to increase the minimum wage and get people working so that drug-dealing and other activities no longer need to be the top viable option for income. I, too, would turn down a $7.50/hour job, if I knew I could make $2,000 a week in heroin sales. In essence, we are subsidizing drug dealers!

Pour money into education, after school programs and implement structure for young adults. The PC police will need to sit back on this one, but we must thoroughly address the problems as they are, not as we think they are. The murder of the social service worker in New York City is another stigma for the mental health field. Let’s stop accepting the occurrence of such events. We need more mental health facilities, more long-term treatments for the chronically ill and a more comprehensive understanding of the ills that plague many people in society. Until we accept that many individuals with severe mental illness need long-term, intensive treatment in a safe environment, more tragedies will continue to occur.

I use the word complacency, because as a society, we have yet to take the necessary measures to address these concerns. The poverty rate today is the same as it was in the 1960s. Money alone is not the issue. We need to come together to form comprehensive legislation that focuses on treatment, education and employment.

Homeless and stuck

 

Barcelona_Homeless_by_Nicolas_R  When we talk about psychoanalytic theory, especially developmental theory, it is often assumed that it is not practical or relatable to every day life. How many people say that one is stuck in the oedipal or the anal stage of development? My guess is nobody, analysts included. But the more one works in the field of psychology, counseling and psychotherapy, it becomes clear that people are in fact “stuck” at times in various developmental phases. Dependent people often represent oral phase characteristics, while those struggling to connect with a boyfriend or girlfriend might be caught in Erikson’s intimacy vs. isolation.

One group of individuals who, generally speaking, become stuck is homeless men in recovery from drugs and alcohol. As I have observed, many homeless individuals (I can only speak about men) yearn for independence, but are often unable to fully break away from their past, from the government and from their own self-imposed barriers (many times, this is resistance). What comes to mind is Mahler’s separation-individuation phase, in which the child tests his or her environment on the quest for autonomy, and periodically touches base with the mother for confirmation of safety and security. What happens many times with the homeless population is an outright desire to be free from shelters, free from mandated treatment and free from curfews. However, many do try to strike out on their own, but do not have the tools nor the ego strength needed to truly be independent.

The lack of independence goes far beyond life skills and coping strategies. The inability to become independent is the result of a long-term process of years of enmeshed relationships, poor or non-existent attachments to a care giver and  dependence on others, mainly the government and substance abuse programs who have provided cover and a safety net. The abuse of  supplemental security income (SSI) and social security disability (SSD) payment provide a reprieve from work and an unintended consequence of denial of autonomy. While the monthly income is little, there still becomes a sense of being taken care of. This attitude is harmful to a group of individuals  need help becoming independent. In addition, some patients in recovery also develop an attitude of entitlement.  Patients often expect me to provide tasks for them at the snap of a finger. When I try to explain my role as a therapist, I am quickly silenced and cast in a light of an oppressor or disciplinarian. In reality, I am encouraging patients to fill out their own paperwork, visit the library and begin to make decisions on their own.

Those of us who provide psychological services to an undeserved and often times misunderstood group of individuals need to understand the significance and symbolic representation of government-assisted programs. While they provide concrete relief for many, they restrict psychological individuation. Reenactments of dependence create transferential relationships of being misunderstood, abandoned and reprimanded. We often fail to understand our patients’ need for proper boundaries and facilitation of taking one’s own life into his hands.

Treatment centers for substance abusers can provide too much comfort, in that patients are at times encouraged to forgo a balanced approach to recovery that focuses on work, therapy and skills-building in favor of mastering one’s own sobriety. A more integrated approach needs to occur.

I am not advocating for the shutdown of government-assisted programs. I am simply shining a light on their impact on a vulnerable population that is often overlooked by policy-makers and providers.

Patient violence in our hospitals

 

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I was pleased to read Dr. Stephen Seager’s article this morning in The New York Times. In his article, Seager discusses the “hell” of working in a forensic psychiatric hospital where patients (upwards of 15%) are violent. It is an important read for mental health professionals, but more importantly, it should be an eye-opener for policy makers across the country. As Seager mentions, some of the most psychologically disturbed patients cause serious injury to staff and other patients. In the article, Seager writes, “In another attack, an assailant beat an elderly man with a sack of quarters and then flung him in his wheelchair onto the patio cement. At times, half the nurses in my unit are on disability from assaults or attempted rape.”

Mental health professionals in all settings can relate to and empathize with the victims of such random assaults. It is not just hospitals where staff members, clinicians and other professionals are targets of abuse by psychotic patients. Homeless shelters, clinics, outpatient psychiatric centers and even private practices can have patients who intend to and actually cause violence. But, it seems that the mental health profession is at a stand still when it comes to interacting effective policies to deal with the 15% or so of patients who become violent and out of control. As Seager argues, the legal system grants more rights to patients than to professionals. Patients can assault a clinician, and, if a clinician fights back, he or she can be fired and terminated. If you are a mental health professional working for a company or hospital, odds are one of the  employee policies includes a prohibition of defending one self. Furthermore, patients who are deemed insane can refuse treatment and medication, all in the name of “patients’ rights.”

As I have written before, this is another product of the deinstitutionalization of America’s psychiatric hospitals in the 1960s. Instead of fixing the abuse, inhumanity and cruelty that existed, the government decided to completely shut them down  and create community mental health centers. As a result, we have far too few hospitals to treat the most severely mentally ill patients on a long term basis. Our new de facto mental health care hospitals are  prisons, where abuse is all too common (see Rikers Island in New York City).

Psychiatric hospitals need more intensive care units where the most mentally disturbed patients can be treated on a long term basis. The problem is nobody wants to pay for this, and as a result, we are forced to deal with ill-equipped hospitals to house and care for the ill. Political correctness has triumphed over treatment. Maybe our policy makers should spend time in one of the nation’s psychiatric hospitals or prisons to have a better understanding of the dangers clinicians face.

What your job says about you (a psychoanalytic perspective)

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Can someone’s neurotic personality structure be revealed by the type of work he or she does? What role does culture or societal norms play in analyzing one’s decision to become a lawyer, teacher or doctor?  While our culture is filled with those seeking power, privilege and possessions, these three factors are not enough to determine or conclude why somebody chose a certain profession. Instead, in the neurotic, we need to analyze the meaning and symbolism of the work itself to begin to understand one’s conflicts.

If you follow the news, especially domestic affairs, you will notice the rise in coverage of police-involved shootings and altercations. When we think of police officers, we are told to assume their job is to serve and protect. But, in many cases, this is not what is happening. Routinely, police officers act aggressively and become combative when civilians question them. Sometimes, violence ensues. This has led me to wonder, what type of person might become a cop? In many cases I would argue, the person’s passion for justice and community service is lacking and the need for power, aggression and control are the dominant factors. If an individual is inclined to help others, why not become a firefighter, a social worker or a teacher?

Let me outline a few job descriptions to make my case:

-Dentists: rip out teeth, drill, extract, break, realign and scrape.

-Architects: Build, create and design

-Anesthesiologists: Numb and silence a patient

-Preacher: command an audience, talk, piety

These are just four professions that can provide insight into one’s character structure. The descriptions of these professions should not be viewed solely as a means to express aggression. They should be looked at it holistically to begin to understand how the profession relates to the person’s conflicts, idealized self and interpersonal demands.

Let’s use a preacher as an example. On the surface (conscious and manifest), this is someone who is pious, committed to God and his community. He is a servant to God and the representative of his congregation. If we were to dig a little deeper, we might find a character structure of self-righteuousness that is a defense against a competitive and ego-centric character. A self-righteous individual might also present with very narcissistic tendencies and yearn for power. His position as the gatekeeper to God is masked by his conscious statements that he is acting out of the benefit of the community, but really, he is placing himself in the presence of a higher power.

In American culture, the quest for power, possession and privilege is ubiquitous. However, this is not enough to explain why people choose a career. For some, there can be a sense of undoing, something I wrote about in a previous post. I’ll use the anesthesiologist as the example. Somebody who grew up in an abusive, chaotic household might have experienced a feeling of isolation and  a lack of importance. Unconsciously, he took this to mean he is of little value and his opinions are worthless. One route is a compromise formation, in which he becomes someone who fosters self-expression and listens to others. Or, there is unconscious hostility, rooted in the childhood experience. As a means to express the hostility, he symbolically and literally silences people and takes control. This is his profession.

These unconscious conflicts are completely out of awareness to the individual. The decision to become a certain professional are rationalized and intellectualized in the context of  helping others. The uncovering of neurotic conflicts takes years to uncover, as these conflicts, usually of anger or anxiety, run counter to the idealized self.

 

 

Understanding anger

anger-management-manchester      Can you name a society or culture where aggression is not present? Somewhere where the need to express aggressive drives, whether physically or verbally ceases to exist? The answer is you cannot, because aggression is ubiquitous. When Freud came up with his aggressive drive, he was writing from a biological perspective. For him, aggression was a human drive that we all had in us. This is a good start, but aggression takes on a more important, more consequential form when we look at one’s character development, i.e. personality.

While it is true that the aggressive drive in us needs to be released, whether through argument, fighting or exercising, how we come to understand, know and deal with anger is more complicated. What is less understood is that not all aggressive expressions are a result of anger. Children often times are scorned or punished for “acting out.” This is routinely seen as aggression in our society. But, what if the acting out is caused by something unknown or uncomfortable to the child? What if the child is suffering from anxiety or a fear that cannot be verbalized? What if the child feels an innate sense of helplessness? This all leads to an outward expression of the emotions, but the emotions are caused by anxiety, not anger. As a result, the child is yelled at and disciplined for misbehaving. His symptoms scream anger, but his underlying character is anxiety.

In many cases, one’s own anger presents a great deal of conflict. Anger has a unique relationship to sex, depression, our idealized sense of self and relationships. Sometimes, the anger within cannot be consciously accepted. As Karen Horney writes in The Neurotic Personality of Our Time, “The main reasons why awareness of hostility may be unbearable are that one may love or need a person at the same time that one is hostile toward him, that one may not want to see the reasons, such as envy or possessiveness, which have prompted the hostility, or that it may be frightening to recognize within one’s self hostility toward anyone.” These three points are all conflicts that one must confront. As a rhetorical question, how many of you have been in a relationship where suddenly you are overcome with feelings of anger or hostility toward a partner’s remarks or actions, but know you cannot react, because you are dependent in some way on the relationship?

Aggression or hostility is present in the bedroom as well. I am not talking about whips and chains, but more in terms of one partner routinely dominating the other, usually out of the need to humiliate or punish. This is aggression. Often, this aggression will lead to neurotic formations in one’s personality. It can be viewed as a power struggle, although both parties are unaware of this.

If one were to analyze him or herself, there are certain areas of anger to explore that include the possibility of anger within (anger directed at the self), jealousy, events in the past and childhood experiences. We tend to think of anger turned inward as depression (This is what Freud said), but it is the result of a conflict. One can be angry at himself for failing to compromise, failing to love or failing to live up to his idealized self. The symptoms might be helplessness, sadness and a lack of motivation, but the real problem is one of anger, one of resentment.

Anger has many forms, and most are nonverbal. The passive aggressive can do as much harm to a relationship as physical actions. Aggression in adults can lead to over-assertivness in the workplace, poor boundary setting and hostile friendships. As I have written before, these personality traits are rooted in our unconscious neurotic conflicts and can create serious relational issues if left unexplored.

Confronting the past

fork-in-the-road-what-now     It is often repeated that one should live life with no regrets. Live life to the fullest! For many, this is easier said than done. Actions we’ve taken (or not taken) can cause tremendous psychic stress, whether we know it or not. I was stunned to learn this morning that there exists a website, http://www.exaholics.com (link not provided), that almost operates like a 12-step program for people trying to get over an ex. Naturally, break-ups can be hard for both parties involved. Causes are often murky, closure is routinely not had and blame is hurled across the room.

What can happen next might seem obvious, but to many, is often unknown. In psychoanalytic terms, the defense mechanism of “undoing” might present itself and lead one down a path filled with obsessions, compulsions, regrets and guilt.  Undoing is a primitive defense that is almost self-explanatory: one tries to undo something that has been done that caused harm or that one regrets. What is not so obvious is that the act of undoing is an unconscious act, hidden from our awareness. If we look at breakups to make the case, we might find individuals analyzing past events during the relationship that could have gone a different way- if only I hadn’t yelled at her, if only he answered his phone, etc. We dive back into the past and recreate a scenario that is acceptable and favorable to our new, yet alternate view of reality. The undoing process can cause intrusive thoughts, painful feelings and tremendous guilt.

If we look at childhood trauma that relates to divorce, bad parenting, abuse or neglect, the belief that the past can be changed is often in the back of the mind.

Undoing is relevant to treatment, because it emphasizes the dynamic approach to therapy that the past dictates the present, and eventually, the future. Regrets often consume our thoughts and we delegate tremendous amounts of psychic energy to wanting to undo the past. As a result, the memories are all-consuming and the past events might lead to drug use, alcoholism or poor work productivity.

Confronting one’s past is painful, but can be helpful in dealing with the present. I see patients who, as adults, are still beholden to the past ills they faced- abuse, neglect and drug use to name a few. One common theme that presents itself is a sense of “if onlys.” These patients are frequently reminded or triggered by past events that almost haunt their daily lives. So, what, if anything, can be done to alleviate such pain and suffering?

If possible, confront the individual(s) who are the source of your pain. For many this is hard, given that past events might have led to a cut-off in communication or legal barriers stand in the way. But, going to the source of the problem can be cathartic. Talking about your feelings is important in the healing process. The goal is not to have the individual apologize and admit to wrongdoing. The goal is for personal healing. The individual in pain can come to  a point of acceptance or reconciliation regarding the event. There is almost a weight lifted off the shoulders that allows for a more tranquil life.

Sometimes, the undoing defense presents itself in multiple aspects of one’s life: relationships, decision making, etc. This would require a deeper self-analysis to explore why one is exposing him or herself to repeated situations that will cause regret. I talked about this briefly in my post on personality and sadomasochism.

Closure is tricky, as many individuals are expecting the other party to be involved. It is good to know that closure can be had on your terms and that regrets can truly before overcome through a healthy process of confrontation and communication.

 

 

Millenials and risk

RISK photoLately, I have been writing about millenials and their aversion to relationships, intimacy and risk. In this piece, I would like to narrow in on the element of risk and explain why I think so few  young adults are mastering what was once thought of as a normal stage of development. While we hear about new start-ups being formed by teenagers and young adults, it seems that this is the exception, not the rule. Risk has many flavors- the risk of leaving one job for another, the risk of moving to a new city to start the next chapter of your life or the risk to ask somebody out on a date.

Margaret Mahler, a developmental theorist in the early 20th century outlined the stages for what she termed “separation-individuation,” which, like Erik Erikson, applied to young children. Leaving out the first stage, which focus on sleep , Mahler’s phases are as follows:

1. Symbiosis- Developing perceptual abilities gradually enable infants to distinguish the inner from the outer world; mother-infant is perceived as a single fused entity

2. Differentiation- Progressive neurological  development and increased alterness draw infants’ attention away from self to outer world. Physical and psychological distinction from the mother is gradually appreciated

3. Practicing- The ability to move autonomously (an increase in the child exploring his or her environment)

4. Rapprochement- As children slowly realize their helplessness and dependence, the need for independence alternates with the need for closeness. *Children move away from their mothers and come back for reassurance.

5. Object constancy- Children gradually comprehend and are reassured by the permanence of a mother and other important people, even when not in their presence

(Descriptions of phases taken from Kaplan and Sadock’s Synopsis of Psychiatry)

As I outlined in my last post, Erik Erikson’s stages of development can easily be applied to millenials. The same is true for Mahler’s theory. Let me explain.

I think there is a generational dilemma that has unintentionally led to this generation’s delay in psychological development. Baby-boomer children were often forced to interact with neighbors due to the lack of technology and solve conflicts the old-fashion way: talking (and sometimes fighting). Societal boundaries were more rigid: teachers and parents were united (unlike today when parents frequently yell at teachers for trivial reasons) and parents were parents, not friends. Baby-boomer children more likely grew up in less liberal (socially, not politically) homes than are present today. Punishment was often harsh and rules were meant to be followed, not broken.

As a result, the baby boomers have done a 180 and in many ways have babied this generation. Unfortunately, millenials have been coddled and told they can do no wrong. Our skill set for the 21st century is minimal, but our confidence sure is high. We have been told we can do anything we set our minds to, despite the cultural and economic realities that have given us push-back.

Mahler’s theory is applicable to us, the millenials, because we have not fully separated from our parents (symbiosis). We have not differentiated ourselves and taken the risk of forming our own identities. Mahler’s stage of practicing emphasizes the need to be autonomous and explore our own environments. That includes the harsh reality of failure, disappointment and loss. While these are all uncomfortable feelings, they are part of  healthy psychological development. I am not a parent, so I cannot write about the challenges of parenting, but, like other observers, we are all familiar with the helicopter parent who hovers over a child and restricts (whether intentionally or unintentionally) development.

Mahler’s theory also applies to the state of contemporary  intimate relationships. If we fail to separate from our parents, we might fail to establish clear boundaries with our significant others. If parents are constantly providing validation and reassurance to their children, rejection from a potential boyfriend or girlfriend will be a hard pill to swallow.

Margaret Mahler’s stages of separation-individuation teach us that risk is crucial to independence and normal development. It enables us to face the  sometimes harsh realities of the world and still obtain autonomy and a sense of appropriate risk-taking skills.

Developing in the 21st century

identityAt what point can culture, societal norms and the environment become as influential as our inherited traits and predispositions in defining how we identify? It seems apparent that outside forces have had a lasting impact on Generation X (also referred to as the millennials) in terms of how each person chooses to identify. Once thought of as static labels, identifiers such as gender, sex and political preference now have more options than Baskin Robbins. Earlier this year, Facebook revealed that users can choose from 51 different gender options, and that still does not cover gender identity in its entirety. Other characteristics, such as occupation and social status  are as important as sex and gender in terms of identity and personal development.

Identity has long been a hot topic among psychologists and developmental theorists. Erik Erikson, perhaps the most famous developmental psychologist (and my favorite) outlined eight stages of the  psychological life cycle that I think are still relevant today. According to Erikson, one passes through the following stages:

1. Trust vs. Mistrust (occurs at birth)

2. Autonomy vs. shame and doubt (approx. 18 months old)

3. Initiative vs. guilt ( 3 years old)

4. Industry vs. inferiority (5 years old)

5. Identity vs. role confusion (13 years old)

6. Intimacy vs. isolation (the 20s)

7. Generatively vs. stagnation ( the 40s)

8. Integrity vs. despair (…the 60s!)

Before you jump to reject this old model, let me defend its practicality and how it is still relevant in the 21st century.

The changing economic and political landscape in America has altered our psychological development. Due to a shortage of jobs, rising costs of living and stagnant wages, more young adults are finding themselves “stuck” and feeling unable to progress. Although the stage of “autonomy vs.  shame and doubt” was theorized to apply to 18 month old babies, it can now be applied to twenty-somethings. The inability to find work or move out of your parents’ house can definitely lead to shame and/or embarrassment, despite its commonality. Progress can be stifled, and one can become depressed, anxious or angry.

Stage six of Erikson’s model, which covers intimacy vs. isolation, is as relevant now as ever before. Intimacy has been pushed aside or delayed due to the demands of a 21st century economy. In many cases, intimacy has fallen by the wayside due to society’s demands of a perception of independence, where there is little time to get to know somebody, start a relationship from scratch and develop together. Despite people saying they choose to be alone, it is hard to believe that someone chooses to navigate life without any companionship or love. Think about people you know (and perhaps even you) who have sacrificed love for work, all in the name of…still to be determined.

What also seems to be occurring is that millenials are moving through these stages out of sequence. Twenty-somethings are finding themselves in the “generatively vs. stagnation” stage- often referred to as the mid-life crisis phase- due to feeling unfulfilled with work, relationship statuses and overall wellbeing. This can very well be a result of culture’s most pressing characteristic: instant gratification. The saying “I want what I want when I want it” has never been more applicable than right now, where young men and women exude a sense of entitlement and power. Once reality hits, stagnation can set in.

These stages act as a roadmap for how we identify and develop both socially and psychologically. The focus should be on the stage characteristics, not the age. Although many developmental theorists believed one could not move  between stages at random, today’s societal norms have altered how Erikson’s model works in the 21st century.

Faking illness to get ahead

malingering The catchphrase “fake it till you make it” has been applied to various aspects of life, ranging from job performance to friendship to clothing companies (Lululemon). I would like to introduce another area of life where this saying is gaining ground, and that is in the field of mental illness. Those who “fake” illnesses is nothing new, but due to the increase in diagnoses such as ADD, ADHD, GAD (generalized anxiety disorder) and PTSD, both adults and children are being over diagnosed with a disorder they may or may not have.

When it comes to pretending to have an illness, people can both intentionally fake symptoms to achieve an external reward (malingering) or, they can take on a role that is more unconscious and act out symptoms for both internal and external incentives. Lately, I have been confronted with patients who report symptoms and traits that fit the  previously mentioned illnesses, but often times, the reported behavior is too suspicious. Some patients claiming to have PTSD will report a trauma, but  have very little hesitation in discussing it. In addition, there is little functional or emotional impairment related to the event. This is not to take away from a real traumatic experience. Rather, this is to highlight the absence of the main symptom of PTSD- avoidance. Similarly, children and adults claiming to have ADD will report an inability to function at work and school, but have no trouble playing video games or sports for hours on end. In a clinical setting, the question of malingering should be asked and is warranted, given the rampant abuse of prescription drugs and the benefits associated with having such illnesses, which I will discuss momentarily.

The focus on faking an illness should center around whether the malingering is conscious or unconscious, not whether the behavior is intentional or unintentional. The patient who lies about suicidality and self-harm to obtain a bed in the hospital is aware of his actions and has already outlined the benefits of lying. Yes, any threat of self-harm should be taken seriously, but that is not the issue at hand.

The unconscious malingerer is different. This person enjoys sympathy and attention from others. The unconscious malingerer often projects and overcompensates by stating that he does not want anyone to feel sorry or pity him, and that he is fully capable of taking care of himself. Yet, this individual mentions his pain at every juncture in his life. He obsesses over his inability to have a job, a relationship and a family, all in the name of pain.

People malinger for various reasons. Here, I have outlined a few common examples.

1. People malinger to obtain medication. This is not new, but given the abundance of medication, it is easier now than ever before to read up on a mental disorder, learn its symptoms and report experiencing them.

2. People malinger to get attention from others. This is evident when an individual repeatedly complains about an illness, exaggerates the pain and makes others focus all of their attention on the malingerer.

3. Young adults malinger to avoid taking risk. Often times, a diagnoses or illness is used as a crutch to avoid dealing with reality, confronting internal conflicts and other family members. Sometimes, children and adults take on the role of a sick patient, which is commonly known as factitious disorder.

4. Malingering is common among individuals who need to fit a certain criteria to obtain public assistance, SSI and housing. This is the most common form of the conscious malingerer. The external reward of seeking assistance has become so bureaucratic , many individuals have to game the system to receive government aid.

Because PTSD, ADD and anxiety are discussed so routinely in the media, there seems to be a need to diagnose any and everybody who reports some of the symptoms. This is both reactionary and harmful, as the diagnoses can be wrong and the underlying issues go untreated.

While psychiatrists, psychologists and clinical social workers learn about and study malingerers, I think more attention needs to be paid to a patient’s unconscious drives at taking on the role of a sick person. Once identified accurately, treatment should focus on the symbolism of the pain, the objectives of malingering and identifying the functions of the prescribed symptoms. These areas will allow the clinician and the patient to work on a more in-depth level to uncover the drives and forces behind the malingering behavior.