Towards a Mythology of Malingering — Part 2

[Ugh, this is a long post. Apologies for that. I will definitely understand if you just want to skim it, or heck, ignore it entirely. Believe it or not, I did cut a great deal, and much of what I cut will probably make it into the part 3 I’m planning to write!]

“At the risk of sounding like a tinfoil-hat conspiracy theorist (I am not, and here’s why), I’d like to illustrate this epiphany with a recent example from my own life involving the billion-dollar, global multinational insurance company that did not just accuse me of malingering, but effectively tried, convicted, and sentenced me for this alleged crime, ultimately coercing me into paying a fine equivalent to a month’s salary!”

— from Towards a Mythology of Malingering — Part 1.

Ferris Bueller pretending to be sick.

Matthew Broderick as Ferris Bueller pretending to be sick in order to skip a day of high school. From the 1986 film Ferris Bueller’s Day Off, directed by John Hughs. Image found here.

For the sake of transparency and precision I should qualify that what I characterized in Part 1 as the insurance company’s accusation, trial, conviction, etc. are really these only in effect, by which I mean as inferred from the havoc they wrought not just on me, but also my wife and especially our children, who were just five years old when these events occurred (they’re twins). To be clear, in the company’s communications with me, they never actually used the word malinger, nor any of its synonyms — they never explicitly accused me of cheating, faking, etc. Nor was there anything like a formal trial, verdict, or sentence, per se. But lived as these “in effect” actions were from our admittedly subjective perspective, they were virtually indistinguishable from the their literal versions. When all was said and done we were poorer by a full month of my salary — exactly as if I had paid a fine equivalent to that amount — and we had all endured a great deal of stress, and this as a direct consequence of judgments and decisions made solely by the company, with no input or oversight by any sort of legitimate judicial authority. If the company had literally accused me of malingering, had literally tried, convicted, and sentenced me for that alleged crime, the effects would have been nearly identical.

With one notable exception, of course, which is that at least these events won’t show up in a criminal background check, because all of this extra-judicial justice took place privately, “behind close doors” so to speak, and there’s no public record of it.

That’s actually supposed to be humorously ironic. I’m trying to ridicule this insurance company’s defacto violation of my legal right to a public trial, as guaranteed by the US Constitution. The following is an audio clip of people laughing, and if you don’t mind, I’d like to pretend they are all laughing scornfully at this insurance company for acting like a totalitarian lynch mob:

In any case, here are the basic facts of the case. Now, as I was writing what follows, I found myself thinking of this episode of my life as…

That Time A Billion-Dollar, Global Multinational Insurance Company Punished Me For Malingering

Man in dunce cap

Image found here.

This story begins with my autistic neurology, and in particular with my brain’s freakish proclivity for latching like a pit bull onto certain topics, ideas, situations, problems, etc. and to subsequently think the shit out of them. (The pit bull metaphor is just one I like to use to describe what this is like for me, as discussed in a post I called Thought Furnace, which is another one of these metaphors.) This can happen with varying intensities, and can persist for varying lengths of time. It often happens that I’ll obsess about something for an hour or less, but I’m pretty sure I’ve had obsessions persist for up to 5 months, and even several years if we’re counting obsessions that seem to go dormant for a while, and then become active again later on.

The Pit Bull in My Head

Smiling pitbull

Image found here.

In any case, this aspect of my neurology is definitely not something I can control rationally, by which I mean first that I cannot just turn any given such obsession on and off at will; second, nor can I direct and sustain it like a flashlight in the direction of some given wholly sensible but otherwise arbitrary topic (finding a cure for cancer, for example). Now, in that last sentence I italicized that word sustain because although I absolutely can direct that flashlight where ever I want, I am wholly unable to sustain that redirect for anything like a useful amount of time. Sooner or later, and usually sooner, my attention automatically shifts back onto the object of obsession. Of course, I can certainly try again, and again, and in fact that is quite often exactly what I do, but that effort to remain vigilant just winds being an even more distracting (and exhausting) form of the original obsession.

Third, the topics, problems, etc. that my brain does eventually select as obsession-worthy do not typically strike objective observers as especially reasonable. Although I almost always think that I understand why I am obsessing about some given topic, problem, etc., there have been plenty of exceptions to that rule; and in any case, despite how much sense any given obsession makes to me, I don’t think I have often succeeded in conveying to another person my private obsessional logic in away that satisfies or persuades, and most importantly quells the incessant “yes, but can’t you just”s that inevitably ping back on me, presumably in the hope they’ll bring me around to acting more like a normal human being (as if autism were nothing more than a deficiency of good-advice).

The Wall of Ice, My Dead Walrus, And The X-Men

Of greatest relevance to this discussion however is that to the extent that my brain has latched on to some given topic, problem, etc., I am more or less unable to concentrate on any other topic, problem, etc.; and this no matter how sensible or important it would be to do so. This aspect of these obsessions can be problematic, to say the least, and it can render me utterly helpless before any task that requires significant thinking. One image I use to describe what this feels like for me is that of a large wall of ice that I’m obliged to climb, even though I cannot find any hand- or footholds. Another image I use is that of a dead walrus chained to my ankle, the stench of its rotting greasy flesh a metaphor for the repellent frustration that my incompetence inflicts on anybody who needs me to be competent in these situations.

Super hero kid

Image found here.

At the end of the day, I really don’t know how my brain selects these obsessions. There are a few general patterns, but I have never felt like I could control this cognitive quirkiness in any useful sense, and I have spent the better part of my waking life trying to figure out how to do exactly that. For a very long time I have striven to see this proclivity and to talk about it as a kind of X-Men super power that I just hadn’t yet figured out how to regulate. Following my diagnosis last year I have started to see it for what it really is: my own, special, idiosyncratic manifestation of autism. Yes, yes, of course I still want to believe that one day I’ll find my Professor X who will help me blossom at last into the bad-ass super hero I’ve always wished I could be, but at this point in my life my main goal is just to keep myself gainfully employed. I have kids to feed, for crying out loud.

A Family Vacation Fail?

Family on vacation.

Why is this a picture of “family vacation fail? Just imagine that they’re on vacation, enjoying the sight of an exploding nuclear warhead, and that in a moment they’ll be vaporized by its fire ball. Haha, sorry about that. The idea just occurred to me and it was too funny not to try. Image found here.

In any case, in September 2016, the pit bull in my head sank its teeth zealously into a problem that was only peripherally related to my job, and the resulting obsession made it impossible for me to do that job. Now, I’m going to skip over a lot of quite significant detail here, saving it instead for what will need to be a much longer version of the present exposition, and fast forward past the urging of my wife and my sister to finally seek psychiatric help for this life-long problem (which many of us suspected by then to be some version of Bipolar Disorder); past the surprising announcement in November by my diagnostician that my symptoms were actually much better explained with an Autism diagnosis (eventually to be confirmed by three separate psychiatrists who specialize in autism); past Christmas and the New Year; straight through to a doctor prescribed medical leave that began in January 2017 and which ended four weeks later in February, the purpose of which being to help me get that pit bull to relax its jaws with the help of some sort of medication.

In case you’re not familiar with how such short-term medical leaves work, there are really two parts to it: the first part involves job protection, so you still have a job to come back to when your leave is done; and the second part is salary protection, so you can pay your bills, rent or mortgage, feed your family, etc. while you are out of work. The job protection is handled (here in the USA) by a piece of Federal legislation called the Family and Medical Leave Act, which requires employers to allow eligible employees to take time off to manage certain health and family related problems. But the FMLA does not require an employer to pay the employee during this time, so many companies offer their employees some sort of short-term disability insurance as part of their employee benefits package, the idea being that an employee on an FMLA-protected medical leave can also file a disability insurance claim in order to have an income during the leave.

As all of this relates to my own case, when I began the leave in January I filed a short-term disability claim to cover my salary during the leave. When I did that I just assumed that the claim would be approved. Why wouldn’t it be? It had been prescribed by my doctor. Had I any reason to think that it wouldn’t be approved, I would not have taken the leave. Instead, I would have just shown up for work as I’d been doing and sat at my desk all day trying to work while the pit bull in my mind gnawed and chewed on its obsession-bone of the month (which was actually still related to the problem from September, but only distally at that point).

But the claim did not get approved — not after the first week of the leave, nor the second, nor the third, nor even the fourth. In fact, I think it was toward the end of February, a good ten days after my return to work when I finally learned that my disability claim had finally been denied, and that I had consequently lost a full month’s salary during that leave. Of course the insurer has an appeal process, and I did appeal the decision to deny payment, but the appeal also got denied.

Wait, So, What About That “Accusation”, and the “Trial”…?

Symbols of Justice

Image found here.

Now, here you may be wondering about this “accusation” I’ve been going on about. Just where in that sequence of events did the insurance company actually accuse me of malingering, or of anything else untoward for that matter? And where was this “trial” I mentioned, “in effect” or otherwise. And what about the “conviction” and the “sentence”? When did they occur? So far as I’ve related the story, it may seem that I just filed an insurance claim and it got denied. What’s the big deal? Just when did all of that tinfoil-hat, totalitarian drama actually take place?

So, no problem if you have those kinds of questions at this point. You didn’t live these events and are looking at them from the outside. And I understand that by choosing to tell this story I am assuming the burden of proof here, and I’m absolutely willing to shoulder that burden. But we should probably set reasonable expectations here nonetheless. I know from a lifetime of trying and failing that I suck at persuasion. I will now do my best to unpack my experience with all of this in a way that will lead you at least in the general direction of agreeing with my way of understanding what happened. But I regret to acknowledge — again based on a lifetime of experience — that if you aren’t already leaning in that general direction, odds are good that you won’t start doing so as a result of this narrative. Anyway, for better or worse, here’s the breakdown:

  1. The “accusation”, though implicit, is nevertheless perfectly obvious to me. What else could it mean that the company denied my claim if they did not think I was merely faking something? My doctor and I were completely transparent, gave them all of the information they requested, answered all of their questions. The medical justification for the leave was obvious to my doctor, and if it wasn’t as obvious to the insurer, then really it can only be because they believed that the information my doctor had given them was an untruth of some sort — an untruth that was based on what they most likely assumed were lies that I had told my doctor. That really looks to me like an accusation of malingering, even though the company never actually used that word.
  2. The “trial” was the insurer’s review of the information provided by my doctor. This includes both the original review and the appeal review.
  3. The “guilty verdict” was the company’s determination, based on their review (the “trial”), that my apparent disability was not actually a disability at all, but rather just me pretending to be disabled, presumably because I wanted to take a month-long family vacation, paid for by the insurance company.
  4. The “sentence” or “fine” was the month salary that I missed because I assumed the insurer would approve the claim.
  5. And finally, regarding my claim that the company coerced me into paying that fine: note that the company could have paid me right away and then done their review. Doing this would have been entirely consistent with the presumption of innocence doctrine that grounds the US Justice system. Then if they found actual evidence that I had been faking my disability, they could have demanded that I pay the money back, and if I refused, they could have filed fraud charges against me, and I would have been granted my Constitutionally protected rights to due process, legal representation, a public trial, etc. But that is not what they did. Rather, they went the other way. The company assumed without evidence that I was guilty, withheld payment, dragged their feet on their review until I had gone a full month with no salary, and then ambushed me with their guilty verdict when I was too poor to hire a lawyer to defend myself. That’s what I mean when I say that they coerced me into paying a month’s salary as a fine.

Anyway, that’s how I see it. That’s how I lived and felt it: accused, tried, convicted and sentenced. Punished!

I Am The Walrus (Coo Coo Kachoo)!

Wow, this is a long post. We’re almost done, but I have one more thing I need to explain, which is just how the above anecdote illustrates my little epiphany, described in part 1 of this post, to the effect that a given accusation of malingering, in and of itself, does very little to establish its own truth.  To elaborate briefly, to my view (for now at least, and until I encounter the sort of evidence that might change my mind) such an accusation is best seen as an invitation to scrutinize the available evidence to determine whether any malingering has actually occurred. Above all it should not be interpreted or acted upon as any sort of proof of guilt. I believe — in general, but especially when the accuser stands to profit from being believed — that such an accusation is at best a weak indicator of actual malingering, really more akin to a sighting of Big Foot or the Loch Ness Monster. Ok, ok, maybe not quite that unbelievable, but still, a lot more like that — like a myth, really — than most folks seem to realize. But I have yet to explain how this micro-epiphany is illustrated by the above described events.

But I think this is a good place to take a break, and to put that part of this exposition into a separate part 3 to this post. When I finish writing it I’ll add a link for it here. In the meantime, please enjoy this almost but not quite totally irrelevant recording of Jim Carrey clowning around with George Martin and acting hilarious while recording his own astonishing interpretation of the The Beatles’ I Am The Walrus:

 

 

19 Comments

  1. Holy hell 😳😳. What you have gone through. I can only imagine 💐💞. This happens more often than people realize. Case in point: I have a dear friend with Lyme disease. She also has the Lyme coinfections, Ehlers-Danlos Syndrome, Hashimoto’s Disease, and POTS. All diagnosed, by multiple doctors, including myself. It’s a tangle of issues. She’s been actively sick for 3.5 years now. She has tried to work, but genuinely can’t. She *wants* to. I’ve known her for 27 years and I know she’s not a slacker. And yet, she applies for disability…and gets denied, after 6 months of waiting. In a state known to be generous with benefits, compared to other states. I have witnessed what you’re going through, albeit from the outside, but still at close range. It sucks. Seriously sucks. I feel for you 💞💞💞

    Liked by 3 people

    Reply

    1. Thank you, Laina. Yes, it was pretty nasty, and I know my own experience was relatively mild compared to that of many. But it did fill me with a kind of lust to figure out how to solve this problem. It sounds like you have a good deal of expertise relevant to such a project. Have you thought about writing a post or two on the topic? I’m not suggesting you need to figure it all out or anything. For my part I see myself at the beginning stages, and I’m really just trying to survey the terrain with these recent posts. Maybe you could start with the comments you’ve shared above and on part 1, adopt the stance that you just want to document a few observations, think it through a bit on “paper”, which is basically what I’m trying to do. Anyway, I know you’re not lacking ideas for projects right now. But I figured I’d point it out as another to add to your list of possibilities. 😊

      Liked by 2 people

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      1. That sounds like a really, fantastically great idea! 👏🏼👏🏼👏🏼. Let me see if I can pull some thoughts together 😉. And I will definitely see what I can do 👍🏼. Because yes, this is totally a convo that needs to be had and info that needs to come out 💖. Definitely added to the list! Probably near the top. If the inspiration strikes, I might be able to get something written for a Mental Health Monday post tomorrow or sometime soon (haven’t done one of those in a while, and I’ve been feeling the inner nudge to) ❣❣

        Liked by 1 person

      2. I don’t know how to express how wonderful it was for me to read what you wrote there other than to just plunk it down with it was wonderful for me to read what you wrote there. Oh, and maybe I can throw in a few of these 👏🏻👏🏻👏🏻👏🏻 or maybe a couple three of these 🎉🎉🎉🎉🎉🎉 or how about quick little sprint like this 👍🏻🕺🐣🌻🌈🎂☮️🎶🎵✊️🙌🌎💚!!!! 😬

        Liked by 1 person

    1. Thank you for those kind words. If you think you have any information, ideas, expertise, etc. that might be relevant to this general problem I encourage you to write about it on your own blog. and I invite you to post a link to it in these comments. 😊

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      Reply

    1. Thanks for reading and for sharing those kind words. If you think you have some kind of experience, insight, or expertise that might be relevant to the general project of trying to solve this problem, I hope you will consider writing a post on your own blog. If you would like to do this , please feel free to call my attention to it by posting a link to it here. 😊

      Liked by 1 person

      Reply

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