Maybe Ask This Next Time Somebody Accuses You of Malingering


President Donald Trump — living proof that with hard work virtually anything is possible if your dad is rich.

When (for example) a wealthy white businessman ignores, or denies, or is perhaps merely unaware of the role that Luck played in his accomplishments, plugging the resultant gap with such virtues as hard work, perseverance, possibly an imagined genetic superiority, education, good character, etc., he is doing something that is very much like what a malingerer does. Only instead of pretending to have a disability in order to leverage the sympathy of his associates, he has gone off in the opposite direction, pretending to have some sort of an ability, and this in order to leverage the admiration of his entourage.  As an extreme example we might imagine a grand prize lottery winner boasting of his skill at picking lottery numbers —

“…The key is to pay attention to everything. You have to stand vigilant. Signs are everywhere, but you have to train yourself to see them. I keep a notebook with me at all times and whenever I notice anything unusual I write it down. Is that the eighth airplane I’ve seen up in the sky today? Are there 19 squirrels in that park? If I have a dream one night about, say, 15 pairs of socks, I’ll write that down when I wake up. Especially if its something like 15 socks, because socks come in pairs and 15 is an odd number….”

But now let’s compare how we feel about these two manipulators. Without overgeneralizing, I think it’s safe to say that many would despise the malingerer on the one hand, while tending to forgive and in extreme cases even adulate the businessman on the other. (With Trump our zeal was so potent we made the guy President and armed him with nuclear weapons!)

And why is that? Both are manipulating us and in similar ways. Shouldn’t we either despise both or forgive both?

For now a least (and until I encounter the sort of evidence that might change my mind) it really looks to me like the critical difference between these two scoundrels is that in the businessman we see the hope of gaining resources, but in the malingerer we see the threat of losing them.

To the extent that this analysis is correct (and if you think it isn’t I invite you to explain what you think I may be missing), it appears to debunk any flattering assumption that the punishment of malingers is really about justice for all; and grounds it rather in a trivial envy.

The next time somebody suggests in some way that you are a malingerer, you may wish to ask,

“And if I truly were malingering, what would actually bother you about that? Do you really think it’s wrong to misrepresent myself for personal gain? Or are you just envious that I might get away with it?

photo credit: Gage Skidmore Donald Trump via photopin (license).

We Need To Stop Calling Them “Invisible” Disabilities

I’ve noticed that it’s common to say things like “he has a so-called ‘invisible’ disability” with the scare quotes around disability and the phrase so-called as a qualifier. I’m assuming this is done to signal the speaker or writer’s understanding that there’s really nothing about an actual disability that is invisible, especially to the person struggling to cope with it.

But I think we need to up our game a bit with this business of disclaiming the idea that a disability can be invisible. I’m thinking we need to either quit using the expression at all, or brazenly interrupt the conversation in order to pontificate on the real problem, which is that the person with the disability is being judged as unreliable in some sense.

To my view, the problem with this class of disabilities is not at all that they are invisible in some way, but that they are mostly visible to just one person, and that person is just assumed for some reason to be an unreliable witness. The issue at hand is one of patient credibility, not disability “invisibility”.

Now, this is actually not to say that all patients should be simply believed without question. I could say a lot more about that and plan to in a future post, but for now I’ll just clarify that what I’m mainly asserting in this post is that if the problem of these so-called “invisible” disabilities is ever to be solved, it must first be properly understood, and in this case that means recognizing that the core issue is really one of witness credibility or reliability.

As I see it — for now, and until I encounter the sort of evidence that might help me change my mind — the “invisibility” thing is just a distraction.

A Better Way To Handle The Malingering Problem

Here are my current thoughts on what I see as a much better way to at least handle the malingering problem. I wish I could say I think it could solve it entirely, but that’s probably not realistic. People are people, and some people seem utterly incorrigible. But even if the following cannot totally solve the malingering problem, the basic gist strikes me as quite promising, and at the very least I think that pondering this sort of approach out in the open could be productive and eventually lead to whatever the best solution(s) may be. Anyway, here’s what I’m thinking:

  1. Insurance companies should not be allowed to make any of their own claim payment decisions. That is just asking for trouble. Their job is just to design and sell policies, collect claims, etc.
  2. The decision to pay or deny claims should be made by a neutral party, whose job it is to collect the relevant information and make the decision.
  3. Doctors should have the right to prescribe a medical leave, and given such a prescription, the initial, default decision should be to pay the fucking claim. This is totally consistent with the core principle of our Justice system to assume innocence and demand proof of guilt. It is also consistent with the way FMLA claims are processed, where’s it is primarily the doctor who decides.
  4. The doctors should be held accountable for their decisions with random audits, and if the auditors discover evidence of fraud on the part of either the doctor or the patient, that evidence should be brought to the appropriate investigative authorities.
  5. If insurance companies and investors don’t like the profits they can make under this system, they should go into a different line of business. This will motivate the establishment and development of suitable non-profit alternatives.

Aside from putting a lot more power in the hands of doctors to provide the kind of care their patients need, it will also reduce the risk of “fox” bias in the decisions regarding which “chickens to eat”. It will also lower the risk of accidentally punishing an honestly but “invisibly” disabled person for being punished for the fraudulent behavior of others.

I’m sure that a lot more could be said about the above, but I think that’s a good place to start.