So…Why Can’t I Use Autism As An Excuse?

No Excuses sign

Image Credit: ShutterStock

Ok, ok, I get it! Really, I do. I cannot — probably must not — use autism as some sort of an excuse.

And I do admit that I have tried to do exactly that, at least a few times in the past year since being diagnosed. One of the more consequential of these took place early last Summer when I tried to explain to a family member why I had recently been fired from my previous job. I’ve lost count of how many times in my life I’ve either gotten fired or quit a job because I knew if I didn’t it was only a matter of time until I got fired. And among the people who know me well enough to know that story, I’m really something of a record holder in that regard. When I started explaining to this individual that I have a hard time controlling my “thought furnace“, and that this has always made it hard for me to do pretty much everything from working to loving, this person cut me off —

“So you blame your diagnosis then?”

The question surprised me –in fact, felt like an ambush of some sort — and I got all jammed up in the head about how to answer. The conversation rapidly veered off into one of the uglier rows I’ve had in a long time, complete with F-bombs from all involved and a subsequent refusal to speak to one another that continues to this day, and which threatens to continue indefinitely.

Because of this experience and a handful of others more or less like it, I have come to understand that “playing the autism card” is probably a bad idea. It probably won’t solve whatever problem I’m hoping it will solve, and this in pretty much any otherwise-apparently relevant situation.

I also admit that I find this quite disappointing. One thing I really enjoy about this diagnosis is that it explains so much about me, my behavior, my personal history. It makes so much sense out of my “thought furnace”, my various learning obsessions, my stalwart commitment to routines, my anxiety problems, etc.. But one thing that I especially love about this diagnosis is that it explains my chronic, lifelong tendency toward all manner of social misfittery — everything from merely boring folks (which happens a lot, apparently), to pestering them, annoying them, frustrating them, and every so often shocking and/or infuriating them (in my defense that happens relatively rarely, but nonetheless far too often for even my own tastes). Especially those latter cases, in which I have to assume that the word most likely used by my adversaries to describe me to others simply must be asshole, I especially like the sense of relief that comes with knowing that I’m not an asshole (gosh darnit); I’m autistic (-ish).

Yeah, sure, wouldn’t that be nice? But apparently it doesn’t work that way. For some reason “playing the autistic card” is a serious no-no, especially in that kind of situation. Yep, I get that now. Really, I do.

But I want to clarify something about that. See, I really do understand that it’s not okay to use autism as an excuse. I really do understand that whenever I try to use autism as an excuse, I’m really just asking for trouble. See, that part is very clear to me. I understand fairly clearly that we have this as a rule, and that if I break this rule I will likely be punished in some way. But, see, what I don’t understand is why this is true. Why do we have this rule?

Why can’t I use autism as an excuse?

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).

Skepticism, Knowledge and Malingering

Man looking skeptical

Image found here.

Never confuse skepticism for knowledge. If I claim to have a disability and you are skeptical of that claim, that does not somehow magically imply that I am faking or exaggerating something.

Of course your skepticism is entirely rational and legitimate, and kudos for that. But simple skepticism is not evidence of anything other than some brain’s rational hunger for actual evidence. If you think otherwise you are badly confused. And especially if you happen to work as a disability-insurance claims investigator, then you are dangerously confused and shouldn’t be allowed anywhere near such an insurance claim.

Skepticism is just a first step toward actual knowledge, and a refusal to take the next one — to scrutinize the real evidence — is the most reckless kind of foolery.

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.

How To Malinger: Lesson From An Expert

“…I always wondered how the “fakers” did it. Like maybe they could give me some helpful hints on how to get the care I needed.”

— King Ben’s Grandma, posted in the comments section of Autism, body awareness, and ‘malingering’ by Laina Eartharcher.

Killdeer bird faking a broken wing

A killdeer faking a broken wing in order lure a predator away from its nest. For more, see the short video after the post. Image found here.

The exercise of writing Towards a Mythology of Malingering helped me parse out from the bloom and the buzz of the disturbing chaos described in part 2 of that post a number of additional minor but potentially useful insights regarding the general problem of malingering. I plan to document each of these in the near future, beginning with the one I’ll just plunk down here for starters, before explaining how I witnessed it in actual use:

A great way to hide your own malingering is to accuse your victims of malingering.

Now, I should probably warn you that what follows might become very confusing for you. You see, I’m about to accuse a billion-dollar, global multinational insurance company (BDGMNIC) of malingering. Also, if you are on the right side of the fence on this issue, there’s an excellent chance that you will find my accusation quite convincing. And if you think too much about that (or even if I just point it out to you), you might start to feel thoroughly confused about which of us — me or this BDGMNIC is the true malingerer.

Now, I actually think such confusion is probably healthy. Yes, absolutely, I think a little skeptical confusion on your part regarding which of us is the real culprit would actually be a good thing. In fact, I would take such confusion as indicating that you really understand the core insight presented in part 1, which I’d like to paraphrase here as follows:

In the absence of actual evidence to settle the issue, and whenever confronted by any given accusation of malingering, an objective, rational observer ought to feel quite skeptical about whether the accusation is really truthful.

See, this skeptical confusion you might begin to feel in a moment (if it hasn’t already started) is like a hunger. The way I see it, this kind of skeptical confusion is basically your brain’s own hunger for a very specific and highly nutritious kind of brain food which usually goes by the name of evidence. It’s like your brain just woke up from a nap, looked around, noticed in the first place that something just happened; noticed next that whatever it was that just happened seems to be important; and then finally formulated the question, “wait a minute, what the heck just happened?!?!

And in that kind of situation actual evidence is really the only kind of brain food that can satisfy that hunger.

And as much as I happen to believe that insurance companies in general are capable of malingering; that they do in fact malinger, and chronically so; that the specific insurance company referred to in Towards a Mythology of Malingering truly did malinger in my own case; and that I definitely did not malinger; the only reason that I truly believe all of that is because I have personally scrutinized the actual evidence.

But you have not. At the moment, all you may have done is read my own narrative about what actually happened — a highly subjective, likely quite biased and self-serving account of the events in question. But that’s not really evidence; or at least, it’s not evidence that is especially strong, or evidence that should be taken at face value. And as much as I feel genuinely grateful for the sympathy you may have felt for me and my family for what we all endured in the clutches of that evil Insurance dragon, in the interest of full disclosure I feel I should point out to you that the elicitation and exploitation of such sympathy is exactly the goal of true malingerers. In part 1 of my narrative I used the phrase sympathy vampire, which I think is an excellent way to conceptualize the animal in question. And if what I’m about to tell you causes you to feel a little disoriented and to start squinting at the possibility that I might actually be such a parasite, I encourage you to value and nurture that sense of dizziness, because to my view there is far too little of it in the world, and not just as regards the problem of malingering. I think it is generally true and also generally quite dangerous that so relatively few of us seem willing to stew for a while in our own skeptical confusion, so quick to cling to whatever soothing dogma happens to be floating near us in the deep-water lake of Life. That skeptical confusion is a kind of resource — easily converted into Curiosity rocket-fuel, a powerful urge to learn. And I think that’s a good thing, for the most part.

But vampires are mythological creatures, which is to say that whatever their basis in reality, they are for the most part fictional beings. Like a large and beautiful pearl that has formed around a much smaller and quite ordinary looking granule of sand, the pearl part, whatever its attributes, actually has very little in common with the quartz granule. Yes, there really are animals and insects that eat blood — bats, mosquitoes, fleas, etc. But none of these is actually immortal; none is actually without reflection before a mirror. And I think that a sympathy vampire, a true malingerer, is a lot like that — which is to say, much of a myth.

Yes, yes, of course human beings can and do cheat. I’m certainly not suggesting that actual malingering is impossible or even infrequent. On the contrary in fact, I’m quite sure that there is a rather good deal of malingering that happens. But if anybody is so afraid of a mosquitoes that he goes around shooting at them with a shotgun; blasting away at them left, right and center with no concern for the legs, arms and ears of the creatures (human or otherwise) upon which these tiny bloodsuckers happen to be feeding at the moment, then such an individual has mythologized mosquitoes in a dangerous way, and that mythology needs to be debunked. And I believe that this aptly characterizes the general problem of malingering. Yes, malingering is a real phenomenon, a genuine problem, and one we would do well to try and solve, but I for one am wholly unimpressed with the current standard ways of solving it — especially with the ways that insurance companies try to solve it, which seem to me not at all unlike the solution implemented by our shotgun-happy skeeterphobe from a few sentences ago.

The fact is that some solutions are worse than the problems they are meant to solve, and some problems make tolerable solutions where the alternatives simply cannot be tolerated. This dour but fundamental fact about the way things really work seems to be a moldy crust of bread for many, no matter how hungry they are. But a fact it is, and a refusal to face it is occasionally disastrous, which I think is an apt comment to make about the general problem of malingering.

In any case, in order to illustrate this sneaky, dastardly way to camouflage one’s own malingering , we need to return to my own narrative and examine one additional piece of the story, which is the explanation given to me by the BDGMNIC for why they rejected my short-term disability claim, both initially and following the appeal review. Let me start by quoting the very last sentence in the appeal review report, prepared by the company’s Senior Psychiatric Medical Director, a man with both an MD and a JD (he’s both a doctor and a lawyer):

The file does not contain incapacitating clinical observations, abnormal mental status exam findings, or other explicit evidence of psychiatric symptoms that are more reliably associated with impairment, such as psychomotor abnormalities, mood lability, difficulties with reality testing, etc. to support functional impairments due to the psychiatric conditions for the period of review.

In other words, the good doctor looked in my file and simply did not see any reliable evidence of impairment. How else might we say that? We could say that he looked for it in the file, but didn’t find it there. We might also say that he listened for it, but didn’t hear it. Or maybe he sniffed and groped around for it, but neither smelt nor felt it. More generally, the good doctor detected no such evidence. But really, I think the most common way to put it is that he did not see it in the file.

And why not? Well, I know for a fact that it was there. My doctor and I were completely transparent with the company, shared with them my entire medical file, including all of my doctor’s session notes. And I know for a fact that my own doctor looked at the exact same evidence, and did see it, which is exactly why he prescribed the medical leave for me in the first place. So, if this lawyer-doctor didn’t see it, then it can only be because the poor man is suffering from a kind of blindness. In the same way that some people can’t see certain colors, this man is simply unable to see certain kinds of evidence — coincidentally that particular kind of evidence that might justify paying out short-term disability claims. We might call this kind of visual impairment evidence-blindness, which under most circumstances is surely a disability that causes serious problems for anyone who suffers from it, not to mention anybody else whose well-being might depend on certain evidence being seen.

But in this case, the doctor-lawyer has been able to turn his weakness into a strength. He has figured out a way to convert his evidence-blindness into real personal asset, what I can only imagine must be a very lucrative kind of super-ability. I bet he’s a real hero around the office, defending his employer — this poor, defenseless billion-dollar, global multinational insurance company — from having to pay all those pesky disability claims. Good for him.

Ok, ok, I’m sure you get it. Yes, I’m an autistic person who understands and knows how to use sarcasm. And FYI, I’m not the only one either, so how about we all let go of that particular stereotype, shall we?

No, this man is not really “evidence-blind”. And here’s the point of all of this: Make no mistake: this doctor is malingering, and I mean that quite literally. This is not a metaphor. He is literally faking this so-called “evidence-blindness”, this inability to see exactly the kind of evidence that would justify a claim payment. That is textbook malingering. Furthermore, the only reason an insurance company hired him is because he’s really, really good at it — a highly skilled malingering expert, who knows exactly what he’s doing, and one of the things he’s doing is accusing his victims of malingering. And he’s doing it precisely because he knows its a wonderful way to hide his own malingering.

I hope that’s useful in some way. And if you are feeling that skeptical confusion I mentioned earlier, if you are perhaps squinting at both me and that doctor and trying to figure out which one of us is the real malingerer, which of us is the “expert” referred to in the title, here’s what I suggest:

Although it really does matter to me personally that you eventually come to believe that I am really not a malingerer, but rather a survivor of the doctor’s malingering (and by extension, the malingering of the BDGMNIC), I’m more than happy to wait while you carefully review the actual evidence for yourself — to the extent that such evidence is or eventually becomes available to you — and make up your own mind, if ever you are even able to accomplish that. And as far as the basic “lesson” of this post is concerned, to my view it really does not matter one whit which way you are leaning on this issue for now. As far as the above insight is concerned, please feel free to just pick one of us as the culprit, and then move on to pondering how you might find some use for this idea that a great way to hide your own malingering is to accuse your victims of malingering. Of course, I hope you won’t actually try to exploit this insight in order to malinger, but I am hoping it may come in handy if you ever need to protect yourself from the malingering of somebody else.

Please share your success stories below (or any other comments you wish to share).

Oh, and check out this short YouTube video of a killdeer faking a broken wing in order to lure a predator away from its nest. Now that’s a true expert malingerer!




Towards a Mythology of Malingering — Part 3

Aztec calendar of the Sun

Image found here.

The exercise of writing part 1 and part 2 of this post has led me to a few additional minor but potentially useful insights that I plan to share with you in future posts, but before I get to those, I need first to address the promise I made at the end of part 2 to explain just how the somewhat-perhaps anti-climatic “insight” documented in part 1, which is to say that,

Any given accusation of malingering is almost nothing like any sort of proof of its own truth, all else being equal

is illustrated by the events related in part 2 — that time I got punished for malingering by a billion-dollar, global multi-national insurance company.

I say “address” because after mulling for several days over just how to actually fulfill that promise, I regret to say that for now at least I don’t know how to do that, or at least, how to do it any better than I think I already have. See, from my perspective, whenever I ponder what happened last year with that insurance company, I just sort of understand automatically that this issue of malingering is weird, or maybe a little confusing, or perhaps mysterious, or puzzling, or troubling — one way or another, not really at all what it appears to be. And I’m pretty sure that what I mean by that is quite adequately captured by this idea that an accusation of malingering by itself — in the absence of real evidence — should do very little persuasion work on its own. For me, this process is quite automatic and intuitive. It just seems perfectly obvious to me, like the way that I know that I have two hands simply by looking at them and seeing that I have two of them, one at the end of each arm. When I review the events of Part 2, I just know by inspection that one should be a good deal more skeptical of any given accusation of malingering than tends to happen. And for now at least I don’t know how to do a better job of explaining what the one has to do with the other. It’s just obvious to me.

As I see it, the situation with malingering is like the situation regarding a Sun god. Is there a Sun god? Well, of course, there is a Sun, so in that sense, yes, sort of, there is definitely a Sun god. But is the Sun actually a god? Yeah, about that, I don’t know about you, but I’m leaning heavily toward the “no” side of that conversation.

In a similar way, one can ask “does malingering ever actually happen?”, to which I feel confident that the answer is “yes, of course it does”, but after having lived through the events of last year, I am now of the mind that if all I know about a given putative instance of malingering is that Mr. Jones, for example, has accused Mr. Smith of the misdeed, then in that situation I’m inclined to lean a lot more heavily toward the “maybe” side of that conversation. Although, yes, of course I agree that malingering is possible in principle, I am also now inclined to think that there is a lot less of it than people seem to realize. When it comes to the general situation of malingering, I think a good deal of it is mythological.

But is that what you think, more or less? When you read part 2, did you just automatically understand what I mean by the insight of part 1? Whether you did or did not, I hope you will share your thoughts with me below. Especially if you think I’m copping out and could do a better job of explaining the connection.

Thanks for reading all of this, and thank you especially for the encouraging feedback you’ve already offered or may be planning to offer. In future posts I will document the additional insights I’ve achieved through the exercise of writing the three parts of this post. As I write them, I’ll add links for them here.