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.


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:

Towards a Mythology of Malingering — Part 1

malinger (intransitive verb): to pretend or exaggerate incapacity or illness (as to avoid duty or work).

  • His boss suspected him of malingering because of his frequent absences from work.

— from Merriam-Webster’s Dictionary

I have been accused of malingering — of acting like some sort of sympathy vampire; of faking it, more or less, and in order to profit from the compassion of others. I have been accused, more than once and by several different people, including a couple of family members.

I find these accusations quite disturbing. They make me feel anxious, and if I’m not careful, I can get quite worked up and even feel some fairly intense anger about them too, although through honest introspection I can see that my anger in these situations is secondary and fundamentally anesthetic. It’s only purpose really is to help me cope, however dysfunctionally, with the more primary anxiety I feel in response to these accusations.

For me this anxiety is like a gasoline spill into my “thought furnace“, which is to say that it can pitch me into an autistically obsessive solution search apropos the problem of these accusations — the problem of how best to respond to them, how best to debunk them, how to defend myself against them. I wish I could tell you that my autistic neurology has succeeded — finally solved that particular problem, but unfortunately it has not…at least, not yet.

But I have made a little progress, gained a little insight — just a little. I have had a micro-epiphany, potentially useful, I hope, and would like to document it here, on the chance that it may prove useful to others, or perhaps even invite collaborators to this general project.

The upshot is this: all else being equal, an accusation of malingering is only weak evidence of its own truth.

(Here’s some dramatic music for emphasis:)

Did you know that already? I know it seems perfectly obvious to me now, but it wasn’t always, for some reason, and I have only recently come to realize it myself, and this only after thinking the shit out of it. And I suspect that most people do not understand this about malingering. I suspect that most people subscribe to the myth that we humans have such a good grasp on reality, that the human brain and perceptual apparatus function so well and are so veridical, that whenever, say, Mr. Jones accuses Mr. Smith of malingering, then it’s a safe bet that Mr. Smith has indeed malingered.

To my view, that is a myth.

To be clear, I am absolutely not claiming here that malingering itself is a myth. Nor am I claiming in general that all accusations of malingering are somehow false; nor even in particular that my own accusers were wrong (even though I do actually think they were wrong). To put it another way, what I mean here is that in the absence of any other supporting evidence, there’s really an excellent chance that any given accusation of malingering is false, especially when the accuser stands to profit from being believed.

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!

(Cue that music again:)

End of Part 1. Here is a link to Towards a Mythology of Malingering — Part 2.