Stereotypes of malingering : a descriptive study

The purpose of this study was to examine stereotypes and perceptions of the behavior of malingering with particular focus on the feigning of mental illness in the context of the insanity defense. A structured, nonschedule interview was developed to elicit descriptions of subjects' perceptions of malingering behavior in general and in the hypothetical context of an insanity defense. Their experience with malingering behavior and their knowledge and opinions of aspects of the criminal justice system dealing with the insanity defense were elicited. Four subject groups with a total of 70 subjects were interviewed. This included 23 criminal, 15 lay/juror, 16 mental health, and 16 legal subjects. Interview responses were scored according to a checklist composed of most frequent responses; a reliability check on scoring was conducted by an independent scorer.

Subject groups were found to have stereotypes of malingering which corresponded with their actual experiences with such behavior. Criminal subjects associate malingering with inmates manipulating the Correctional system. Juror subjects associate it with people in general trying to avoid responsibilities and obligations. Mental health and legal professionals associate it with criminal defendants trying to somehow help their case. Stereotypes of feigning mental illness in the hypothetical situation of a defendant trying to malinger an insanity defense differ among the four groups in terms of when and how that would happen. The prevalent opinion is that malingering would be most likely to occur in the case of someone facing serious felony charges and/or a long prison sentence. Criminal and juror subjects expect that a malingerer would present obviously bizarre symptomatology. The two professional groups expect claims of amnesia/blackouts and hallucinations/delusions to be asserted. Descriptions of personal simulation of illness by criminal and juror subjects consisted primarily of attempts to avoid some responsibility by claiming a common physical symptom such as a cold or stomachache. A total of six episodes of personally faking mental symptom-atology were described by four criminal subjects.

Subject groups differed in the accuracy of estimations of the frequency of use and success of the insanity defense and the criteria for not-guilty-by-reason-of-insanity adjudications, with professional groups giving more accurate responses than criminal and juror groups. Relationships were also found between accuracy of knowledge of the defense and the nature of recommendations made for its modification. Overall the impression was conveyed that subjects think there is a need for the insanity defense and for the role of the mental health expert witness therein, but there is also dissatisfaction with both particularly among the criminal and juror subjects. A correlation was also found between perceptions of the use of the insanity defense and the question of whether malingering is an issue for concern. Finally, in general, malingering mental illness in the context of the insanity defense is considered by the majority of criminal and juror subjects as an issue for concern and by the majority of professional subjects as not needing further attention and/or concern.

Limitations in terms of number and representativeness of subjects and inherent difficulties with the open-ended interview format are presented. Implications in terms of influence upon decision-making regarding the insanity defense are discussed.