تمارض در سیستم تادیبی: آیا انگیزه برآن تاثیر دارد؟

Incentives to malinger vary greatly dependent on the context, as does the prevalence. Malingering in the medico-legal context of the criminal courts is generally for one of two purposes: to present as incompetent to stand trial or to successfully plead not guilty by reason of insanity. Estimates of the prevalence of malingering in these contexts vary between 8 and 21%. The prevalence of malingering increases dramatically in a general offender sample, where the external incentive is likely to be substantially different. Malingering in this context can be as high as 56% and generally occurs to obtain a more desirable housing situation or desired medications. Our study examined data from two distinct samples to evaluate incentives to malinger: patients found incompetent to stand trial (IST) and sent to a state hospital for restoration and jail inmates seeking psychiatric services (JPS). Our results indicate that the rate of malingering in the IST sample was consistent with rates published in comparable samples (17.5%) and the rate for the JPS sample was substantially higher (64.5%). Only in the IST sample was rate of malingering associated with offense severity: patients found IST for murder and robbery evidenced malingering rates more than double the sample as a whole. Offense severity bore no relationship to malingering in the JPS sample.

The malingering of mental illness for external incentive has been recognized for centuries. Odysseus feigned madness to avoid going to the Trojan War; Hamlet feigned madness to avenge the murder of his father; more recently, and with an external incentive commonly seen in forensic psychology, Randle McMurphy, the protagonist in “One Flew over the Cuckoo's Nest” feigned insanity to serve his sentence for statutory rape in a psychiatric hospital. Feigning is often used interchangeably with malingering although in fact the two concepts are different. According to the American Heritage dictionary, feigning is defined as “to represent falsely; to imitate so as to deceive” (Feigning, 2011) whereas malingering means “to feign illness or other incapacity in order to avoid duty or work” (Malingering, 2011). Other than deception, there is no inherent motivation contained in the definition of feigning. Some authors (Heilbronner et al., 2009 and McCullumsmith and Ford, 2011) discuss the distinction between feigning and malingering in terms of the difference between detection and diagnosis. A clinician may know that a symptom is falsely produced (detection), but in order to diagnose (malingering), the external incentive for that production must be elucidated.