Self-Fulfilling Fakery: Feigning Mental Illness Is a Form of Self-Deception

By pretending to be sick, people can convince themselves they really are















Share on Tumblr

In a second experiment the researchers asked a group of 28 different undergrads to complete the Symptom Checklist-90 (SCL-90)—a 90-item self-report survey of general psychiatric stress, including difficulty concentrating, social anxiety, depression, sadness and panic attacks as well as somatic symptoms like headaches. Participants rated how frequently they experienced each item using a five-point scale, where 0 meant "not at all," 2 meant "occasionally" and 4 meant "all the time".

Once more, the experimenters had undergrads busy themselves with sudoku puzzles after completing the survey—but this time the researchers secretly changed some of the participants' answers while they were distracted. Specifically, the researchers manipulated two items: one about concentration difficulties and another about social anxiety, increasing low scores by two scale points or decreasing scores by two points if the participant had circled a 3 ("a lot") or 4.

Then the experimenters returned the answer sheets to the undergraduates and asked them to explain their scores on 10 items, including the two tweaked answers. Fifty-seven percent of the subjects failed to notice both manipulated answers, and more than two thirds of the subjects justified scores they had never actually reported. For example, if the researchers had switched a participant's original score on concentration difficulties from 0 to 2, the participant would explain the answer by citing an excess of coffee or anxiety about exams. The experimenters subsequently provided the participants with an abbreviated 30-item version of SCL-90 and found that on the second time around people who had justified their manipulated answers filled out the SCL-90 in the direction of the manipulation. Although this shift was statistically significant, Merckelbach and his colleagues would like to independently confirm it with more research, they noted in their study.

"If you play the role of having a disease, then at some point the symptoms may become very real to you," Merckelbach says, adding that the progression from purposefully faking symptoms to truly believing them could be exacerbated by doctor–patient relationships. "For example, when you talk about whiplash or chronic fatigue disorder, you can imagine a patient who starts out playing these symptoms, but when he is asked by a physician, 'Do you also have this or that?' and the questions are posed over and over again, the patient may lose sight of the fact the they are playing a role."

Loftus thinks the new study also shows how people can delude themselves. "The second experiment is more like the misinformation experiments I have done," Loftus said, referring to studies in which intentionally manipulative questions affected people's memory of footage from a car accident. "They don't know they are being deceived. But this study shows you can deceive yourself, too. In the first experiment, they [the participants] know they are deliberately faking. It's like a lie—a kind of a lie. But later on, they don't stop lying, even though they know they don't need to. They've deceived themselves."

Both Merckelbach and Loftus think the recent study is particularly relevant to malingering in legal procedures—when people feign illness or injury for a specific personal gain, like decreased criminal responsibility or increased financial compensation. Merckelbach drew inspiration for the study from the 20th-century Russian playwright Leonid Andreyev's The Dilemma, in which a character who malingers a disease eventually develops the symptoms that he faked. "Andreyev was the first to describe this phenomenon, and he was a court reporter," Merckelbach says. "He may have seen it with his own eyes."



13 Comments

Add Comment
View
  1. 1. PLING 04:03 PM 7/28/10

    As a Clinical hypnotherapist one thing we get people to do is to do a lot of positive imagery, so this thinking yourself well has been going on for years...

    Reply | Report Abuse | Link to this
  2. 2. bongobimbo 04:45 PM 7/28/10

    This is a slippery slope toward charlatanism! Encouraging positive imagery doesn't have to be dishonest since everyone has strong points, but I would draw the line at a psychologist faking a patient's strengths through lying and manipulation of questonnaire answers. In fact, that might be something a healer could (and should) be sued for doing, whatever the therapeutic results. I'm not a physician, but how would lies fit into the guidelines of the Hippocratic Oath?

    I remember faking a Ninth Grade attitude (not aptitude) test we all had to take. It was big on rating ourselves for intro- and extraversion. I was a great reader of "loner" adventure stories from Natty Bumppo to Raymond Chandler to sci-fi heroes. Although an ordunary ambivert who loved parties as much as reading, ambivert seemed too ordinary so I skewed my responses toward rather extreme introversion. For some reason that got it out of system and from then on it was a lot more fun to cultivate ny extraversion! Not exactly the result these researchers got.

    Doesn't this article describe many different kinds of hypochondria, not just mental? Practically everyone has at least a slight tendency to exaggerate worries about health, I'd imagine, just as everyone benefits now and then from the placebo effect. But I wouldn't want psychologists or physicians faking "positive thinking"! I shudder to think that they would encourage New Agers who already believe they can psych or natural-remedy themselves to good health and suddenly find out it's too late to treat a metastasized cancer . It ain't all in the head! (I never liked Norman Vincent Peale anyhow.)

    Reply | Report Abuse | Link to this
  3. 3. Rohbiwan 07:45 PM 7/28/10

    I find it amazing that people might think this wasn't the case. A person can convince themselves of anything, given the time and I am sure many of you would agree that while you won't stop a metastasized cancer from spreading, it could help you lose weight, sleep, and generally feel better (or worse if that is the choice).

    We know happier people live longer... that should tell you something.

    Reply | Report Abuse | Link to this
  4. 4. KamranBehzad 03:15 AM 7/29/10

    Whether we like it or not "fake it till you make it" has a lot of merit both for faking negatives in our life or the positives. The faking creates a feedback loop that propagates itself.

    But as rightly pointed out, this has its limitations. It does not cure cancer, though it can help the procedure. For those familiar with the AQAL concept of Ken Wilber, this faking, or positive imagery is only half the story belonging to the left hand side of the quadrants. What the" new-age"ians miss, is that to complete the picture we need the AQAL (All Quadrants All Levels) approach where the external scientific observations and actions of the right-hand side quadrants (external medical observation, scrutiny and application) are also required for a full recovery.

    As long as we are aware of this, we do not need to deny "positive imagery" advice.

    Last but not least: even Norman Vincent Peale has admitted he is not such a positive person after all. His book was to compensate for the negative aspects of himself he had disowned. We are all a bit of both.

    Reply | Report Abuse | Link to this
  5. 5. Lawrence Patihis 11:13 PM 7/29/10

    I think this also shows the power of even a false diagnosis, and how it can lead to an incorporation into the self concept.

    Reply | Report Abuse | Link to this
  6. 6. cecilia@eyes-wide.com in reply to bongobimbo 06:20 PM 7/30/10

    Re: bongobimbo 7/28/10

    Very good points raised. In fact there is now a suggestion to take "intention" out of criminal justice, as people can lie and believe themselves. The article in the 1/12/10 issue of PNAS (www.pnas.org), The Lucretian Swerve, provides proof that "Free Will" does not exist from a neurobiological viewpoint. And if people are really just "bags of molecules" that can be manipulated, our justice system should change the basis for punishment.

    Reply | Report Abuse | Link to this
  7. 7. stylendelivery 12:28 PM 8/3/10

    This is a very interesting read. Science is all about evidence. Based on the research and studies performed, it shows that there is a significant change in the group that constantly lied about their symptoms and a consistency in those who weren't. I truly believe that you are who you make yourself to be. I came from a country where PSYCHOLOGY does not exist. Labeling individuals with disorders does not exist. No one in my country believes that they are sick of something such as depression, anxiety, panic attacks etc... because there are no Psychiatrist or Psychologist to label them with such type of disorders. Additionally, the media does not talk about such things since again, this does not exist. The people of this country does not have knowledge in these kind of disorders, therefore, they can't label nor fool themselves from having experienced such symptoms. Now, this leaves me questioning if CULTURE have a huge impact on this? How about MORALITY?

    Reply | Report Abuse | Link to this
  8. 8. royniles 02:55 PM 8/5/10

    If you examine symptoms of something you'd never considered before, it's hard to forget that you then saw a bit of those behavioral aspects in yourself.

    Reply | Report Abuse | Link to this
  9. 9. FaithC 11:47 AM 8/9/10

    I just need to clear something up:
    >The experimenters told all participants to pretend they were the defendant in the story and complete a 75-item true-or-false self-report survey

    and then:

    >The group that initially reported their symptoms honestly hardly changed their answers

    I thought all participants reported as the defendant at first?

    Reply | Report Abuse | Link to this
  10. 10. FaithC 11:50 AM 8/9/10

    I just need to clear something up:
    >The experimenters told all participants to pretend they were the defendant in the story and complete a 75-item true-or-false self-report survey

    and then:

    >The group that initially reported their symptoms honestly hardly changed their answers

    I thought all participants initially filled out the survey as the defendant?

    Reply | Report Abuse | Link to this
  11. 11. MaryCS 10:57 AM 10/5/10

    In my experience, providing respite care for cognitively challenged individuals, I have born personal witness to both sides of this coin. The power of positive thinking comes to mind, which was determined by some to be a half thought out treatment. I was happy to find this method had advanced with books like "What to say when you talk to yourself". Helmstetter brought us a more complete therapeutic understanding/process for those desiring positive thinking methods. Which, I believe, in conjunction with other types of treatment, can be very effective in resolving a variety of psychiatric issues.

    I am skeptical though,especially with the rise of diagnoses, such as "Borderline Personality Disorder", I believe this one is dangerous. The affect of "faking good" used to resolve the symptoms of BPD is literally a person who convinces themselves they are good while their behaviors typically fail to follow. Really, many Axis II diagnosis is prone to thinking of themselves, as a general rule, as "good", which they relieve themselves of responsibility for how they treat others.
    Mine truly is a layman's view. I think this is a good topic to discuss with the friends I have who actually work in the field of Psychology/Psychiatry. Interesting comments on this article. It does give me something to ponder.

    Reply | Report Abuse | Link to this
  12. 12. NYNYAnnie 10:12 AM 7/17/12

    When I was a kid, my mother was diagnosed with multiple personality disorder, one of the most infamous iatrogenic psychiatric conditions. It was definitely the case that the longer she behaved in a certain way, the worse her "illness" became.

    However, I think that, for my mother, these symptoms were a form of communication with her doctors. I believe she was actually mentally ill (thought not with multiple personalities), and the psychiatrists essentially told her, "people who are distressed do such and such and experience these things."

    In our case, the DSM was like a Psychologeese-to-English dictionary. It was instructions in how to communicate mental distress in a way the doctors could understand.

    But, once the symptoms were established they were hard habits to break, especially because they were extreme and led to loss of relationships, family problems, etc. So, they became real. And, the distress increased.

    Role playing is really very powerful. Not only did my mother start speaking in baby voices, but the rest of the family played roles, for example the kids pretending to be parents to my mother's "child" alters. The doctors also played roles -- they affected thoughtful, Yoda-like, fakey personalities. We were all like actors in a bizarre and sick play. But it was real for a long time. The US Taxpayers footed the bill for my mother's treatment, which was at least hundreds of thousands of dollars, maybe more. So, role playing has real consequences.

    Reply | Report Abuse | Link to this
  13. 13. desperatelydeluded 08:37 PM 9/12/12

    Hello. I hope somebody can help me or point me in the right direction. When i was younger i experienced a psychosis ever since then i have been terrified of going into a psychosis again. I also carry alot of guilt from it around with me. Because of this psychosis happening so early on in my life i have been convincing myself ever since that i am somewhat "destined" to end up mentally ill. Lately i have been signed off work by the doctor with depression but i feel i am wholly responsible for this depression happening to me and that i have essentially convinced myself of being depressed when perhaps if i just tried a little harder i wouldn't be in this situation right now. Not only have i (do i) suffer from debilitating spells of depression i also have episodes of feeling very special and good about myself.This sounds like bipolar disorder but i really don't know. I am becoming ever so confused. Please help me, somebody.

    Reply | Report Abuse | Link to this
Leave this field empty

Add a Comment

You must sign in or register as a ScientificAmerican.com member to submit a comment.
Click one of the buttons below to register using an existing Social Account.

More from Scientific American

Follow Us:

See what we're tweeting about

Scientific American MIND

More »

Free Newsletters


Get the best from Scientific American in your inbox

Solve Innovation Challenges

Powered By: Innocentive

  SA Digital
  SA Digital

Science Jobs of the Week

Email this Article

Self-Fulfilling Fakery: Feigning Mental Illness Is a Form of Self-Deception

X
Scientific American Mind

Subscribe Today

Save 66% off the cover price and get a free gift!

Learn More >>

X

Please Log In

Forgot: Password

X

Account Linking

Welcome, . Do you have an existing ScientificAmerican.com account?

Yes, please link my existing account with for quick, secure access.



Forgot Password?

No, I would like to create a new account with my profile information.

Create Account
X

Report Abuse

Are you sure?

X

Institutional Access

It has been identified that the institution you are trying to access this article from has institutional site license access to Scientific American on nature.com. To access this article in its entirety through site license access, click below.

Site license access
X

Error

X

Share this Article

X