How can you tell if someone is faking schizophrenia?

Jack Nicholson Loughner

In medicine, it’s called “malingering” if a patient is trying to deceive someone by faking, feigning or exaggerating symptoms.

Doctors try to discover fakers the same way that people good at detecting lies discover liars. They look for inconsistencies, or things that don’t quite match.

For instance, if a supposed schizophrenic can tell you clearly and without confusion that they’re extremely confused, their actions don’t correspond with what they are saying. A very confused person can’t clearly say how confused they are.

Or, if they act mentally disorganized while talking with a psychiatrist, yet later they can play chess with another patient, something doesn’t match.

It’s considered an advanced skill to detect a malingering schizophrenic, because a psychiatrist must know in detail the difference between real and fake psychotic symptoms.

So how do doctors catch the fakers?

A malingerer is like an beginning actor who’s overacting. A beginning actor may try to play a drunk person by slurring every word and swaying and falling down, but an experienced actor knows what a drunk is like, and plays the drunk as someone who is drunk, but is trying to act normal.

Many people who try to fake a mental illness try to “play crazy.”

A faker will try to make their illness front and center, and make their psychosis the first thing they want to discuss, while a real patient will be reluctant to explain their symptoms.

A faker will be hostile and act as if nobody believes him or her, which is rare in genuine psychotics.

A faker will act stupider than they should be, not realizing that intelligence will not diminish just because he or she is psychotic.

Fakers will be vague about details. Instead of saying that a voice was male or female, the faker might say “I don’t know.” Real psychotics would know the answer.

It’s also difficult to fake certain schizophrenic symptoms, such as getting off track while speaking, coining new words, finding associations between unrelated things, or speech which is so disorganized that at first it sounds correct but which actually makes no sense.

In acting, a beginning actor will keep trying to add things to a performance. To play the emotion “sad,” a bad actor will add heavy sighs and crying, while a good actor will subtract emotion, such as letting the character smile just a little, but making it a tight smile with no happiness showing around the eyes.

An inexperienced faker will do the same, by adding symptoms of “craziness,” forgetting that there are also many things that get subtracted from an individual with schizophrenia.

Faking it: How to detect malingered psychosis - Feigned schizophrenia symptoms usually won’t deceive the clinician who watches for clues and is skilled in recognizing the real thing, The Journal of Family Practice>>