RedFox
Senior Member (Voting Rights)
Recently, I saw an S4ME discussion about a Reddit thread, and in the Reddit thread, a doctor accused people with ME of subconsciously making themselves sick for secondary gain. That inspired me to look up research on malingering. Disturbingly, most papers claim malingering is very common. For example, this paper, Estimated Costs of Malingered Disability, claims around half of people applying for Social Security Disability in the US are malingering.
That's patently absurd and it doesn't align with my experience as a person with chronic illness, and knowing other people with chronic illness. Most people denied SSDI are still not working 5 years later. And I hear many accounts of people with terrible diseases being denied disability.
The "secondary gains" associated with getting SSI or SSDI are pretty slim. SSI benefits are, at most, 75% of the poverty level, the current maximum is $914/month or $10,968 a year. The average SSDI benefit is very low, with most 23.5% of normal SSDI recipients live in poverty, with the "average" (mean?) being $1358.30/mo or $16,300 a year, but the distribution has a significant right skew, so the median is lower. That's equivalent to working full-time (2000 hrs/yr) for $8.15 an hour, which is only 1.12x the $7.25 federal minimum wage and below minimum wage in 30 states. It's 30% of the median wage.
Nobody would quit their job making $50,000 a year, fake their symptoms, and spend potentially years trying to get SSDI, so they could receive a benefit barely above poverty. It would be far easier to just get a low-stress or part-time job.
I'm highly skeptical of the claim that malingering is common because the benefits are small, it's inconsistent with the experiences of people with disabilities, and because patients' claims about their symptoms are essentially unfalsifiable.
Many of the studies are either based on memory tests, or expert opinion. I wonder what flaws could exist in the memory test. And those experts don't have a solid benchmark to go off,, so their decisions are based entirely on their own biases. It's well known (among us, not doctors) that many impairments are inconsistent: They fluctuate, affect some areas of functioning more than others, exhibit uncommon presentations, lack outward signs entirely, have outward signs that aren't commensurate with symptoms, or are of unknown cause. Many doctors will label a patient as malingering because their symptoms are inconsistent, but people with lived experience of chronic illness, or mental illness, know inconsistent symptoms are the norm, not the exception.
If you wanted a more reliable study, you could ask families of people with chronic illness. Statements like, "He only brings his wheelchair to doctor's appointments where he mostly sits, but goes shopping for hours without it" would point at someone exaggerating symptoms, but statements like, "She stopped taking her kids fishing because couldn't stand for long enough" would reinforce the veracity of the patient's claims. However, this method find false negatives if family members conspire with the malingerer, and false positives due to inconsistent symptoms and disbelieving relatives.
That's patently absurd and it doesn't align with my experience as a person with chronic illness, and knowing other people with chronic illness. Most people denied SSDI are still not working 5 years later. And I hear many accounts of people with terrible diseases being denied disability.
The "secondary gains" associated with getting SSI or SSDI are pretty slim. SSI benefits are, at most, 75% of the poverty level, the current maximum is $914/month or $10,968 a year. The average SSDI benefit is very low, with most 23.5% of normal SSDI recipients live in poverty, with the "average" (mean?) being $1358.30/mo or $16,300 a year, but the distribution has a significant right skew, so the median is lower. That's equivalent to working full-time (2000 hrs/yr) for $8.15 an hour, which is only 1.12x the $7.25 federal minimum wage and below minimum wage in 30 states. It's 30% of the median wage.
Nobody would quit their job making $50,000 a year, fake their symptoms, and spend potentially years trying to get SSDI, so they could receive a benefit barely above poverty. It would be far easier to just get a low-stress or part-time job.
I'm highly skeptical of the claim that malingering is common because the benefits are small, it's inconsistent with the experiences of people with disabilities, and because patients' claims about their symptoms are essentially unfalsifiable.
Many of the studies are either based on memory tests, or expert opinion. I wonder what flaws could exist in the memory test. And those experts don't have a solid benchmark to go off,, so their decisions are based entirely on their own biases. It's well known (among us, not doctors) that many impairments are inconsistent: They fluctuate, affect some areas of functioning more than others, exhibit uncommon presentations, lack outward signs entirely, have outward signs that aren't commensurate with symptoms, or are of unknown cause. Many doctors will label a patient as malingering because their symptoms are inconsistent, but people with lived experience of chronic illness, or mental illness, know inconsistent symptoms are the norm, not the exception.
If you wanted a more reliable study, you could ask families of people with chronic illness. Statements like, "He only brings his wheelchair to doctor's appointments where he mostly sits, but goes shopping for hours without it" would point at someone exaggerating symptoms, but statements like, "She stopped taking her kids fishing because couldn't stand for long enough" would reinforce the veracity of the patient's claims. However, this method find false negatives if family members conspire with the malingerer, and false positives due to inconsistent symptoms and disbelieving relatives.
