It seems like a strange choice. Why fake insanity?
Maybe to get away with a crime, maybe for sympathy. The point is, it happens.
And when it happens, doctors are armed with the knowledge of how to bring it out in the open.
Here were some of those answers.
When They're Laced With
Psychologist, not psychiatrist, but I used to work at the VA as a trauma psychologist. My job had NOTHING to do with whether people got service connected - that was an entirely different process. That said, a small minority of people thought if they could trick me into dxing them with PTSD, they would be rolling in dough. (They would not have been.) The most blatant version of this was someone who had clearly found the DSM criteria online and tried to parrot it back to me without knowing at all what the symptoms meant. At one point this person told me they have "hipper...um...hippervizzilance." (hypervigilance). When I asked them to give me an example, they looked like a deer in the headlights.
I want to stress how small a minority of people this was. Most people I worked with 1) really did have PTSD 2) were extremely distressed by it and had it affecting their lives immensely and 3) wouldn't actually file for service connection because they didn't think they deserved it.
I think Veterans get a lot of flack for filing spurious claims for service connection, but on my side it was a very very small minority who were trying to "pull one over" on people. Most of these men and women just wanted to feel better.
I Can't Believe You Think I Like Attention!
A resident's face fell quite dramatically when I informed them the 'Attention' in ADHD doesn't mean you "like attention".
Not a Psychiatrist, but a secretary for a Psych Ward at a VA Hospital as a college student, who was also trained to be part of the "take-down" team i.e. When a patient gets unruly and non-compliant, we're sent in to safely get them restrained.
One day I came into work expecting it to be a normal day, I immediately hear the code over the comm system for the takedown team to come to room 3. Room 3 is the intake room and where all new patients are seen. We arrive in the room to assess the situation and there are feces spread on the walls, and a man rubbing it all over his chest, completely naked.
We managed to get him restrained without too much hassle, and we are all covered in feces at this point due to him fighting us at first. We get done and him restrained and the doctor on the team asks him, "Why did you feel the need to rub feces all over?", his response:
"I'm homeless, the US Govt. won't take care of me and I want food and a place to stay. The shelters are full and I knew that I could get at least 72 hours of warmth and food by acting crazy."
We gave the man a full two-week treatment stay instead, and had the VA and DAV come in to get him housing. Literally one of the BEST patients I've dealt with while working there from that point forward. Even helping to calm other vets down on the floor before we had to do a takedown.
It's absolutely atrocious that these veterans feel the only way they can get the help they need is to do something this extreme. Last I heard the guy was doing much better, DAV helped him get a job doing clean-up at construction sites and an apartment of his own.
Munchausen's By Proxy
Had a mother come in and INSIST that her child had Silver-Russell syndrome. You can go read on it. It's not that easy to fake, as it's a bunch of metabolic conditions mixed with congenital abnormalities.
The kid was small, but not that small (around 6th percentile). He didn't weight much (5th percentile). All of this, with a right arm length 2 cm more than the left side, were borderline criteria for Silver-Russell. Did genetic testing, which came back negative, but 30% of cases are negative.
So the deciding factor was one of the "soft" criteria of hypoglycemia. Once she heard about this (she printed out 30-40 articles on the disease), she came back with the kid in a coma. But when the kid was in the hospital, he was never hypoglycemic. He went home, and came back in a coma a few weeks later. Again, as soon as he was eating normally at the hospital, he was never hypoglycemic.
She starved her child into comas repeatedly for the diagnosis of Silver-Russell. She was also a "bougon", people who live off welfare and make a game out of it. By the way, she was in a wheelchair when at the hospital. Once I had enough of her BS and walked into the room after only knocking once. She was walking around normally and jumped into the wheelchair as soon as she saw me.
I believe it was for money since in Canada/Quebec, you get money when your child has a genetic disability...
Simple Comforts That All Should Have
Did a psych placement as a student and was in a discharge meeting with this homeless guy. He was brought into the hospital because police had been called as he was threatening to jump off a bridge. He claimed depression and suicidal thoughts, which it was found out not to be. So he said he was hearing voices, which was also not true. Dude was just desperate to have shelter and food. Sad case.
Once Again, Needs Are Important
Not a psychiatrist but I am a psychiatric nurse. We used to have soooo many malingering inpatients. Homeless. Come in suicidal. Would not get out of bed for days except meals. No participation. Denied suicidal ideation for days. Doc then tries to kick them out. All of a sudden screaming about being suicidal and hearing voices. Rinse repeat x100.
We literally had people with 50+ inpatient visits. Revolving door.
That's Not A Real Diagnosis
Sorry for tangent but has anyone else heard someone say "I / my mother / my friend was diagnosed as clinically insane"? I used to hear it all the time in high school, it was trendy. I remember talking to a guy in my year about how I thought I might have bipolar and he was like "don't joke about that stuff. I'm literally clinically insane. Sometimes I go stand in the square in the middle of the city and just scream at the sky."
I had a lady who loooooved attention. She thought she was crazy and had dissociative identity disorder (think the movie Split). Actually, now that I think about it, I saw her around the time that movie came out. She claimed to have many different personalities, one of them where she regresses into a 10 year old boy named Billy.
Anyways, this lady started screaming, tantruming, throwing herself on the floor. Nurses were trying to control her without giving too much attention and feeding into it. She then saw the medical student and the patient told him "TELL DR MACARONI-AND-SNEEZE THAT BILLY IS OUT NOW!" She said this incredibly clear and concise, not in a whining 10 year old tone she was switching in and out of.
The Extreme Solution
I worked as an on call Crisis Worker in a community hospital responding mostly to ER calls. A chronic patient with a borderline personality disorder diagnosis presented with behavior that did not warrant an inpatient hospitalization, despite wanting it. When I was getting his discharge instructions together, he left the exam room he was in and found a cleaning cart and sipped some cleaning solution. I walked into the room and I could smell it and asked what the smell was and he very nonchalantly pointed to the cart and said he didn't know what it was, he drank something off the cart. I think he swished and spit it out, but he got his wish.
Sudden Arrival Of A New Human
A serial killer named Kenneth Bianchi tried to plea insanity during his trial until the prosecution's psychiatrist did this:
At his trial, Bianchi pleaded not guilty by reason of insanity, claiming that another personality, one "Steve Walker", had committed the crimes. He convinced a few expert psychiatrists that he indeed suffered from multiple personality disorder, but investigators brought in their own psychiatrists, mainly Martin Orne. When Orne mentioned to Bianchi that in genuine cases of the disorder, there tends to be three or more personalities, Bianchi promptly created another alias, "Billy".