INDEX OF QUOTES
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How does a care worker know whether a child is malingering or not? This question is perhaps an unfortunate one because of the perjorative connotations of the word "malingering", with its moralistically loaded undertones. The child is thus seen as bad rather than sad. Objectively speaking, malingering suggests a conscious falsification of complaints as opposed to the predominantly unconscious origins of psycho-somatic illness. It may be difficult to assess to what extent, if any, somatic complaints are deliberately fabricated by a child. A more important consideration is what purpose is to be served by such an assessment. If the aim is to identify “malingerers” in order to expose them as liars and frauds, then the care worker will be embarking on an exercise which is not only futile but also counter-productive. Much more important questions for the care worker to consider are “if this child is malingering, why has he/she found it necessary to adopt this maladaptative way of dealing with his/her problems”, and “how can I find ways to try to understand this child better and help him/her to cope more constructively with his/her problems?” This approach does not imply that malingering should be encouraged or reinforced by the care worker. It does, however, suggest that the care worker’s suspicion that a child may be fabricating or exaggerating his/her complaints should not form the basis of a power struggle between the care worker and the child with the child’s body as the arena for the contest. The outcome of such power struggles can only be a defeat for the care worker, the child, and their relationship, with the child who has been upbraided for “putting on an act” either feeling unjustly accused or else believing that he/she will have to try to be more convincing next time. In either case, any possible chance of helping the child with his/her problems will have been lost. On the other hand, if the care worker can indicate to the child that he/she is not unduly concerned about the severity of the child’s complaints without adopting a critical or punitive attitude, the child may gradually come to the realisation that there might be better ways of coping with life’s difficulties than producing physical symptoms. In cases of persistent suspected malingering, it may be necessary for the care worker to adopt quite a firm approach to the child and state clearly that the child will not be allowed to stay away from school, for example. However, even then the care worker’s firmness should not turn into hostility, and at a later stage the opportunity should be created to discuss with the child the circumstances e.g. unhappiness at school, which gave rise to the malingering. |
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