Yes, can you? Someone has allegedly got himself discharged from the army by feigning depression.
Many Singaporeans would have taken the person’s Facebook confession with a pinch of salt.
“Not easy to feign depression,” said Ang Yong Guan, a retired military psychiatrist who had served in the Singapore Armed Forces for more than 17 years.
To distinguish between the genuine and the feigned, Ang said that it is important to look for consistency in the symptoms of depression.
Symptoms include persistent negative thoughts and emotions, bodily discomfort like insomnia and tightness in the chest, and even suicidal tendencies. Negative thoughts and emotions are mutually reinforcing, causing many patients to lapse into chronic depression, where they become vulnerable to suicidal thoughts.
“Anything that is not in keeping with this depressive picture here, we will suspect that you are not telling the truth,” said Ang.
The patient’s verbal account is first compared with feedback from his colleagues, family and friends to verify its authenticity.
But what if a malingerer’s entire social circle colludes to weave a flawless story of a loved one trapped in depression?
“Then we will rely on the mental state examination,” he said.
One example of the mental state examination involves asking the patient a simple mathematics question.
“Then we will review him again in a week’s time. If the week before he could say eight times eight gives 64, but this week he scratches his head and says 63, then that’s what we are looking for—inconsistencies,” he said.
“Depression will not cause you to forget what you learned in school long ago,” he added.
Head of Counselling Services at Singapore Association of Mental Health, Voon Yen Sing, also said that it is difficult to fake depression because they may not be familiar with the “full range of depressive symptoms”.
“There is a difference between depression as an emotion and depression as a condition,” said Voon.
The Institute of Mental Health declined to comment.
Analysing a patient’s background can also help to verify a patient’s claim to being depressed.
He said: “Say you are a recruit coming to me claiming you are depressed. I will check with your trainers how you have been in camp and I will study your school records. If you were a prefect, represented your school in football, or played a leadership role in the school committee, then obviously I would be quite guarded about your claim.”
“But if you don’t have any extra-curricular activity and you are basically a very quiet person — you are always very anxious, you have sweaty palms and a high pulse rate, then I would think this guy is a nervous wreck and is likely to suffer from depression,” he added.
While Ang acknowledged that psychiatry is an “inexact science”, where there are “no blood tests and medical scans” to ascertain depression, he argues that it is nonetheless difficult to feign depression because all accounts given by his family, friends and colleagues have to be rigorously examined by psychiatrists to ensure that they are corroborative.
Ang revealed that as a military psychiatrist, he was often torn between his duty as a doctor and his duty as a military officer.
“On the one hand, I am a doctor trying to treat depression and to care for you. On the other hand, I am an officer trying to enforce discipline,” he said.
“When you are trying to expose malingerers, the military doctor is always in a dilemma.”