Train medical officers to tell mentally ill from malingerers

The transition from civilian life to a uniformed one in the Singapore Armed Forces (SAF) is a challenging and somewhat traumatic time, but almost all Singaporean males adapt well after some uncomfortable settling-in moments ("Do more to help soldiers in their mental health" by Mr John Lim Le Sheng; Feb 1).

The strawberry generation is far tougher than we think.

There will always be malingerers hiding behind psychotic and neurotic disorders, feigning delusions and hallucinations.

As a group, they do a big disservice to the SAF, as much professional time and resources are needed to weed them out from genuine sufferers.

It does not help that many junior doctors are at the frontline, diagnosing or misdiagnosing psychiatric and malingering cases.

Doctors need to be far more objectively critical and less accepting of a clinical impression, as they are for normal physical ailments.

While missing a diagnosis of a genuine case may lead to tragic consequences, ascribing mental illness to a malingerer often leads to the doctor becoming a laughing stock in the barracks, and surges in attendance at the medical centre by those trying their luck in fooling him.

A young, freshly graduated doctor can have his whole professional career ruined with one wrong stroke of the pen.

While he can expediently refer all cases, pertinently or otherwise, to tertiary institutions for reassessment, such a strategy disrupts army training unacceptably, and the doctor faces the ire of the commanding officer.

Increasing understanding of mental illness among enlistees may help alleviate the problem, but it can be a double-edged sword, as those intent on conning can learn to game the system and malinger more "professionally".

Other than the short stint medical students must do in institutions of mental health, all army medical officers should also attend a well structured and detailed course by psychiatrists and psychologists on the recognition of malingering and its differentiation from true psychosomatic and psychiatric conditions.

Yik Keng Yeong (Dr)

A version of this article appeared in the print edition of The Straits Times on February 02, 2017, with the headline 'Train medical officers to tell mentally ill from malingerers'. Print Edition | Subscribe