This, as the saying goes, is a different kettle of fish, and there appears to be little to no published data about them. 10 A recent report by Coristine and colleagues 18 describes an interesting approach to triaging such patients more effectively.Įmergency clinicians face an even greater challenge, one which severely tests their equanimity and clinical acumen: seeing persons who have made a bad habit of malingering, who believably report not feeling welcome anywhere, who repeatedly come to clinicians seeking services, and who repeatedly fabricate psychological or physical symptoms. One study reports the number of patients suspected of malingering to be as high as 13%. Practitioners in EDs and PESs clearly face these challenges.
#JOKER AND THIEF HOW TO#
When clinical management of the condition is described in the literature, its usual focus is on how to inform the person of one's impression of malingering safely, respectfully, and without undue damage to the physician-patient relationship. 2-17 This is entirely appropriate when, as is often the case, the malingering person is wrongfully seeking benefits or advantages from the military, criminal justice system, insurance industry, or Social Security Administration. To a large extent, existing psychiatric literature on malingering focuses primarily on detection of the condition. Eventually, he discloses that he was very upset with the staff at his group home for reprimanding him over his returning from a shopping trip after dinner, and he agreed to return there that night. His case manager is contacted she indicates he was fine that morning when she made her daily medication delivery. Medical records show that he has had numerous similar presentations in recent months. His voices are at baseline, and there is a marked discrepancy between his complaint and his observable clinical condition. In the psychiatric interview, the man is unable to explain how his life is in crisis in any way. Moments later, however, the physician sees him smiling, talking pleasantly with a nurse's aide, and enjoying a bologna sandwich. The patient tells the triage nurse that he is suicidal and needs to be hospitalized. In addition, the patient may have a documented mental illness, but that aspect of his or her medical history is clearly not in need of urgent or emergent clinical attention.Īn example of such a scenario follows: The police voluntarily transport a 45-year-old man with a documented schizoaffective disorder to the PES. 1 It is distinguished from factitious disorder by its easily identifiable secondary gain, such as evading criminal prosecution, and its absence of indications that the person has an intrapsychic need to maintain the sick role and a relationship with a treatment provider.Ĭommonly, a person presents to the emergency department (ED) or psychiatric emergency service (PES) with a chief complaint of suicidal ideation or auditory hallucinations and a contradicting clinical picture of relative ease and comfort. He’d drafted various outlines of how it would go, spoken to numerous friends over the years about it, but he kept getting pulled into other work.įortunately much of what has become his body of work on Dylan, from concert and album reviews to prose pieces, span many of the ideas Peter had for the book and are contained herein.Malingering is the intentional production of false or grossly exaggerated physical or psychological symptoms that is motivated by external incentives.
In the end his notes didn’t make the final release but were posted on .įor more than twenty years Peter spoke of writing a book about Bob Dylan called The Joker and the Thief.
In 2008 Jeff Rosen commissioned Peter to write liner notes for Bob Dylan’s Tell Tale Signs, he spent about a week listening to tracks sent by Dylan’s office, suggesting songs and writing as he listened. He had a love for Bob Dylan that would find him attending nearly 200 concerts spanning 1963 to 2018. Debuting on the Americana charts in 1996, it featured many legendary Austin session players including Cindy Cashdollar who would play on Bob Dylan’s Time out of Mind the following year. His rootsy debut album Up Against It was recorded in the Austin studio of childhood friend Ray Benson of Asleep at the Wheel. A collection of the best writing about Bob Dylan by the late Peter Stone Brown. Peter was a freelance writer, singer-songwriter and renowned Dylanologist.