Dr. David B. Adams – Psychological Blog

Psychology of Illness, Pain, Anxiety and Depression

Treated by Tests

Multi-case building behaviors a term I coined after years of seeing patients who consciously refuse to improve since recovery would interfere with other legal cases that they were pursuing…”building.”

Discussing when, why and how individuals build cases, so that they can increase their financial compensation, would be redundant. This is discussed continuously in the scientific literature.

When you are attempting to provide the highest quality of care of which you are capable, and you find yourself impeded by deliberate manipulations of the patient, it is very ungratifying if not outright discouraging.

For example, I recently saw a patient who had sustained a gunshot wound in the course of performing his work. This occurred in another State, and he had relocated to Atlanta. While in the other locale, he had repeatedly accessed a broad range of mental health care for the trauma (which had physically healed long ago).

He was referred for evaluation and treatment, and I saw him with the goal of determining what (and how much) care he would need. However, I very quickly discovered that he had been instructed not tell provide me with any details of his injury. None whatsoever.

Why? Well, someone had found for him a new source for a law suit, and they were afraid that if he provided any data as to how he had been wounded that it might (would?) conflict with other versions he had given to others. Thus, it might ruin his case.

He was completely comfortable following those instructions. They made a great deal of sense to him since his desire for money exceeded his desire for care. It is hard to predict how long this had been true. As best I can determine, he initially needed care. He continued in care long after the need no longer existed since it made him appear (to the courts) as more impaired.

Once he had relocated to Georgia, in order to remain in care, he had to either lie or simply prevent anyone from knowing the truth.

The fact that he was so comfortable with this role was the most disappointing aspect. All one can do in such instances is state that there was no need for care and that the patient had been instructed to not provide any data that would clarify his current mental status.

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