Making it up

Once in awhile, psychiatrists consult me to assist with figuring out a patient’s diagnosis. This happened the other day. The referral involved a patient who was in jail who said he heard voices tell him to kill himself. The patient had been having lots of conflicts while in jail with the prison guards and apparently hated it there. Who wouldn’t hate prison I guess. Anyway, when the patient was taken to the hospital for psychiatric evaluation, the doctors began to question whether he indeed heard voices or just made the story up to get out of the prison for awhile. So I was called to evaluate whether the patient was really psychotic through the administration of a personality test.

Now, one thing to keep in mind here is that personality tests can be helpful, but it has to be combined with a good clinical interview so the results can be put into context and understood correctly. As it turns out, the personality test wasn’t very helpful. So I go into to meet with the patient, introduce myself, and say, “Remember when you told everyone that you heard voices telling you to kill yourself. Well, did you make that up to get out of prison?” The patient looked around the room for awhile, glanced back and me, and said, “Yeah. I made it up. Just wanted to get the heck out of there for awhile.” Case solved! Everyone suspected it, but I was the only one who asked.