The year in research began on a sour note with a study that appeared in The Journal of Psychosomatic Research entitled "MMPI-2 validity, clinical and content scales, and the Fake Bad Scale for personal injury litigants claiming idiopathic environmental intolerance (IEI)" (Staudenmayer & Phillips, 2007). The journal name says it all.The researchers attempted to prove that litigants who suffer IEI are psychosomatic through the use of the Minnesota Multiphasic Personality Inventory 2 (MMPI-2), which is a personality test that was administered to 50 female and 20 male personal injury litigants alleging IEI. The subjected were said to "allege" IEI. The study is inconclusive if these subjects were not medically diagnosed with IEI, multiple chemical sensitivities (MCS), or another environmental illness (EI). Perhaps the finding that they were psychosomatic had to do with the fact that they were not true sufferers of IEI or EI at all. Who diagnosed these subjects with IEI? How long had they suffered IEI? Were they under treatment for IEI by a qualified environmental medicine specialist? Alleging IEI and being diagnosed with IEI are vastly different. One who is not diagnosed certainly may allege but that does not reflect appropriately on properly diagnosed subjects though that seems the implication.
The researchers reported results stating "the validity scales indicated no over reporting of psychopathology" (Staudenmayer & Phillips, 2007). Perhaps this is simply because IEI is not a psychological disorder. The MMPI-2 has many criticisms including "helping to create and perpetuate the oppressive groupthink of mid-century corporate capitalism" (Minnesota Multiphasic Personality Inventory, 2006), the fact that "ethical use of psychological tests means that results must be interpreted in the context of other information about the individual, i.e., personal history, reason for assessment, the intended uses of the report about the results, who made the referral for assessment" (Minnesota Multiphasic Personality Inventory, 2006), and the mistaken belief that "the tests results are infallible, can stand on their own in isolation from other information about the test taker" (Minnesota Multiphasic Personality Inventory, 2006).
It appears this result confirmed the researches hypothesis that IEI litigants are malingering as they do not recognize their own psychopathology. What fails to be addressed is that any psychopathology that exists may simply be comorbid and completely unrelated to IEI. The overriding question again seems to be that persons who allege IEI are not the same as persons who are diagnosed with IEI.
The study continues to report "half of the cases had elevated scores on validity scales suggesting defensiveness" (Staudenmayer & Phillips, 2007). Half is not a statistically significant finding yet the study concludes, in part, that "idiopathic environmental intolerance litigants are more defensive about expressing psychopathology (Staudenmayer & Phillips, 2007). It would seem any litigant would be defensive, especially one who was injured severely enough to require litigation. An amputee would also be quite defensive when taking the stand to litigate against the state's negligence in repairing a step that cost him his leg. Why would someone who is chemically injured by another's negligence feel any less defensive?
A more appropriate study would have compared the scores of IEI litigants to the scores of litigants suffering other damages to determine if the scores of the IEI litigants were truly higher than that of any other personal injury litigant. Such a study would have provided more factual, scientifically based findings.
The researches also reported that a large number of subjects who had elevations on the Fake Bad Scale (FBS) suggesting over reporting of unauthenticated symptoms. A study by Butcher et al (2003) found that "the scale is likely to classify an unacceptably large number of individuals who are experiencing genuine psychological distress as malingerers. It is recommended that the FBS not be used in clinical settings nor should it be used during disability evaluations to determine malingering." How then was it determined the symptoms were unauthenticated?
A scale is not a blood test, a brain scan, a urinalysis, or other medical test. A mere scale and the researchers preconceived belief that IEI is not a real physiological illness seems the likely answer, along with a misperception that the MMPI-2 and FBS are valid measures. If that was the case then cancer victims, stroke victims, heart disease patients, and many other physiological disorders would also show large elevations on the FBS. Had any of these patients been seen and diagnosed by a qualified environmental medicine specialist trained to identify IEI and other environmental illnesses? It seems this study was rigged for the results the researchers wanted from the beginning. The researchers apparently never considered that IEI might be a real illness.
The primary criticism of Staudenmayer & Phillips research is the "assumption" made that the litigants were malingering. First of all, that assumption is saying that as much as 16% of civilians and 33% of Gulf War Veterans suffering with conditions such as MCS are malingering (Meggs et al, 1996; Gibson, 2005). That number is too large for malingerers. Surely a few psychopaths would malinger, but not 33% of the population!
The next problem is the test used is not designed to eliminate confounding variables such as "real" reasons for the insistence of the litigants. It is only designed to find indications, though not proof, of malingering. Anyone who was in the shoes of being sick and injured by a defendant's negligence would be insistent in the face of disbelief, if not defensive.
EI patients want answers and want to get well (Koch, 2004; Gibson et al, 2005; Gibson et al, 1994). One would have to be a true psychopath to have given up his home, life, business/career, and future to malinger. Why? For what benefit is malingering? I can see it if one has a large trust or insurance plan that pays out upon disability and will support lavish living in luxury for the rest of his/her days. I can see it if one has a spouse who will continue to bring in income while the malingerer stays home playing and enjoying life. However, EI is quite a different reality.
Most with EI slowly lose everything in their lives including friends, family, credibility, health, housing, and employment. In addition, even if they have a supportive spouse who will look after them, they often react to their own homes. What an EI wants and needs in a home is not a big, luxurious mansion. Rather, they need a simple, stripped down, lack of amenities home that does not make them ill. For many this becomes a tent or a vehicle. Unable to go out without becoming very ill they often become isolated, alone, and suffer greatly.
They are not out at the movies enjoying their disability and munching on Bon Bons. Quite to the contrary, many are denied disability and those who are able to obtain it are too sick to go out and have fun. Why would someone malinger for a life like that? Malingering is contradictory to what they ask for. Most only want clean, safe air to breathe. Many report they had successful, professional careers prior to becoming ill and reported that they would happily resume their old lives if they found relief from their EI (Koch, 2004; Gibson et al, 2005; Gibson et al, 1994).
EI could more easily be misconstrued for attention seeking. But then I have to wonder, as a sane human being and a professional in the helping profession, would it not be easier to get attention by acting out? Say yelling or moving and dancing about in an unusual manner with no logical reason? Or perhaps one could gain attention by buying a fancy sports car. One could do that and still hold a job. One could do that and still have a home. One could do that and still go out to dinner with friends, catch a movie, and attend social gatherings. It seems an awful far fetch to give up the basic constituents of life for mere attention. Actually, it's contradictory!
From a personal perspective, the attention EI's often get is highly undesired. They receive stares when they have a respirator on, unwanted questions, strange and/or disdainful looks, and hurtful comments. They want that all to go away so they can be another face in the crowd and enjoy life again. It is contradictory then that they would malinger for attention or any other purpose. The only attention they long for is someone who would just listen, give a "safe" hug, believe in them, understand and appreciate the difficulties they am facing, and perhaps help them to find some real solutions.
But then who am I to say? According to Staudenmayer and Phillips I'm just a malingerer writing self-serving and defensive articles.
References:
Butcher, JN, Arbisi, PA, Atlis, MM, & McNulty, JL (2003). The construct validity of the Lees-Haley Fake Bad Scale. Does this scale measure somatic malingering and feigned emotional distress? Archives of Clinical Neuropsychology. 18(5), 473-85.
Gibson, P (2005). Understanding & accommodating people with multiple chemical sensitivity in everyday living. Houston, TX: Independent Living Research Utilization.
Gibson, PR, Placek, E, Lane, J, Brohimer, SO, & Earehart Lovelace, AC (2005). Disability induced identity changes in persons with multiple chemical sensitivity. Qualitative Health Research. 15:4, 1-23.
Gibson, PR, Cheavens, J, & Warren, ML (1994). Chemical injury chemical sensitivity and life disruption. James Madison University.
Koch, L (2004). Multiple chemical sensitivity and rehabilitation planning implications. Kent State University Center for Disability Studies.
Meggs WJ, Dunn KA, Bloch RM, Goodman PE, Davidoff AL (1996). Prevalence and nature of allergy and chemical sensitivity in the general population. Archives of Environmental Health. 51(4):275-82.
Minnesota multiphasic personality inventory (2006). Wikipedia. St. Petersburg: Wikimedia Foundation Inc. Retrieved January 10, 2007, from:
http://en.wikipedia.org/wiki/Minnesota_Multiphasic_Personality_Inventory
Staudenmayer, H & Phillips, S (2007). MMPI-2 validity, clinical and content scales, and the Fake Bad Scale for personal injury litigants claiming idiopathic environmental intolerance (IEI). Journal of Psychosomatic Research. 62(1), 61-72.
Copyrighted © 2007 Lourdes Salvador
