"How easy is it to fool the medical establishment into thinking that you are mentally ill, if you are not?"

We've debated this topic here before — a propos of the Piano Man — with me saying it would be hard to fool them and a commenter insisting Piano Man was a big phony. Consider this, by someone who works with homeless people with mental problems:

The theorist Talcot Parsons, in the 1950s, described what he called the "sick role". He argued that illness is a temporary, medically sanctioned form of deviant behaviour. He went on to suggest that there was a conflict for people labelled "ill" to, on one hand, get better, and on the other, to continue to enjoy the "secondary gains" of attention and exemption from normal duties.

Doctors act as the gatekeepers to the sick role, in that they are the ones who decide whether or not a person enters this role. While society must show compassion to those deemed unwell, it must also make sure that the gains are not so great that everyone wants to join in.

The difficulty for doctors is to identify those that are faking, and those that are genuinely unwell. It's a surprisingly common difficulty, and with mental illness, it's especially tricky because psychiatrists aren't mind readers - diagnosing exactly what is going on inside someone's head relies on them exhibiting certain symptoms.

Mutism, for example, is a symptom in a number of serious mental illnesses, but is also fairly easy for sane people to mimic. However, living a lie isn't easy and the impressive thing is maintaining the charade, because there is something inherent in us that seems to make us want to come clean. It occurs to me that you'd have to be pretty mad to want to stay in a psychiatric hospital in the first place, but perhaps this shows how desperate the Piano Man was. Then again, being ill means you get attention, and when in hospital, shelter and food. If you are actually well, in some ways it's like a trip to Butlins, but with white coats instead of red ones.

There's a fine line between what's classed as malingering and what is accepted as genuine illness. When someone has a breakdown, for example, what they're saying is that they've had enough, that they can't cope any more and that things have got to change in their lives. They enter the sick role, which facilitates the attention and change that is needed. But when does this become manipulative?

What surprises me is that more people don't do it.

Have you ever played sick to take a break from the pressures of life — not just called in sick to a job, but tried to fool people whom you took advantage of for care and support? Have you ever wondered whether you were really sick — physically or mentally — or whether you were indulging yourself and exploiting other people?

Has anyone ever done it to you, or have you ever suspected anyone of doing this? How much would it upset or outrage you if someone who wasn't really that sick, let himself droop into a sickly way of being and let you take care of him? How long would it take you to feel suspicious and stop providing your services?

Or are you the sort of person who suspects people who actually are sick are just faking it to get attention?