J.-M. Charcot and simulated neurologic disease: attitudes and diagnostic strategies.
BACKGROUND
Neurologists have long wrestled with the diagnosis of elaborated or feigned disease. Studies have not focused on early techniques utilized to diagnose malingering.


OBJECTIVE
To analyze cases of purposeful neurologic malingering among patients treated by the 19th century neurologist J.-M. Charcot, describe his attitudes, and study his methods to separate malingering from primary neurologic diseases.


METHODS
A study was conducted of Charcot's printed and original documents from the Bibliothèque Charcot, Paris, and added documents on American neurology.


RESULTS
Charcot recognized that purposeful simulation occurred in isolation as well as in established neurologic disorders. Charcot was strict with subjects motivated by greed or spite, but showed forbearance and wonder in those who created illness as "art for art's sake." Charcot developed diagnostic equipment that measured inspiratory depth and muscle activity as a strategy to identify malingerers. His approach strikingly contrasted with contemporary military medical treatises on malingering and S.W. Mitchell's civilian neurologic approaches that unmasked patients through more aggressive strategies.


CONCLUSIONS
Charcot provided an academically professional approach to the assessment of neurologic malingering, with a stern, often patronizing attitude, but without categorical condemnation. His diagnostic techniques are echoed by contemporary approaches and emphasized an attention to enhanced and inconsistent patterns of behaviors by malingerers.
Goetz
Christopher G
CG
Department of Neurological Sciences, Rush University Medical Center, Chicago, IL 60612, USA. cgoetz@rush.edu
D000328:Adult; D001291:Attitude of Health Personnel; D002375:Catalepsy / Q000175:diagnosis; D003286:Contracture / Q000175:diagnosis; D003291:Conversion Disorder / Q000175:diagnosis / Q000266:history* / Q000523:psychology; D008192:Deception; D003937:Diagnosis, Differential; D003943:Diagnostic Techniques, Neurological / Q000266:history* / Q000295:instrumentation; D005260:Female; D049672:History, 19th Century; D006772:Hospitals, Military; D006778:Hospitals, Psychiatric; D006801:Humans; D007297:Inpatients / Q000523:psychology; D008297:Male; D008306:Malingering / Q000175:diagnosis / Q000266:history* / Q000523:psychology; D008887:Military Medicine / Q000266:history / Q000379:methods; D008889:Military Personnel / Q000523:psychology; D009422:Nervous System Diseases / Q000175:diagnosis / Q000266:history*; D009440:Neurasthenia / Q000175:diagnosis / Q000266:history / Q000523:psychology; D009462:Neurology / Q000266:history* / Q000379:methods; D009482:Neurophysiology / Q000295:instrumentation; D010297:Paris; D015143:Philadelphia; D010817:Physician-Patient Relations; D014857:Warfare