Found: The book that helps the government smear the sick as ‘malingerers’


Denied benefit: This is the late Karen Sherlock. Her illnesses included chronic kidney disease, a heart condition, vitamin B12 deficiency, anaemia, high blood pressure, high cholesterol, underactive thyroid, asthma, diabetic autonomic neuropathy, gastropaeresis, and diabetic retinopathy. She died on June 8, 2012, of a suspected heart attack, after the Department for Work and Pensions stopped her Employment and Support Allowance. John LoCascio would describe her as a malingerer. Considering the list of her illnesses, how would you describe him?

Denied benefit: This is the late Karen Sherlock. Her illnesses included chronic kidney disease, a heart condition, vitamin B12 deficiency, anaemia, high blood pressure, high cholesterol, underactive thyroid, asthma, diabetic autonomic neuropathy, gastropaeresis, and diabetic retinopathy. She died on June 8, 2012, of a suspected heart attack, after the Department for Work and Pensions stopped her Employment and Support Allowance.
John LoCascio would describe her as a malingerer. Considering the list of her illnesses, how would you describe him?

Some of our least favourite people contributed to a book entitled Malingering and Illness Deception in 2003, that seems to provide much of the ammunition used by the current government to demonise claimants of disability and incapacity benefits.

One of the relevant chapters is ‘Malingering, insurance medicine and medicalization of fraud’ by John LoCascio of the criminal American insurance giant Unum, that has been heavily involved in British social security work since the 1990s.

The other is ‘Origins, practice and limitations of Disability Assessment Medicine’ by Mansel Aylward, the Unum puppet who was formerly chief medical officer at the Department for Work and Pensions.

These are the two charmers who put forward a perversion of Professor George Engels’ biopsychosocial theory that calls an individual’s illness into question, rather than treating it, to the then-Department of Social Security back in the 1990s.

The assertion that it was a tool to reduce claimant numbers can be proved by the fact that Mr Aylward was asked to change the test used to determine whether a claimant deserved benefit, in order to reduce the flow of claimants with mental health problems. When politicians ask for specific results, you know impartiality has gone out the window!

Look at the title of the book: It labels incapacity and disability claimants as “malingerers”, defined in the book’s first chapter as those who engage in “the intentional production of false or exaggerated symptoms motivated by external incentives” – in this case, the desire to receive state benefits.

This fits with what we know of the Unum-influenced benefit system already – that claimants are to be treated as if they are trying to cheat the system, unless they can prove to a state-provided official (not necessarily medically-trained) – who has been briefed to find ways to prevent them receiving the benefit – that they are unwell. Their own doctor’s reports are ignored.

Let’s look at LoCascio’s chapter. He starts by suggesting that “disability-related programmes in both the public and private sectors are faced with increasing numbers of disability claims despite improved health care and job design (the disability paradox).”

Already we are in the realm of fantasy as he fails to mention the logical reasons for these increases, which include poor implementation of health and safety measures in the workplace under ‘light touch’ regulation, and the discovery of new medical conditions whose causes are unknown and which require protracted study before they are understood – all made possible by the “improved health care” to which Mr LoCascio refers.

Amusingly, LoCascio also claims that the commercial insurance industry “is neither medically nor legally driven. It is driven by societal imperatives”. What a whopper! Commercial insurance is driven by the desire for money. That is why his company has a criminal conviction to its name – it changed its medical procedures to make it almost impossible for anyone to claim successfully that their Unum health insurance policy had matured.

Much of the remainder of his chapter attempts to convince the reader that the lack of data available – to support claims that a medical patient is “malingering” – should not be used as evidence that they really are ill. He asks the reader to believe that three questions should be asked: Did the patient understand the medical issues? Are the patient’s reported and actual behaviours consistent through time and across observers? And are the functional capacities in question (the patient’s abilities) well-defined?

What a cheat.

It seems perfectly likely that any patient will understand the medical issues informing their condition. However, in a Work Capability Assessment it is common for the assessor to have a completely different opinion of what those issues are. This discrepancy allows the assessor to find fault with the benefit claim.

The second question supports evidence of those who have read assessment reports claiming that patients did not display the behaviours expected of a person with their condition – one famous example was that the patient was not “rocking back and forth”. The simple reason for this was that their condition did not display in that manner but the assessor – who was not an expert in this field of medicine – did not know that because the only advice available was a biased screed from the Unum-influenced DWP.

The final question – are the functional capacities in question well-defined? – can be defeated with a simple, two-word counter-question: By whom?

Also of interest is the concept of ‘Functional Capacity’ (FC). LoCascio argues that a person should not be expected to be incapable of any type of work, just because they are incapable of one. His example is that a person limited to typing for 20 minutes due to forearm pain may be able to play piano for an hour. This is entirely possible but contradicts one of the quotations Mr LoCascio uses four pages previously: “The question of disease—that and nothing more—is the one for the physician to determine” (Drewy 1896). It is not the assessor’s job to dream up functions a claimant might be able to carry out and then discount a claim for benefits on the basis of that possibility. That is not evidence; it is fantasy.

All of the above questions are also rendered pointless by the simple fact that a claimant’s condition may be variable. LoCascio acknowledges this! However, he then goes right off the rails: “I favour a series of three questions: ‘Please describe a bad day. Please describe a good day. Please tell me how many good days and bad days you have in an average week.’ Armed with this knowledge about any particular symptom and the corresponding reduction in an FC, the medical resource can proceed to analyse the consistency of the history against the medical or observational data.”

That is an inaccurate assumption. When you are ill with (for example) fibromyalgia, there can be a huge range of difference between days. Sometimes Mrs Mike has seemed able to function almost normally (she can never walk far without suffering a huge amount of pain in the following days, as an example of why she only seems more able); other times she has been confined to the sofa for days on end in terrible pain for which medical science currently has no alleviation. At other times her condition may be anywhere between those extremes. Asking for a description of a good or bad day, or how many of these take place in an average week, is not only pointless – it hinders understanding of the condition.

“In conclusion,” LoCascio writes, “the most important product of the medical consultant is clear, credible, and defensible
documentation.” It seems strange, then, that the most clear, credible and defensible documents – those written by the patient’s doctor – are the first to be ignored in any Work Capability Assessment.

What we have here is a propaganda screed, riddled with inconsistencies and running against reason, that has been used to support the government’s position on sickness and disability benefits. As an argument in favour of current policy, it is worse than useless. In fact, it should be a tool for campaigners to use against that policy.

It tells us why a claimant who lives in agony every day should be outraged when assessors use LoCascio’s nonsense to explain away their pain.

Follow me on Twitter: @MidWalesMike

Join the Vox Political Facebook page.

Buy Vox Political books!
Health Warning: Government! is now available
in either print or eBook format here:

HWG PrintHWG eBook
The first collection, Strong Words and Hard Times,
is still available in either print or eBook format here:


Vox Political needs your help!
This independent blog’s only funding comes from readers’ contributions.
Without YOUR help, we cannot keep going.
You can make a one-off donation here:

Donate Button with Credit Cards


  1. Gen William Taggart August 4, 2014 at 11:24 am - Reply

    How long did it take Vox Political to catch up on this?

    We have been talking about Unum and Professor Sir Mansel Aylward publications of their bastardisation of Professor George Engels’ biopsychosocial theory for years now.

    Mansel Aylward has been promoting this pseudo science (as if it is factual) as far and wide as the UK to New Zealand and Australia Governments.

    • Support August 4, 2014 at 11:52 am - Reply

      Well now, let me see…
      I started writing a blog on December 31, 2011. First post on the welfare state was January 5, 2012, first on DLA was January 9, 2012 and the first on incapacity benefits was January 13, 2012.
      These issues have been a running thread throughout the life of this site. First Unum article was (I think) January 16, 2013, and there is a section about that company’s involvement in British social security in Health Warning: Government, which you can buy using the Amazon button at the top of the sidebar, or by clicking on the image at the bottom of the article (you get a choice of print or digital editions).
      The question really is, how long did it take you to realise that Vox Political has been running articles on this?
      Next you’ll be saying you’ve never heard of the Vox FoI request for up-to-date ESA fatality statistics…

      • Gen William Taggart August 6, 2014 at 1:09 pm - Reply

        Sorry no offence intended, I should have worded that better. It was the implied that this has been found, which most interpret as ‘just found’. When I posted this several years ago, notably following it with several more up to date links last year across a number of platforms.

        When as we know this is not actually true, as it has been in public domain for many years, with all of us, including Vox Political giving reference to it.

        It was after I started to directly link Professor Sir Mansel Aylward’s Unum backed facilities in Swansea, that Unum started to hide it’s links with him and the facility from open public access on the net. (It’s still there, just you have to dig deeper on the sites).

        I know from direct personal experience just how deep this involvement with Governments runs

        Anyway respect goes out to you for highlighting the bastardisation of Professor George Engels’ biopsychosocial theory by Unum and Professor Sir Mansel Aylward.

        • Mike Sivier August 6, 2014 at 2:31 pm - Reply

          Thanks for that!

  2. Mike Sivier August 4, 2014 at 11:32 am - Reply

    One of the hidden joys of having adverts on the page – it’s entirely possible that the Amazon ad space in the sidebar to the left of the page will be offering ‘Malingering and Illness Deception’ when you read this article!
    Of course, if you’re one of the few who are determined to deny me any revenue by switching ad-blockers on, you’ll have missed that particular pleasure…!

    • Peeve August 4, 2014 at 1:42 pm - Reply

      Indeed it is – at £63.98 I think I shall pass on buying that, thank you. But thanks for the illuminating post – sickening, but still illuminating. Back on the advert front, I’m also being offered oak furniture as I recently sold mine on Facebook. Sigh. I have learned to ignore them and if it helps pay you for your good work, it is a small price to pay.

      • Joanna August 4, 2014 at 7:48 pm - Reply

        I clicked on a link on this page and got a pdf version, though I’m not sure if it is the full version but anyway it was free!!

        • Mike Sivier August 4, 2014 at 9:47 pm - Reply

          That was the idea when I linked to it. I had no way of knowing that there was a print version available on Amazon or that the company’s ad software would use the reference in the article to link to it.

    • phillevans August 4, 2014 at 9:47 pm - Reply

      Yup, its up there under the advert for a stair lift…

  3. david August 4, 2014 at 11:34 am - Reply

    ooh I was a senior staff nurse on reasonable pay in a job I mostly enjoyed. I am so happy that I was only malingering to get the wonderful level of benefits I get now ( =diddly squat as part of a couple as on income based). Their own assessment ignores DWP guidelines for my condition ( ie unlikely ever to recover)

    • phillevans August 5, 2014 at 12:43 pm - Reply

      Retired, disabled ex-psychiatric nurse here. I wonder what happened to the RCP or the BMA to let political appointee bureaucrats re-diagnose people, or alter the acceptable meaning of disabled? I remember the quacks and shrinks as being VERY averse to anyone (even the patient) telling them what the problem was…

      It seems to be the perception that DLA needed to be done away with because so many people were “getting better”. I wish I could get better.

  4. Nigs Cradoc August 4, 2014 at 11:58 am - Reply

    Really, how do these folks sleep nights. I mean the authors of the tracts to which you refer not the users of ad-blockers .. :-) – They’ll all go to hell along with Adam Smith and all his Laissez-Faire crowd – they say nothing that wasn’t extant in the late 1700’s and 1800’s – save to manipulate and purposefully misrepresent more recent statistics and trends. mutter, mutter – I’d better buy a copy of your book to make up for the ad-blocker – (skulks away into a dark corner).

    • Support August 4, 2014 at 12:02 pm - Reply

      That would be very welcome. I’d appreciate a review if you’re up for it!

  5. Nick August 4, 2014 at 12:23 pm - Reply

    these so called people John LoCascio David Cameron and IDS and co don’t hate just the sick and disabled they hate all people worldwide that are in need

    they hate anything that they themselves have to administer they believe in everything should be private and that everyone across the board stands on their own two feet or dies

    these people have never known Christianity or indeed met any Christians and yet somehow they get to lead and wield power not only in the uk but the world causing much pain and suffering

    i should add the conservatives have always taken this line and if it were up to them they would ban people without a degree from having children as they have always resented the average person and their waste full habits along with their delinquency from having children

    Hitler was never on his own the same with all of the other middle east tyrants over the past 80 years David Cameron and co are all in the same mould

    the give-away signs are very easy to spot as when they talk their faces change quite remarkably to one of hate

  6. Bill Kruse August 4, 2014 at 12:34 pm - Reply

    “… Mr Aylward was asked to change the test used to determine whether a claimant deserved benefit, in order to reduce the flow of claimants with mental health problems.” This would benefit from a reference, I think.

  7. George Berger August 4, 2014 at 3:38 pm - Reply

    Here are some useful references:
    1. The paper by Professor Engel is hard to obtain. I have a copy but cannot link to it for copyright reasons. One useful source is here .
    2. Another is this: . See the references in this text.
    3. A tiny bit on LoCascio er al is here: .
    4. On UNUM see this: .
    5. This too: .

  8. karrie o'ke August 4, 2014 at 3:40 pm - Reply

    I am not shocked or surprised by this at all.The fact that is an American who came up with this BS surprises me even less. We all know of insurance companies only too happy to relieve you of your money but who do not wish to part with it when you wish to make a legitimate claim. It is vile that the government allows this but then what do you expect from corrupt government and this proves without a shadow of a doubt, the lies told and the campaign against the sick and disabled.

  9. The Infamous Culex August 4, 2014 at 3:59 pm - Reply

    First of all, George Libman Engel was the American headshrinker whose biopsychosocial model of illness was traduced by Unum and their puppets. Whilst his ideas may have some validity for purely psychosomatic conditions – and it would be difficult indeed to determine that a condition was just psychosomatic – it is utterly absurd to extend that model of illness to any condition that has any physical manifestation. That does tend to be the problem with some psychiatrists – they see every condition as being largely or wholly “in the mind”, much as someone skilled in the use of a hammer might perceive every problem as being a nail to be driven home.

    Engel was spared the anguish of seeing his life’s work abused by those idiots, as he died from heart failure on 26 November, 1999. Doubtless, LoCascio might claim that Engel was malingering, at least until the time Engel was buried.

    Next, there is the question of their professional standing in the UK. It will doubtless be no surprise to see that LoCascio seems to be utterly unknown to the General Medical Register, but it may be interesting to comment that, while Mansel Aylward is registered – qualified 1967, GMC Number 0043805 – he does not have a licence to practice any sort of medicine in the UK. Doesn’t the law state that only licensed practitioners may be used or consulted by the DWP?

    • Mike Sivier August 4, 2014 at 9:43 pm - Reply

      We’re aware of Engel’s involvement but your opinion of his theories is extremely useful; thank you.

  10. George Berger August 4, 2014 at 4:38 pm - Reply
  11. The Infamous Culex August 4, 2014 at 4:52 pm - Reply

    Of the two authors of that book, only Christopher Maurice Bass is a registered and licensed medical practitioner – qualified in 1971, GMC Number 1502871.

    He is still writing the same contradictory nonsense; as recently as March 2014, a paper he wrote was published in The Lancet.

    It may be entertaining to quote from it, if only to highlight what the DWP takes care NOT to do:

    “Compared with other psychiatric disorders, diagnosis of factitious disorders is rare, with identification largely dependent on the systematic collection of relevant information, including a detailed chronology and scrutiny of the patient’s medical record. Management of such disorders ideally requires a team-based approach and close involvement of the primary care doctor.”

    If applied to Munchausen Syndrome, his observations might be valid but, applied to physical disability as a whole, they seem to be utter nonsense.

    • The Infamous Culex August 4, 2014 at 11:30 pm - Reply

      Here’s another (earlier) publication by Christopher Maurice Bass. Despite admitting near the start of the “paper” that determination of “malingering” should be left to the courts and that it depends on nothing more infallible than one man knowing what is going on in another man’s mind, he nevertheless seems to ignore those criticisms and carries on regardless, with data selected apparently from learned journals yet without any of the explanations which undoubtedly accompanied those data.

      I do hope that he would not be too offended were one to point out that – no doubt, purely by accident – such is also the method of the quack and of the charlatan. I am sure that he really wanted to discuss those data in greater depth and even to present contradictory data so one might have a fuller understanding of the problems, but considerations of time doubtless prevented this more considered approach.

      However, one may recall that glib piffle of that sort led to the wrongful conviction of Sally Clarke when Professor “Sir” Roy Meadows gave mistaken statistical or epidemiological evidence on the incidence of cot deaths.

      I am sure that we would all feel safer if doctors could refrain from straying from the natural bounds of their chosen specialisation, whether that were to be a paediatrician who mistakenly thought that he knew about statistics, or a psychiatrist who seems to imagine he is also a physician AND a psychic.

  12. jeffrey davies August 4, 2014 at 6:05 pm - Reply

    unum the root of it all but untill the final deed is done the final seell off of the nhs then their input into all this will be over has then they have all that the rest will find out has for all those puppets who took this cowboy company monies will have no rest of it but the real benefit fraud is caused by them in power jeff3

  13. amnesiaclinic August 4, 2014 at 6:12 pm - Reply

    Good blog Mike. The more we can inform ourselves the better. And the answer to how do they sleep at night is simple – like babies! No conscience whatsoever!

    • The Infamous Culex August 4, 2014 at 11:12 pm - Reply

      One might suppose that whisky or brandy might also help them to slumber.

  14. Tara White August 4, 2014 at 6:12 pm - Reply

    Karen, from her list of conditions had poly auto immune syndrome, not a good one at all, and any good specialist would have no problem listing the risk factors. Sadly these days b12 and thyroid conditions are dealt with less well than they used to be. Failure to treat means long term serious damage. Very sad, she is missed by many.

  15. Tara White August 4, 2014 at 6:19 pm - Reply

    You ask what this perverseness should be called.. Would maliciously ignorant do?.

  16. Angela Kennedy (@AcademicAnge) August 4, 2014 at 6:24 pm - Reply

    May I promote my own book as an antidote to the above book? It’s “Authors of our own Misfortune? The Problems with Psychogenic Explanations for Physical Illnesses”, published in 2012:

  17. Tony Dean August 4, 2014 at 6:43 pm - Reply

    I am REALLY surprised no-one here seems to knows about this, I have been quoting it for what must be 10 years now:-

    New Labour,
    the market state,
    and the end of
    Jonathan Rutherford
    Jonathan Rutherford looks at the connections
    between government and the insurance business in
    their joint project to reduce eligibility for sickness

    In November 2001 a conference assembled at Woodstock, near Oxford. Its
    subject was ‘Malingering and Illness Deception’. The topic was a familiar one
    to the insurance industry, but it was now becoming a major political issue as
    New Labour committed itself to reducing the 2.6 million who were claiming
    Incapacity Benefit (IB). Amongst the 39 participants was Malcolm Wicks, then
    Parliamentary Under Secretary of State for Work, and Mansel Aylward, his Chief
    Medical Officer at the Department of Work and Pensions (DWP). Fraud – which
    amounts to less than 0.4 per cent of IB claims – was not the issue. The experts
    and academics present were the theorists and ideologues of welfare to work.
    What linked many of them together, including Aylward, was their association
    with the giant US income protection company UnumProvident, represented at
    the conference by John LoCascio. The goal was the transformation of the welfare
    system. The cultural meaning of illness would be redefined; growing numbers of
    claimants would be declared capable of work and ‘motivated’ into jobs.

    • Mike Sivier August 4, 2014 at 9:48 pm - Reply

      Yes, I think the book must be the result of that conference.

      • The Infamous Culex August 4, 2014 at 11:03 pm - Reply

        With the infamous Waansee Conference, Reinhard Heydrich (and his sidekick, Eichmann) tried to suppress what had been decided.

        At least THEY had some sense of shame.

    • George Berger August 4, 2014 at 10:48 pm - Reply

      Eh….I referenced that above ;)

  18. holmey August 5, 2014 at 7:37 am - Reply

    LoCascio’s father was the consigliere to one of the US’s biggest crime families, but I suppose it’s not a major shift in a business plan from extorting protection money to selling health insurance that doesn’t pay out….

  19. bigleyma August 5, 2014 at 8:33 am - Reply

    It’s a revolting book. Aimed at that very worst of human ‘qualities’- scepticism towards one’s fellow man, and especially repugnant because that particular fellow man is sick and vulnerable.

    Since I’ve been researching, and experiencing the effects of these ‘reforms’, and directly as a result of this book, I’ve found my impression of medical professionals has lowered. I know some to be very compassionate and caring, but have experienced far less favourable aspects of them as well.

    This is my mention of the book in an article I wrote a couple of years ago about the WCA:

    “It is the ‘big book’ of ‘Malingering and Illness Deception’ (Halligan et al, 2003). This is a volume which can only be described as remorselessly zealous in the pursuit of its topic, so heavily belaboured is the message: that deception is rife among humans, and the sick are no exception. It marshals every possible argument, covering a span from history to neuroscience, drawing even upon child development theoriesand the vague, unproven proposition, via primate studies, that ‘feigning’ sickness may be embedded into
    our very evolution.

    The treatment is so ‘thick’, the overall impression contributing to a sense of paranoia about deception around every corner, that, were it a human, one would expect it to be wearing a tinfoil hat. But, fear not, reassurance is on hand in the form of the closing section, which focuses on the progress made in ‘deception detection’ and the news that neuroscience may be on the verge of developing scanning technology with which to indentify lying activity in the brain.

    This publication seems to have been welcomed by the ‘psycho’ professions, with one reviewer from that field expressing delight at the way the book “gets off to a cracking start” (Fleminger, 2004), almost as if it was a bestselling thriller, rather than the purported exposition of a serious issue for the medical profession.
    Somewhat unseemly for a professional to express such glee at the fact that “many of our patients may be deceiving us, and that much of this deception may be conscious“.

    Fleminger particularly seems to relish Wessely’s “delightful tour of the history of malingering”, concluding that though the book is not likely to be of any help in detecting deceit, readers will have been “entertained and educated“.
    In this sense, considering the ostensibly serious tone of the book, perhaps there is an aspect of it, withrespect to certain of its target readership, which is acting as a ‘dogwhistle’, encouraging and reinforcingscepticism, doubt and cynicism of professionals towards those in their care.”

  20. Angela Kennedy (@AcademicAnge) August 5, 2014 at 9:39 am - Reply

    The ME community have been victims of these and other sorts of psychogenic explanations for their impairments for many years. Indeed, I would argue that this sort of practice, where medics and the DWP work to trivialise/ deny people’s impairments, using very dodgy, fallacious ‘medical’ assertions, in order not to provide them with Social security/health support they need, was piloted and perfected as a cohesive political strategy and government policy on the ME community first. Its outstanding success, and lack of objection from others, on the left, even disability rights movements, is what has led to the rolling out of the policy onto other disabled people. The DWP funded an extremely flawed study, the ‘PACE’ trial, which tried out psychological and exercise ‘treatment’ on patients to get them to believe they are not physically ill, basically, just thinking wrong: the DWP’s involvement with a medical trial being, as far as I know, unprecedented. Unfortunately, these strategies have been pursued under both Tory AND Labour governments.

    • George Berger August 7, 2014 at 11:19 am - Reply

      As of today there are many indications that illnesses involving chronic fatigue are physiological; the psychological feelings are just that: feeling what it is like to have a certain type of physiological illness. This shows that the PACE recommendations, and the claim that these illnesses might have a physical cause (e.g. long term stress) are worse than useless. CBT is ineffective as it does not address the physiology and graded exercise can be dangerous, as it can aggravate the illness due overexertion. The HPA Axis, cellular receptors, cortisol levels and the immune system, have been implicated in these illnesses. Maybe more than one factor are simultaneously active in most cases. The details are a “hot topic” in medical research. Given all this, it’s hard to see how anything but prejudice, lack of knowledge and a desire for profit-increases by insurers and government, can perpetuate these psychiatric abuses.

  21. George Berger August 7, 2014 at 11:26 am - Reply

    OOPS Mike. Please amend my reply as follows: ” ….(e.g. long term stress) but are only psychologically self-sustaining mental phenomena after the cause ceases to act, are worse than useless.”

Leave A Comment