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Art of Illness

There is a long history of inventing illness, such as pretending to be sick for attention or accusing others of being ill. This volume explores the art of illness, and the deceptions and truths around health and bodies, from a multiplicity of angles from antiquity to the present.

The chapters, which are based on primary-source evidence ranging from antiquity to the late twentieth century, are divided into three parts. The first part explores how the idea of faking illness was understood and conceptualized across multiple fields, locations, and time periods. The second part uses case studies to emphasize the human element of those at the center of these narratives and how their behavior was shaped by societal attitudes. The third part investigates the development of regulations and laws governing malingering and malingerers. Altogether, they paint a picture of humans doing human actions—cheating, lying, stealing, but also hiding, surviving, working.

This book’s careful, accessible scholarship is a valuable resource for academics, scientists, and the sophisticated undergraduate audience interested in malingering narratives throughout history.

Wendy J. Turner is Professor of History in the Department of History, Anthropology, and Philosophy at Augusta University, where she also holds affiliate professorships in the Center for Bioethics and Health Policy in the Institute for Public and Preventative Health and The Graduate School.

Routledge Advances in the History of Bioethics

Series Editors: Chris Mounsey, Stan Booth, and Madeleine Mant

Routledge Advances in the History of Bioethics aims to act as a nexus for debates typically in collections of diverse but explicitly interrelated essays about the histories and literatures of bioethical debates from a wide spectrum of disciplines, methodologies, periods and geographical contexts. This series champions conversations from within interdisciplinary collision spaces, considering the effects of physical and metaphysical environments upon factual and fictional spaces.

The History and Bioethics of Medical Education

“You’ve Got to Be Carefully Taught”

Edited by Madeleine Mant and Chris Mounsey

Reconsidering Extinction in Terms of the History of Global Bioethics

Edited by Stan Booth and Chris Mounsey

Stewardship and the Future of the Planet

Promise and Paradox

Edited by Rachel Carnell and Chris Mounsey

Coastal Environments in Popular Song

Lost Horizons

Edited by Glenn Fosbraey

Art of Illness

Malingering and Inventing Health Conditions

Edited by Wendy J. Turner

For more information about this series, please visit: https://www.routledge.com/ Routledge-Advances-in-the-History-of-Bioethics/book-series/RAITHOB

Art of Illness

Malingering and Inventing

Health Conditions

Edited by Wendy J. Turner

First published 2024 by Routledge

605 Third Avenue, New York, NY 10158

and by Routledge 4 Park Square, Milton Park, Abingdon, Oxon, OX14 4RN

The right of Wendy J. Turner to be identified as the author of the editorial material, and of the authors for their individual chapters, has been asserted in accordance with sections 77 and 78 of the Copyright, Designs and Patents Act 1988.

All rights reserved. No part of this book may be reprinted or reproduced or utilised in any form or by any electronic, mechanical, or other means, now known or hereafter invented, including photocopying and recording, or in any information storage or retrieval system, without permission in writing from the publishers.

Trademark notice: Product or corporate names may be trademarks or registered trademarks, and are used only for identification and explanation without intent to infringe.

Library of Congress Cataloging-in-Publication Data

Names: Turner, Wendy J. (Wendy Jo), 1961– editor.

Title: Art of illness : malingering and inventing health conditions / edited by Wendy J. Turner.

Description: New York, NY : Routledge, 2024. | Series: Routledge advances in the history of bioethics | Includes bibliographical references and index.

Subjects: LCSH: Malingering—History. | Malingering—Case studies. | Malingering—Law and legislation.

Classification: LCC RA1146 .A78 2024 (print) | LCC RA1146 (ebook) | DDC 616.8—dc23/eng/20230824

LC record available at https://lccn.loc.gov/2023033464

LC ebook record available at https://lccn.loc.gov/2023033465

ISBN: 978-1-032-58961-9 (hbk)

ISBN: 978-1-032-58962-6 (pbk)

ISBN: 978-1-003-45232-4 (ebk)

DOI: 10.4324/9781003452324

Typeset in Sabon by Apex CoVantage, LLC

For Nathan Yanasak

My friend, champion, and husband

5 ‘Because She Pretended to Be Pregnant and Was Not’: Fake Royal Pregnancies in Medieval Scotland

EMMA TRIVETT

6 Feigning Madness: The Case of William Hawkyns, 1552 London

WENDY J. TURNER

7 “A Decietfull Gypsay [sic]”. Malingering, Performance and Princess Sophia’s “Fitts”

CAROLYN A. DAY

8 Faking It: Thirteenth-Century Bolognese Responses to Feigning Leprosy

COURTNEY A. KROLIKOSKI

9 Expertis Medicis Videatur: Legal Medical Expertise in the Apostolic Chancery’s Assessment of Personal Injury Damages During the Avignon Period (1309–1378)

NINON DUBOURG

10 Compensatory Damages and the Construction of Injury in Prenatal Torts

LUKE I. HAQQ

Abbreviations

ASB: Archivio di Stato di Bologna, the State Archive of Bologna, Italy.

ASLu: Archivio di Stato di Lucca, the State Archive of Lucca, Italy.

BAR: British Archaeological Reports.

CIA: Central Intelligence Agency, U.S. Intelligence Community.

COVID: Shortened form of COVID-19, which is the abbreviation for “Coronavirus Identified in 2019”.

CFS: Chronic fatigue syndrome is a complicated disorder that causes extreme fatigue that continues for six months or more.

CSPD: Calendar of State Papers: Domestic Series, Edward VI, Mary, and Elizabeth, 1547–1580, ed. Robert Lemon (London: Longman, etc. for HMPRO, 1856)

DSM: (Sometimes DSM-I) American Psychiatric Association, Diagnostic and Statistical Manual: Mental Disorders. Washington, DC: Mental Hospital Service, 1952.

DSM-II: American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders, second edition. Washington, DC: American Psychiatric Association, 1968.

DSM-III: American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders, third edition. Washington, DC: American Psychiatric Association, 1980.

DSM-IV: American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders, fourth edition. Washington, DC: American Psychiatric Association, 1994.

DSM-5: American Psychological Association, Diagnostic and Statistical Manual of Mental Disorders, fifth edition. Washington, DC: American Psychological Association, 2013.

EETS: Early English Text Society.

FD: “Factitious disorder”.

x Abbreviations

HMPRO: His Majesty’s Public Record Office. After about 1910, only called the Public Record Office (PRO), it has become a branch of The National Archive (TNA).

HMSO: His Majesty’s Stationery Office.

IBS: Irritable bowel syndrome.

ICD: International Classification of Diseases, WHO. The current version is ICD-11 (2022). ICD-9 was used from 1979 to 1994. ICD-10 was in use from 1994 to 2021.

ME: Myalgic encephalomyelitis, commonly called chronic fatigue syndrome.

MED: Middle English Dictionary, second edition, edited by Robert E. Lewis, Ann Arbor: University of Michigan Press, 2007.

MISAS: “Medically insignificant signs in the absence of symptoms”, see Chapter 4.

MRI: Magnetic resonance imaging.

MUS: “Medically unexplained symptoms”.

OED: Oxford English Dictionary, Oxford: Oxford University Press, 2023, online: https://www.oed.com/.

PET: Positron emission tomography scan, used to reveal the metabolic or biochemical function of the tissue.

POTS: Postural orthostatic tachycardia syndrome, which causes the heart to race, dizziness, and fatigue when the patient moves from lying down to standing.

PRO: see below—TNA.

PTSD: Post-traumatic stress disorder.

s.v.: A Latin expression of sub verbo or sub voce, meaning “under the heading”.

TB: Tuberculosis.

TNA: The National Archive. Located in Kew, London, this archival collection of records and other ephemera holds most of the royal, legal, and governmental records of England from the earliest history, even before the various kingdoms were united as England, until today with some records also pertaining to Ireland, Scotland, Wales, Sicily, Spain, France, and other locations globally.

WHO: World Health Organization.

Foreword

In the summer of 1249, Robert Malingre(s) and his wife, Maroie, transferred a Vermandois house and property to Emmeline le Poure, under the aegis of Adam le Conte. From the little documentation that exists, the transfer, from couple to individual, was without complication or challenge, easily escaping historian’s notice.1 For at least one etymologic authority, however, Robert’s name suggested the origin of the term, ‘malinger’.2 Those who use medieval tax records to answer social historical questions are familiar with unpacking the meaning of names in those lists, with both profit and caution.3 More typically, the roots of ‘malinger’ are seen in some association between mal- ‘bad’ via ‘illness’ and haingre, ‘weak, thin’, ultimately perhaps from Latin or German, with hypothetical medieval connections ‘malgengos’ (1225) and ‘malengous’ (1278).4 Its more robust attestations, though, are of the late eighteenth and nineteenth centuries.5

While a true, etymologic linkage to Robert and his wife is dubious, the notion that ‘malinger’ might originate with a particular person signifies the individuality inherent in the word. The re‘birth’ of the individual in Western culture roughly in the eleventh to twelfth centuries (hotly debated by historians as it is) makes it possible to study malingering in Europe and beyond from the Middle Ages to now. But beyond individuality, that a certain person’s baseline attributes are then overridden by fabrication to imitate another’s, in order to change a bureaucratic categorization (whether governmental, religious, economic, cultural, or other)6 is only possible if four elements exist: (a) that identification of an individual (and their attributes) can occur, (b) that the ability (and desire) to feign someone else’s status for gain is possible, (c) that an institutional need to label those attributes (with functional consequences) is asserted, and (d) that the institution then recognizes that (b) can occur and wants to prevent it, using both individual and aggregate comparisons.7 Thus, the components making up those elements, from institutions to individuals, from dissimulation to bureaucratic labeling, become analytic fixtures depending on and undergirding

Foreword

‘malingering’. Put in concrete terms, individual, neurotypical beggars in fourteenth-century Paris recognized that they could make more money from charitable giving if they feigned a disability (motor or sensory) and did so;8 the French crown then promulgated laws to enjoin such dissimulation.9 Malingering, in the form of avoiding a duty (work, military service, education, etc.), also developed a legal foothold and response; a number of English and French customaries from the twelfth century forward allowed for essoin(e), a validated excuse for being a witness or other legally binding role due to illness or other accepted cause; faking essoin(e) was strongly discouraged.10 Predating Talcott Parsons’s sick role, the essoin(e) was much debated on both sides of the Channel.11 All of these facets and more are fair game for study because of malingering’s framework.

To some degree, the previous points explain the ‘how’ of assembling this book and its expert authors. But they also begin to suggest the ‘why’ as to malingering’s value as analytic lens. Malingering is so valuable to investigate precisely because of its mediating influence in a wide variety of topics that affect the social contract, including, among many: identity, illness, disability, health, truth, verifiability, governmental categorization, sick roles, and social supports (and cohesion). Regarding the latter, Pierre Rosanvallon stressed that governmental means testing for social benefits can become socially divisive, not only because of the action itself, but because of the fractured levels of understanding policy in which,

individuals do not evaluate the justice of the system [“la justice dans ses principes”] (according to the principle [“règle”] and its intention), but rather its practical and individualized effects [“du système”]. It is never the quantity [“condition”] of resources in general that is discussed, but the fact that someone knows such and such a family whose situation seems comparatively ‘abnormally’ favorable or unfavorable.12

The (dis)simulation need not only be intentionally fraudulent on the individual’s part, but it can also be unintentionally errant on a bureaucracy’s part. Malingering thus impacts cultural heuristics from the contested semiotics of psychology13 (vide Freud’s ‘all neurotics are malingerers; they simulate without knowing it, and this is their sickness’)14 to the social roles of protest,15 from the meaning of slavery16 to the justification of pacifism,17 while still evoking the power of countercultural farce18 even to the boundaries of myth-making.19 In contemporary policy, malingering impacts the interpretation of the U.S. Constitution’s Fourth Amendment,20 immigration processing,21 and, of course, military service,22 while pushing up against

Foreword xiii developmentalism.23 And each of these dimensions has a sociocultural history that we need to understand in order to better address our current predicaments. The efforts of this volume’s scholars (and their inevitable successors) are thus critical.

In 1897, the Franco-American physician and promoter of electricity, Dr Cornelius Herz (1845–98), traveled to England while resisting proceedings against him for a suspected crime. A Knight-Commander of the Légion d’Honneur, Herz was embroiled in a scandal that also involved President Georges Clémenceau, Thomas Edison, the Rothschilds, JeanMartin Charcot, and the Panama Canal. He arrived in England and sought to avoid extradition on the grounds of a severe illness, necessitating evaluation by physicians. In particular, the consultants were charged with evaluating whether he was feigning illness, malingering. The artist H.S. Robert painted a skein of images of these encounters, reflecting not only the concern for fraud but also contemporary antisemitism.24 A wealth of potential insights at a myriad of sociocultural levels remains to be learned from this story. And to this day, it is difficult to ascertain which luminaries of two premier medical establishments, French and English, were ‘right’ and which ‘wrong’ in characterizing the veracity or lack thereof in Herz’s illness. Abundantly clear, however, is that his case casts an enormous range of topics and ‘analysands’ into relief—all because of the subject of malingering. In guiding us a long way from thirteenth-century Vermandois, our Vergil, ‘malingering’, points out a wondrous path of riches before us. While it may not be that Robert and Maroie’s property transfer led to the birth of ‘to malinger’, there is no doubt that the authors’ knowledge and wisdom in the following pages will transfer to the reader with great profit and no dissimulation.

Walton O. Schalick, III, MD, PhD

Notes

1 Fernand Le Proux, “Chartes françaises du Vermandois de 1218 à 1250”, Bibliothèque de l’École des Chartes 35 (1874): 437–77 at p. 466.

2 Alain Rey, éd., Dictionnaire historique de la langue Française, Nouvelle éd. (Paris: LeRobert, 2010), 1256.

3 See, among others, Sharon Farmer, The Silk Industries of Medieval Paris (Philadelphia: University of Pennsylvania Press, 2017), pp. 8ff & variously, and Walton O. Schalick, III, “Add One Part Pharmacy to One Part Surgery and One Part Medicine: Jean de Saint-Amand and the Development of Medical Pharmacology in Paris, c. 1230–1303” (Ph.D. diss., The Johns Hopkins University, 1997), 158–70.

4 The etymology is essentially unchanged from the 70s (Shorter Oxford English Dictionary (Oxford: Oxford University Press, 1973), vol. I, 1266), although the online OED entry from March 2022 suggests “back-formation” from “linger”. See also Rey, Dictionnaire, 1256.

Foreword

5 Christian Kay et al., eds., Historical Thesaurus of the Oxford English Dictionary (Oxford: Oxford University Press, 2009), vol. I at p. 67 and online OED from March 2022 “malinger” and “malingerer”.

6 Williamson, for example, highlighted the differential transaction costs between the medieval and modern periods, including the impact of malingering (Oliver E. Williamson, The Economic Institutions of Capitalism (New York: Free Press, 1985), 223–26). See also Richard T. Lindholm, “Why Were Renaissance Florentine Wool Industry Companies So Small?” in Quantitative Studies of the Renaissance Florentine Economy and Society (London: Anthem Press, 2017), 235–62.

7 Frederick Schauer, “The Relevance of the Past to the Present”, in his The Proof: The Uses of Evidence in Law, Politics, and Everything Else (Cambridge: Belknap/Harvard University Press, 2022), 203–25, at pp. 222–23.

8 Walton O. Schalick, III, “Neurology in the Middle Ages”, in Handbook of Clinical Neurology, eds. Stanley Finger, François Boller, and Kenneth Tyler (Edinburgh, UK: Elsevier, 2010), 79–90.

9 Nineteenth-century echoic interpretations of medieval malingering resonated with modernist notions of disability and of work-avoidance (see, e.g., KyleeAnne Hingston, “Grotesque Bodies: Hybridity and Focalization in Victor Hugo’s Notre-Dame de Paris”, in Articulating Bodies: The Narrative Form of Disability and Illness in Victorian Fiction (Liverpool: Liverpool University Press, 2019), 19–48).

10 Ron (F.R.P.) Akehurst, The Establissements de Saint Louis: Thirteenth-Century Law Texts from Tours, Orléans, and Paris (Philadelphia: University of Pennsylvania Press, 1996), 68 ff.

11 Talcott Parsons, “The Sick Role and the Role of the Physician Reconsidered”, Millbank Memorial Fund Quarterly 53, no. 3 (1975): 257–78.

12 Pierre Rosanvallon, The New Social Question: Rethinking the Welfare State, transl. Barbara Harshaw (Princeton: Princeton University Press, 2000), 47–48 and his La nouvelle question sociale: Repenser l’État-providence (Paris: Éditions du Seuil, 1995), 91; I include the bracketed French original, as I believe the translations, otherwise excellent, miss a slight nuance that Rosanvallon intended in the original.

13 Eric Y. Drogin, “ ‘When I Said That I Was Lying, I Might Have Been Lying’: The Phenomenon of Psychological Malingering”, Mental and Physical Disability Law Reporter 25, no. 5 (2001): 711–15.

14 Thomas Szasz, “Malingering,” in Psychiatry: The Science of Lies (Syracuse: Syracuse University Press, 2008), 17–32 at p. 17. For a creative riff on this resonant point, see Douglas Waxman, “The Dream: Freud & Szasz in Conversation”, Review of Disability Studies: An International Journal 16, no. 1 (2020): 1–12.

15 William Urban, “Review of Prussian Society and the German Order: An Aristocratic Corporation in Crisis, c. 1410–1466, by M. Burleigh”, Journal of Baltic Studies 15, no. 4 (1984): 308–10.

16 Dea H. Boster, “ ‘I Made Up My Mind to Act Both Deaf and Dumb’: Displays of Disability and Slave Resistance in the Antebellum American South”, in Disability and Passing: Blurring the Lines of Identity, eds. Jeffrey A. Brune and Daniel J. Wilson (Philadelphia: Temple University Press, 2013), 71–98.

17 Yücel Yanikdag, “From Cowardice to Illness: Diagnosing Malingering in the Ottoman Great War”, Middle Eastern Studies 48, no. 2 (2012): 205–25.

18 Robert Brightman, “Traditions of Subversion and the Subversion of Tradition: Cultural Criticism in Maidu Clown Performances”, American Anthropologist 101, no. 2 (1999): 272–87.

19 Edward Yelin, “The Myth of Malingering: Why Individuals Withdraw From Work in the Presence of Illness,” The Milbank Quarterly 64, no. 4 (1986): 622–49.

20 Jamelia Morgan, “Disability’s Fourth Amendment”, Columbia Law Review 122, no. 2 (2022): 489–581, at p. 526.

21 Sarah C. Bishop, Emotional Labor: A Story to Save Your Life (New York: Columbia University Press, 2022), 60–87; Shauer, “The Relevance of the Past to the Present”, 203–25.

22 Matthew Stibbe, “(Dis)entangling the Local, the National, and the International Civilian Internment in Germany and in German-Occupied France and Belgium in Global Context”, in Out of Line, Out of Place, eds. Rotem Kowner and Iris Rachamimov (Ithaca, NY: Cornell University Press, 2022), 25–51.

23 Sandra W. Russ and Alexis W. Lee, “Assessing Disordered Thinking and Perception in Children and Adolescents”, in Psychological Assessment of Disordered Thinking and Perception, eds. Irving B. Weiner and James H. Kleiger (Washington, DC: American Psychological Association, 2021), 271–86.

24 For a contemporary account on the British side, see “The Case of Dr. Cornelius Herz”, British Medical Journal 2, no. 1711 (1893): 858–59. For a broader view, see Jean-Yves Mollier, Le scandale de Panama (Paris: Fayard, 1991), variously, and David G. McCullough extremely influential The Path Between the Seas: The Creation of the Panama Canal, 1870–1914 (New York: Simon and Schuster, 1977), 98–99 and 213–38 variously.

Reference List

Akehurst, Ron (F.R.P.). The Establissements de Saint Louis: Thirteenth-Century Law Texts from Tours, Orléans, and Paris. Philadelphia: University of Pennsylvania Press, 1996.

Bishop, Sarah C. Emotional Labor: A Story to Save Your Life. New York: Columbia University Press, 2022.

Boster, Dea H. “ ‘I Made Up My Mind to Act Both Deaf and Dumb’: Displays of Disability and Slave Resistance in the Antebellum American South.” In Disability and Passing: Blurring the Lines of Identity, edited by Jeffrey A. Brune and Daniel J. Wilson. Philadelphia: Temple University Press, 2013.

Brightman, Robert. “Traditions of Subversion and the Subversion of Tradition: Cultural Criticism in Maidu Clown Performances.” American Anthropologist 101, no. 2 (1999): 272–87.

“The Case of Dr. Cornelius Herz.” British Medical Journal 2, no. 1711 (1893): 858–59.

Drogin, Eric Y. “ ‘When I Said That I Was Lying, I Might Have Been Lying’: The Phenomenon of Psychological Malingering.” Mental and Physical Disability Law Reporter 25, no. 5 (2001): 711–15.

Farmer, Sharon. The Silk Industries of Medieval Paris. Philadelphia: University of Pennsylvania Press, 2017.

Hingston, Kylee-Anne. “Grotesque Bodies: Hybridity and Focalization in Victor Hugo’s Notre-Dame de Paris.” In Articulating Bodies: The Narrative Form of Disability and Illness in Victorian Fiction. Liverpool: Liverpool University Press, 2019. Kay, Christian, et al., eds. Historical Thesaurus of the Oxford English Dictionary. Vol. I. Oxford: Oxford University Press, 2009.

Le Proux, Fernand. “Chartes françaises du Vermandois de 1218 à 1250.” Bibliothèque de l’École des Chartes 35 (1874): 437–77.

Foreword

Lindholm, Richard T. “Why Were Renaissance Florentine Wool Industry Companies So Small?” In Quantitative Studies of the Renaissance Florentine Economy and Society. London: Anthem Press, 2017.

Little, William, (Henry) H. W. Fowler, and Jessie Coulson. Shorter Oxford English Dictionary. Vol. I. Oxford: Oxford University Press, 1973.

McCullough, David G. The Path Between the Seas: The Creation of the Panama Canal, 1870–1914. New York: Simon and Schuster, 1977.

Mollier, Jean-Yves. Le scandale de Panama. Paris: Fayard, 1991.

Morgan, Jamelia. “Disability’s Fourth Amendment.” Columbia Law Review 122, no. 2 (2022): 489–581.

Parsons, Talcott. “The Sick Role and the Role of the Physician Reconsidered.” Millbank Memorial Fund Quarterly 53, no. 3 (1975): 257–78.

Rey, Alain, éd. Dictionnaire historique de la langue Française. Nouvelle ed. Paris: LeRobert, 2010.

Rosanvallon, Pierre. La nouvelle question sociale: Repenser l’État-providence. Paris: Éditions du Seuil, 1995.

———. The New Social Question: Rethinking the Welfare State. Translated by Barbara Harshaw. Princeton: Princeton University Press, 2000.

Russ, Sandra W., and Alexis W. Lee. “Assessing Disordered Thinking and Perception in Children and Adolescents.” In Psychological Assessment of Disordered Thinking and Perception, edited by Irving B. Weiner and James H. Kleiger. Washington, DC: American Psychological Association, 2021.

Schalick, Walton O., III. “Add One Part Pharmacy to One Part Surgery and One Part Medicine: Jean de Saint-Amand and the Development of Medical Pharmacology in Paris, c. 1230–1303.” Ph.D. diss., The Johns Hopkins University, 1997.

———, “Neurology in the Middle Ages.” In Handbook of Clinical Neurology, edited by Stanley Finger, François Boller, and Kenneth Tyler. Edinburgh, UK: Elsevier, 2010.

Schauer, Frederick. “The Relevance of the Past to the Present.” In The Proof: The Uses of Evidence in Law, Politics, and Everything Else. Cambridge: Belknap/ Harvard University Press, 2022.

Stibbe, Matthew. “(Dis)entangling the Local, the National, and the International Civilian Internment in Germany and in German-Occupied France and Belgium in Global Context.” In Out of Line, Out of Place, edited by Rotem Kowner and Iris Rachamimov. Ithaca, NY: Cornell University Press, 2022.

Szasz, Thomas. “Malingering,” In Psychiatry: The Science of Lies. Syracuse: Syracuse University Press, 2008.

Urban, William. “Review of Prussian Society and the German Order: An Aristocratic Corporation in Crisis, c. 1410–1466, by M. Burleigh.” Journal of Baltic Studies 15, no. 4 (1984): 308–10.

Waxman, Douglas. “The Dream: Freud & Szasz In Conversation.” Review of Disability Studies: An International Journal 16, no. 1 (2020): 1–12.

Williamson, Oliver E. The Economic Institutions of Capitalism. New York: Free Press, 1985.

Yanikdag, Yücel. “From Cowardice to Illness: Diagnosing Malingering in the Ottoman Great War.” Middle Eastern Studies 48, no. 2 (2012): 205–25.

Yelin, Edward. “The Myth of Malingering: Why Individuals Withdraw From Work in the Presence of Illness.” The Milbank Quarterly 64, no. 4 (1986): 622–49.

Introduction

The Bioethics of Malingering, Misrepresentation of Health, and Forensics of Illness

Wendy J. Turner

There is a long history of people faking medical conditions from women claiming pregnancy to avoid the death penalty (if for only a few weeks), to members of the military feigning health conditions or infirmity to leave service. The performative aspects of health conditions can lend themselves to being reproduced: Individuals pretend to be “leprous” beggars with painted-on sores or to be lame with a bandaged leg and crutches. When those elements are not correct, when the lame man can limp away without crutches, the public may doubt the person is ill, impaired, or in need of assistance. In contemporary society, there are some locations where those who might be critical of others are told through signage: “Remember, not all disabilities are visible”. People do abuse the “system” and/or the charity of others, for instance, those who use their grandmother’s disabled parking decal to get a premium parking space at school and the local shopping center. Most of these individuals do not bother to hide the fact that they are cheating for selfish reasons.

There are also examples of unscrupulous family members that accuse healthy people of being unhealthy for gain. They might point to a family member who is a weak thinker and claim they are mentally disabled, or state that an aging individual is not being capable of managing affairs, or suggest that a person in the prime of life with any number of health-related conditions is too afflicted to manage on her own. These accusations permit the accuser to assume power over the weaker person (whether aging or disabled or having health issues) and their resources. These accusations can cause doubt in the mind of a jury, and every accusation needs to be investigated, true or not, causing delays that might advantage the accuser. Complicating this situation is the role of physicians, who began serving as expert witnesses in trials in the Middle Ages. Although expected to be truthful and dispassionate—they began to be paid for this service because their time at court took away from the time they could spend in their clinic. In the United States and other places with accelerating economies, those payments became large, and the right “truth” could be purchased—real,

ethical, or not. In contemporary societies, there are often safeguards, but not always and not many; it depends on the stakes, where we are, and if the physician on the stand takes her oath of “do no harm” seriously or not. Even under the best and most ethical circumstances, sometimes at the trial, there is no clear answer and whatever the interpretation, it makes no difference to the health of the person. Even if properly explained, the performative aspects of the trial, the actions of the attorneys and the judge, will be what the jury hears. All these ideas—the feigned pregnancy, the pretend limp, the performative health condition as well as the use of a parking pass or signs telling us not to judge others, as well as the legal routine—fit together to form a network of mistrust, trust, trickery, reality, seen, and unseen illness, injury, impairment, and disability.

Expectations of Illness

In all these examples, an individual has tapped into something important about how the public reacts to and understands illness or, conversely, has failed to recognize these common expectations. The common denominator is that all these individuals know what is expected of them to garner interest or sympathy. The behavioral element is not hardwired but learned in human society. The man with the sign at the bottom of the off-ramp from the highway knows that his cardboard poster might say, “Have a Nice Day”, but his clothing and demeanor ask for handouts. Is he faking? Maybe. We do not know. Is he performing? Yes. It is an art form that many have perfected—globally and historically. The local hospital might have patients, young and old, describe their pain today as an emotion and by use of graduated emojis, happy to sad. We are good a demonstrating pain and discomfort; we use it to reach out to our parents for help when we are young and scrape a knee.

The art of being ill is a socially acceptable way of demonstrating pain, and there is the reverse. The fabrication of illness, whether perpetrated on another or by an individual, for social or monetary gain is accomplished because the public believes certain tropes about illness generally, and they weigh proof of illness or disability within a common framework of ideas. If this framework is not intact, the public might also not believe a person who is disabled is who he says he is. The unseen disability—gut issues, heart troubles, or other internal problems—leaves the spectator with questions of truth.

This collection of essays explores the art of illness, and the deceptions and truths around health and bodies, from a multiplicity of angles from antiquity to the present. They are divided into three parts on “Conceptualizing Malingering”, “Historic Cases of Malingering”, and “Regulations and Laws Against Malingering”. Furthermore, the authors represent a

large swath of the world being from or living in Belgium, Canada, England, France, Germany, Scotland, and the United States bringing a variety of perspectives to this conversation.

Conceptualizing Malingering

The opening section on “Conceptualizing Malingering” brings together four vastly different chapters, each of which defines the idea of the bioethics of malingering for their own field, location, and time period. The first essay is “Malingering in Ancient Greece and Rome” by Lisa LeBlanc. It is startling to learn that the idea of malingering—as a concept of faking illness to get out of work or retire from the army early—was not only understood in ancient Greece and Rome but also legislated. Moreover, playwrights and authors used the concept to their advantage, having characters use the art of faking illness to get out of slavery or uphold their values, by lying to those the audience knew were bad, thereby preserving goodness. The second chapter is Chelsea Silva’s “Form, Fraud, and Performance in Middle English Medical Satire”. Silva examines the work of a charlatan who owns a parchment filled with lines and figures that seems quite scientific, perhaps even mystical to the medieval patient. A patient, much like today, expected certain things from his physician, and this “formula” made the practitioner appear real. Yet, as we know now, any “formula” or diagram for even the best doctoring could be copied or, more significantly, faked. Silva takes us into this world of medieval medical expertise, magic, and quackery, explaining the organizing principles that shaped the medieval experience of health. In the third paper in this opening section, Irina Metzler brings the medieval and contemporary together. Metzler examines “Pathologising Ecstatic Dance: Reflections on Medieval Dansomnia and the Love Parade in Berlin, 1996”. It is striking to see the same terms—“illness”, “twitching”, “frantic”, and “distortions of the body”—in both the records of the fourteenth century and those of the late twentieth. It is not the dancers who are malingering or faking, but rather, it is those reporting on what they witnessed who pathologize the dancers’ actions. The reporters, in both time periods, considered the dancers to have some sort of mass mental health disorder. In the Middle Ages, viewers question what might have “[given] rise to this mental plague”,1 and in 1996, reporters saw, “a bunch of sick people. . . . Paths of contagion and methods of treatment are unknown”.2 This might be hyperbole on the part of the twentieth-century reporter, but the point of both writers is clear—to use medical terminology to discredit and malign.

Taking us in a different direction, for the fourth paper in this section on “Conceptualizing Malingering”, Herb Leventer asks critical questions about “malingering” for contemporary society. In his chapter,

“Philosophical Paradoxes of Factitious Disorders”, Leventer inserts several case studies or study examples throughout to unpack several related disorders for the reader, including factitious disorders, malingering, and Munchausen’s disease, among others. He walks through the myriad of ever-changing elements in American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders since its inception, pointing to cracks in diagnoses and understandings of factitious disorders and malingering. Leventer reminds readers that not all physical and mental issues are, as yet, understood. Contemporary medicine at times over-medicates and over-tests while simultaneously coming often, and oddly, to the conclusion that if the tests show nothing, the patient is fine. The patient is left frustrated at best and labeled as a “malingerer” or with a mental health flag on their record at worst. Leventer concludes with some suggestions on how contemporary medicine might rethink these diagnoses if for no other reason than to be more ethically responsible to patients that genuinely need assistance.

Historic Cases of Malingering

The second section covers several “Historic Cases of Malingering” from the Middle Ages to the beginning of the Modern period. These case studies review the human element in the story of malingering and faking illnesses and the chapters, in the section, focus on a case or two to center their work around the pinpoint of one core theme.

In the first chapter of historic malingering, Emma Trivett delves into the lives of two queens in Scotland who used the idea of pregnancy to stay alive and stay queen in her chapter, “ ‘Because she pretended to be pregnant and was not’: Fake Royal Pregnancies in Medieval Scotland”. Once a person rose to the level of the aristocracy, it was a long way to fall if found out. Queen Yolande de Dreux, the second queen of Alexander III, not only faked her pregnancy but also tried to substitute an heir. Queen Margaret Logie, who was married to David II, divorced because she faked her pregnancy. However, these pregnancies were each only recorded in one chronicle and the stories there seem suspect. The chroniclers may have used the idea of the queens lying about the heirs to the throne, much like those witnessing the dancers in Metzler’s chapter, above, to discredit and malign them.

The second chapter by Wendy J. Turner, “Treason and Malingering: Faking Frenzy in a Sixteenth-Century English Prison”, is a close reading of a case study, some of which were originally state secrets. The case concerns William Hawkyns, a London teacher who ran afoul of the Star Chamber Council under Edward VI. Hawkyns feigns madness for a year while locked in the Tower of London, finally confessing that he and a conspirator

had planned treasonous acts against the crown. While the details are vague, faking a mental disorder for such a long time takes its toll and either Hawkyns is injured in the interrogation process or becomes mentally ill under the stress of what he is attempting and ends up in Bedlam Hospital. Case studies are valuable ways of teasing apart what individuals know, how people behave, or what the attitudes of society are. Carolyn A. Day’s chapter examines the life and supposed illness of Princess Sophia, daughter of George III of England. Scandals abound among her family and friends, and Day suggests that this might be Sophia’s way of getting attention. With a detailed analysis of the archival evidence, Day carefully recreates what and when Sophia might have been doing to trick the country and her family and friends into believing she was ill.

Regulations and Laws Against Malingering

The final section covers “Regulations and Laws Against Malingering”, and, while this part of the book focuses on this topic, certainly other concepts in law concerning malingering have already been discussed by the authors mentioned earlier in the volume. In the first chapter on regulations, Courtney A. Krolikoski considers false beggars, particularly those faking leprosy, in her chapter, “Faking It: Thirteenth-Century Bolognese Responses to Feigning Leprosy”. Krolikoski notes that the people of Bologna wanted to be charitable citizens, but they also wanted to make sure their funds were going to the truly needy and not impostors. They passed statutes against false beggars entering the city and, at the same time, protected those suffering from what was then called “leprosy”. The second chapter on regulations is “Expertis medicis videatur: Legal Medical Expertise in the Apostolic Chancery’s Assessment of Personal Injury Damages During the Avignon Period (1309–1378)” by Ninon Dubourg. Dubourg takes a close look at the pontifical institution, one of the first entities to assess personal injury. This research investigates how forensic medicine worked in the institution’s adjudication process and how that became the model for the Apostolic Chancery at the end of the Middle Ages. She finds that these records demonstrate that physicians were trusted medical experts and advisors on cases, verifying the reports on personal injuries and the damages to be paid. This section concludes with a fabulous chapter by Luke I. Haqq, “Compensatory Damages and the Construction of Injury in Prenatal Torts, 1960–1975”. This chapter sifts through the changing use and abuse in law of suits concerning “wrongful conception” and “wrongful life” and how these prenatal and natal torts have led to a culture of parents of children with serious prenatal diseases—sometimes preventable—giving birth and turning around to sue for multimillion-dollar awards based in part on the care of the child, but in large part on their own (the parents’) alleged pain

and suffering, even when they are happy to have the child in their lives. Haqq argues that this is because the U.S. legal system has a serious flaw and suggests ways to reevaluate the U.S. legal path.

Understanding Health, Ill Health, and Malingering

From the point of view of each individual field, all of the chapters in this volume take on the task of defining malingering or faking illness. A common method among many of these chapters is the use of case studies to provide evidence and support to the arguments. The concept of fraud appears in nearly all of the chapters. Fraud as a topic comes up in LeBlanc’s work on Greek and Roman military regulations, Silva’s research on medieval medical quacks, Dubourg’s study of personal injury damages in medieval Avignon, Krolikoski’s examination of regulations against faking so-called leprosy in late medieval Bologna, and in Haqq’s examination of intent among those suits for “wrongful” conception or birth. Both Trivett and Turner look at the larger issue of fraud: treason. Leventer’s quick look at avoidance of contemporary military obligations also looks at fraud; however, that is not the focus of his chapter. His chapter is a philosophical discussion about how and why to define certain elements, and so-called diseases, that surround patients perceived as malingerers. Metzler’s work, like Leventer’s, is a look at how perception and terminology can harm or distort the truth of what a person is suffering (or not suffering). This too is a type of “faking” but done so for the benefit of the viewer.

Overall, this book is about health deception and invented health conditions. Many people took this “faking” to the level of an art form, while others imposed medical terminology where there was no illness or injury. Performative life is not new, and neither is malingering, as demonstrated by the chapters presented here that span almost 3,000 years of history. The human elements within these pages also tell the stories of real problems in society: of thwarted attempts to have children, find a job, or explain a real condition; of avoiding the death penalty, work, or military duty; of condemning others for differences, disabilities, dancing, or inability to have children. Some of these cases have health policy implications for contemporary societies. Altogether, they paint a picture of humans doing human actions—cheating, lying, and stealing, but also hiding, surviving, and working. They enable us to see the good as well as the bad, the “malingerers” who are sufferers mislabeled as well as those wanting only attention or to cheat the system.

1 J. F. C. Hecker, The Epidemics of the Middle Ages, transl. B. G. Babington, 3rd ed. (London: Trübner, 1859), p. 88.

2 “die Töne bollern mit der Gewalt eines Preßlufthammers ans Ohr,” Rainer Schmidt, “Deutschland, liebes Technoland”, Die Zeit, no. 30 (July 19, 1996).

Reference List

Hecker, J. F. C. The Epidemics of the Middle Ages. Translated by B. G. Babington. 3rd ed. London: Trübner, 1859.

Schmidt, Rainer. “Deutschland, liebes Technoland.” Die Zeit, no. 30 (July 19, 1996).

Part I Conceptualizing Malingering

1 Malingering in Ancient Greece and Rome

Lisa LeBlanc

The fear that people are faking illnesses to get out of military duty or to gain additional financial benefits from the government often appears in modern times. These fake illnesses may be complaints of actual problems that have gone away, or they may be entirely fictionalized problems. Since people who are ill are often treated differently from the healthy, those who want at least one aspect of the treatment given to the ill have feigned illness in order to gain those benefits. Records of people malingering go all the way back to ancient times, appearing in Greek and Roman texts. Reasons for malingering, the benefits the individual seeks, have not changed that much over time. Individuals are still trying to avoid unpleasant or dangerous jobs or seeking to gain extra help that they would not get if they were whole. While the explanatory texts show a clear concern with detecting and averting malingering, the narrative texts from the ancient world tended to be more sympathetic to those who feign illness, often presenting the situation as the only or best solution available.

Defining Malingering

The concept of malingering is defined not just by the actions, but also by the motivations for those actions. Malingering does not appear in the Diagnostic and Statistical Manual of Mental Disorders, 5th edition (DSM-5) as a mental health diagnosis, but it is listed as a V code (an occurrence when a client meets with a provider for a reason other than disease or injury but that does influence care) under “Nonadherence to Medical Treatment”.1 The DSM-5 describes malingering as “the intentional production of false or grossly exaggerated physical or psychological symptoms, motivated by external incentives such as avoiding military duty, avoiding work, obtaining financial compensation, evading criminal prosecution, or obtaining drugs”.2 The DSM-5 does acknowledge that malingering can sometimes serve as an adaptive behavior, giving the example of a prisoner of war malingering to adapt to the situation.3

The DSM-5 also distinguishes between malingering and actual disorders. For instance, malingering requires the presence of external motivations. While factitious disorder is a disorder in which the patient feigns physical or psychological symptoms, it is not done for external reasons. Both conversion disorder and somatic symptom-related disorder lack the external motivations, but they also differ from malingering in that the symptoms are not intentionally created.4

Because one of the motivations for malingering is avoiding military duty, the U.S. Uniform Code of Military Justice has its own specific definition of malingering. Article 115 refers to it as “feigning illness, physical disablement, mental lapse, or derangement carried out in a hostile fire zone or in time of war”.5 Thus for the military definition of malingering, the feigning must be motivated by avoiding the danger of war. The term “malingering” was derived from the French malinger and was first used in the nineteenth century and was restricted to military use.6 Halligan, Bass, and Oakley argue that the term “malingering” is often not used in modern psychology because of the negative connotations, and they define malingering, or illness deception, as “the intentional production of false or exaggerated symptoms motivated by external incentives”.7 For all the definitions, the intentionality of the act and the presence of exterior motivations are necessary.

Halligan, Bass, and Oakley point out that the external incentive may go beyond financial benefit, such as that gained in lawsuits or from disability. It can also include improving the quality of life (relying on others to take care of them), avoiding stressful work (such as in the military), avoiding a job that one does not like, avoiding a trial or jailtime, and obtaining drugs by feigning illnesses that need them.8 In addition to varied motives for malingering, the degree to which malingering is occurring also varies in severity. A four-part typology, created by Lipman, includes “(1) invention: where a patient without actual symptoms claims he has, (2) perseveration: genuine symptoms previously experienced are alleged to be present, (3) exaggeration: symptoms or their associated effects (disabilities) are magnified or embellished, (4) transference: where genuine symptoms currently present are falsely attributed to previous or unrelated injuries”.9 Clinical reports indicate that an important characteristic of malingering is that the patient shows restraint. Those who do not exaggerate their symptoms have a better chance of not being discovered. The patient must either exhibit behaviors that are atypical or avoid typical behaviors consistently, but not to excess.10

Malingering is a fairly consistent condition, with various sources using the term to explain the motives behind a person intentionally feigning physical or psychological symptoms. Although the term develops much later, the characteristics of malingering are clearly seen in ancient works, both works meant to teach and explain and narrative works meant to entertain.

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however, the more he washed in the hot tears, the redder grew his clothes, until he was just the colour of the scarlet bean blossom.

“You told me a story,” said Gillydrop to the giant when he saw how red he was getting.

“I know I did,” said Dunderhead, drying his eyes, for he had now wept enough, and was growing hungry; “but if I hadn’t told you a story, I wouldn’t have got any supper. You’ll never be green again, so don’t trouble your head. I’m going to get some wood to cook these nice fat children.”

On hearing this, Teddy and Tilly roared like bulls, and Gillydrop roared too, for he was afraid he would never be able to go back to Faeryland in his red clothes; but the giant only laughed at them, and went out to light a fire under his big kettle.

Gillydrop was naturally very cross with the giant for having deceived him, and determined to punish him for having done so. Bringing the two children to Dunderhead for his supper could not be the kindly deed he had to do, or else he would have turned green again; so Gillydrop made up his mind to take Teddy and Tilly back to earth, and thus leave Dunderhead without his supper. While he was thus making up his mind, seated at one end of the table, the two children, seated at the other end, were crying bitterly at the plight in which they now found themselves, for it certainly is not a nice thing to be boiled for an ogre’s supper

“Poor mother!” wailed Tilly, weeping; “she’ll miss us so much.”

“I don’t know if she will,” replied Teddy dolefully; “we’ve always been so naughty, I daresay she’ll be glad we’ve gone.”

“Oh no, she won’t,” said Tilly, nodding her head; “she loves us too much for that; but if we could get back I’d be so good.”

“And so would I,” cried Teddy; and then they both wept again, while Gillydrop, seeing their tears, wept also out of sheer sympathy.

“Perhaps the giant will only eat one of us,” said Tilly after a pause; “so while one of us is boiling, the other must run away and go back to comfort mother.”

“Who will be boiled?” asked Teddy sadly “Will you, Tilly?”

“I don’t like being boiled,” answered Tilly, with a shudder. “I’m sure it isn’t nice ”

“Well, I don’t like being boiled either,” observed Teddy. “Suppose we draw lots who is to run away ”

“Yes, that would be fair,” said Tilly, drying her eyes; “and the one who wins must go back to cheer mother ”

Gillydrop was quite sorry now that he had brought them for Dunderhead’s supper, when he heard how they regretted their mother; so he made up his mind to save them.

“You shall neither of you be boiled,” he said, walking up to them across the table, which was like a large plain. “I will take you back to your mother.”

“But how?” asked Teddy and Tilly, both together. “We cannot go back across the sea alone.”

“Oh yes, you can,” replied the Red Elf. “I brought you here, and can send you back; that is, if I only had a leaf.”

“Here is one,” cried Tilly eagerly, pulling a faded leaf out of her pocket. “I picked it up in the wood to-day, it had such pretty red and yellow colours.”

“Oh, that will do for a boat,” said Gillydrop joyfully.

“But it’s so small,” objected Teddy

“I’ll make it large enough,” said the elf. “You’ll see.”

“But how can we go on without sails or oars?” said Tilly timidly.

“You don’t need any,” rejoined Gillydrop, laughing; “you know every tree has power to draw back its own leaves. The boat we came in was a leaf, and, as soon as it was launched on the air, it went straight back to the tree in the Country of the Giants upon which it had grown; and as this leaf comes from a tree on earth, it will go straight back to its tree.”

“Then we can get home,” cried Tilly, clapping her hands, “for the tree isn’t far from mother’s cottage.”

“Mind, you are never to be naughty again,” said Gillydrop solemnly

“Oh, no, no!” cried both children.

“And be very, very good to your mother.”

“Yes, yes! We’ll be very good.”

“Then go down to the beach by the path,” said Gillydrop, spreading his wings. “I’ll fly down and get the boat ready; be quick, or the giant will return.”

Then he flew away through the open window, and Teddy scrambled down the steep path, followed by Tilly, both of them in a great fright lest the giant should catch sight of them and pop them into his big kettle. When they reached the beach, they found Gillydrop had launched the leaf, which had now been transformed into a beautiful red and yellow coloured boat.

“Good-bye,” said Gillydrop, as soon as they were comfortably seated in the boat. “I’m sorry I brought you here, but it will do you no harm, as it will teach you to be good. Mind you don’t quarrel in the boat—if you do, the leaf will vanish, and you’ll sink for ever in the black waves.”

“Oh, we’ll be very, very good,” promised both the children eagerly, and then Gillydrop gave the boat a push, so that it moved rapidly away from the land, leaving him seated on the beach, a lonely little red figure.

Teddy and Tilly were rather afraid at finding themselves alone in the darkness, but they kissed one another, and fell asleep, while the leaf-boat sailed rapidly over the Sea of Darkness towards its parent tree. When the children awoke, they found themselves lying on the ground under the tree, and there above them was their red and yellow boat, hanging, a red and yellow leaf, on a high bough.

“Now we’ll go home,” cried Tilly, jumping up; “now we’ll go home to mother.”

“And be very good,” said Teddy, also rising

“Yes; very, very good,” replied Tilly. And then, taking one another’s hands, they ran home to their cottage through the dark forest

Dame Alice, who thought they had lost themselves in the wood, was very glad to see them, and, after she had kissed them, gave them a good supper of bread and milk, which they enjoyed very much, for you see they were very hungry with the long journey.

They told Dame Alice all their adventures, and she was very glad they had gone to the Giants’ Country, for she guessed, like the wise mother she was, that this was the lesson the faeries had foretold.

Ever afterwards, Teddy and Tilly were good children; there never were two such good children, because they thought, if they were not good, they would be taken back to the Giants’ Country and boiled for an ogre’s supper But after a time they liked to do good actions because they found it pleasant, and Dame Alice was so pleased with their behaviour that she made a rhyme about them, which soon passed into a proverb:

“The magic power of a faery Cures a child when quite contrary.”

HOW THE RED ELF RETURNED TO FAERYLAND.

W Gillydrop saw the magic boat disappear into the darkness of the sea, he thought that, now he had done one kindly deed, his clothes would change from red to green, and he would be able to return to his dear Faeryland. But nothing of the sort occurred, and the poor elf began to cry again, thinking he was lost for ever, but this time his tears were not red, which was a good sign, although he did not know it.

Very soon he heard Dunderhead roaring for the loss of his supper, so, drying his eyes, he flew back again to the hall of the castle, to see what the giant was doing. He found a great fire was lighted, over which was suspended a great kettle filled with water, which was now boiling hot. Dunderhead was searching everywhere for the children, and when he saw Gillydrop he shook his great fist at him.

“Where’s my supper, you red rag?” he roared fiercely. “Your supper has gone back to earth,” replied Gillydrop angrily, for no one likes to be called a red rag. “You told me a story, so I thought I’d punish you.”

“Oh, did you?” bellowed Dunderhead, in a rage. “Then I’ll punish you also for spoiling my supper.” And before Gillydrop could fly away, he caught him in his great hand and popped him into the boiling water.

Oh, it was terribly hot, and Gillydrop thought it was all over with him; but, being a Faery, he could not be killed, as the foolish giant might have known. He sank down, down, right to the bottom of the great kettle, and then arose once more to the top. As soon as he found his head above water, he sprang out of the kettle and flew away high above the head of Dunderhead, who could only shake his fist at him

To his delight and surprise, Gillydrop found his clothes had all changed from red to green, and instead of being dressed in crimson, his suit was now of a beautiful emerald colour. He was so delighted that he flew down on to the floor of the hall, and began to dance and

sing, while the giant joined in as he tried to catch him; so that they had quite a duet.

Gillydrop Now I’m gay instead of sad, For I’m good instead of bad: Dreadful lessons I have had.

Giant. I will catch and beat you!

Gillydrop Tho’ a naughty elf I’ve been, Now my clothes are nice and clean: I dance once more a faery green.

Giant I will catch and eat you!

But you see he could not do that, because Gillydrop was too quick for him, and flew round the hall, laughing at Dunderhead, who roared with anger. Then the elf flew out on to the terrace which overlooked the Sea of Darkness, followed by the giant. Gillydrop flew down on to the beach to escape the ogre, and Dunderhead tried to follow; but, as he could not fly, he fell right into the Sea of Darkness. Dear me! what a terrible splash he made! The waves arose as high as the castle walls, but then they settled down again over Dunderhead, who was suffocated in the black billows. He was the very last of the giants, and now his bones lie white and gleaming in the depths of the Sea of Darkness, where nobody will ever find them nor do I think any one would trouble to look for them.

As for Gillydrop, now that Dunderhead was dead, he flew away across the dreary plain towards Faeryland, and soon arrived at the borders of the sullen grey sea which still rolled under the pale light of the moon. Gillydrop was not a bit afraid now, because his clothes were green once more, and he had performed one kindly deed; so he sat down on the seashore and sang this song:

“When from Faeryland I fled, All my nice clothes turned to red; Now in emerald suit I stand Take me back to Faeryland.”

And as he sang the grey ocean faded away, and in its place he saw the green trees of the faery forest, waving their branches in the silver moonlight. Only a bright sparkling stream now flowed between Gillydrop and Faeryland; so, spreading his silver and blue wings, he flew across the water, singing gaily:

“Thanks, dear Oberon. At last All my naughtiness is past; Home I come without a stain, And will never roam again ”

So at last Gillydrop got back to Faeryland after all his trials, and ever afterwards was one of the most contented elves ever known. You may be sure he never wanted to see the Country of the Giants again, and whatever King Oberon said he did willingly, because he knew it must be right.

He was quite a hero among the faeries, and had the honour of telling all his adventures to King Oberon himself, which he did so nicely that the King gave him a title, and ever afterwards he was called “Sir Gillydrop the Fearless.”

SHADOWLAND

IT was Christmas Eve, and the snow, falling heavily over a great city, was trying to hide with its beautiful white robe all the black, ugly houses and the narrow, muddy streets The gas lamps stood up proudly, each on its tall post, and cast their yellow light on the crowds of people hurrying along with their arms filled with many lovely presents for good children.

“They are poor things,” said the gas lamps scornfully. “If we did not shed our light upon them, they would be lost in the streets.”

“Ah, but the people you despise made you,” cried the church bells, which were calling the people to prayer. “They made you—they made you, and gave you your beautiful yellow crowns.”

But the street lamps said nothing, because they could not deny what the church bells said, and instead of acknowledging that they owed all their beauty to the people they despised, remained obstinately silent.

Near one of these lamp-posts, at the end of a street, stood a ragged boy, who shivered dreadfully in his old clothes, and stamped about to keep himself warm. The boy’s name was Tom, and he was a crossing-sweeper, as could be seen by his well-worn broom. He was very cold and very hungry, for he had not earned a copper all day, and the gaily-dressed army of people swept selfishly past him, thinking only of their Christmas dinners and warm homes.

The snowflakes fell from the leaden-coloured sky like great white angels, to tell the earth that Christ would be born again on that night, but Tom did not have any such ideas, as he was quite ignorant of angels, and even of the birth of the child-Christ. He only looked upon the snow as a cold and cruel thing, which made him shiver with pain, and was a great trouble to brush away from his crossing.

And overhead the mellow bells clashed out their glad tidings in the bitterly chill air, while below, in the warm, well-lighted churches, the organ rolled out its hymns of praise, and the worshippers said to one another, “Christ is born again.”

But poor Tom!

Ah, how cold and hungry he was, standing in the bright glare of the lamp, with his rags drawn closely round him for protection against the falling snow The throng of people grew thinner and thinner, the gaily-decorated shops put up their shutters, the lights died out in the painted windows of the churches, the bells were silent, and only poor Tom remained in the deserted, lonely streets, with the falling snowflakes changing him to a white statue He was thinking about going to his garret, when a gentleman, wrapped in furs, passed along quickly, and just as he came near Tom, dropped his purse, but, not perceiving his loss, walked on rapidly through the driving snow. Tom’s first idea was to pick the purse up and restore it to its owner, whom Tom knew very well by sight, for he was a poet, who daily passed by Tom’s crossing. Then Tom paused for a moment as he thought of all the beautiful things the money in that purse would buy; while he hesitated, the poet disappeared in the darkness of the night, so Tom was left alone with the purse at his feet.

There it lay, a black object on the pure white snow, and as Tom picked it up, he felt that it was filled with money. Oh, how many things of use to him could that money buy bread and meat and a cup of warm coffee—which would do him good. Tom slipped it into his pocket, and thought he would buy something to eat; but just at that moment he seemed to hear a whisper in the air,

AS TOM PICKED IT UP HE FELT THAT IT WAS FILLED WITH MONEY

“Thou shalt not steal.”

With a start of terror Tom looked around, thinking a policeman had spoken, and would take him off to prison for stealing the purse, but no policeman was in sight. He saw nothing but the whirling flakes and his ragged shadow cast blackly on the white snow by the light of the lamp. It could not have been the shadow speaking, as Tom thought, for he knew that shadows never speak; but, ah! he did not know the many wonderful things there are in this wonderful world of ours

Whoever had made the remark touched Tom’s heart, for he remembered how his poor mother had blessed him when she died, and told him to be an honest boy. It certainly would not be honest to steal money out of the purse, but Tom was so cold and hungry that he half thought he would do so. He took out the purse again and looked at its contents four shining sovereigns and some silver. Then he put it back in his pocket, and trudged home with his broom under his arm.

Home! ah, what a dreary, cheerless home it was! nothing but a garret on the top of an old house—a bare garret, with no table or chairs, but only the sacks upon which Tom slept at night.

He closed the door, and then lighted a little bit of candle he had picked up in the streets with one of the matches from a box given him by a ragged match-seller.

Tom placed the candle on the floor, and, kneeling down, opened the purse to look at the money once more. Oh, how tempted he was to take one of those shillings and buy some food and wood it would be a merry Christmas for him then! Other people were enjoying their Christmas, and why should he not do the same? The great poet who had dropped the purse had plenty of money, and would never miss this small sum; so Tom, desperate with hunger, took a shilling, and, hiding the purse under his bed, was about to blow out the candle before creeping down-stairs to buy some food, when he heard a soft voice whisper,—

“Don’t go, Tom.”

He turned round, and there was the shadow cast by the reflection of the candle-light on the wall. It was a very black shadow, much blacker than Tom had ever seen before, and as he looked it grew blacker and blacker on the wall, then seemed to grow out of it until it left the wall altogether, and stood by itself in the centre of the floor, a waving, black shadow of a ragged boy. Curiously enough, however, Tom could not see its face, but only the outline

of its whole figure, yet it stood there shaking with every flicker of the candle, and Tom could feel that its eyes were looking right into him.

“Don’t go, Tom,” said the shadow, in a voice so like his own that he started. “If you go, you will be lost for ever.”

“Lost?” said Tom, with a laugh; “why, I couldn’t lose myself. I know every street in the city.”

“I don’t mean really lost,” replied the shadow; “but it will be your first step on the downward path.”

“Who are you?” asked Tom, rather afraid of the shadow, but keeping a bold front.

“I am your shadow,” it replied, sighing. “I follow you wherever you go, but only appear when there is light about you. If you had not lighted that candle I would not have appeared, nor could I have spoken.”

“Was it you who spoke at the lamp-post?” said Tom doubtfully.

“Yes, it was I,” answered the shadow. “I wanted to save you then, as I do now, from committing a crime. Sit down, Tom, and let us talk.”

Tom sat down, and the shadow sat down also. Then for the first time he caught a passing glimpse of its face, just like his own, only the eyes were sad oh, so sad and mournful!

“Thou shalt not steal,” said the shadow solemnly

“I don’t want to steal,” replied Tom sulkily; “but I’m cold and hungry. This shilling would buy me fire and food I don’t call that stealing ”

“Yes, but it is stealing,” answered the shadow, wringing its hands; “and you know it is. If you steal you will be put in prison, and then I shall have to go also. Think of that, Tom, think of that.”

Tom did not say a word, but sat on the floor looking at the bright shilling in his hand which could procure him so many comforts. The shadow saw how eager he was to take the shilling, and, with a sigh, began to talk again.

“Think of your mother, Tom,” it said softly. “She was the wife of a gentleman—your father; but he lost all his money, and when he died

she could get no one to help her Do you remember how she died herself in this very place, and how she implored you with her last breath to be an honest boy?”

“Yes, I remember,” said Tom huskily; “but she did not know how cold and hungry I would be.”

“Yes she did she did,” urged the shadow. “She also had felt cold and hunger, but she never complained. She never stole, and now she has her reward, because she is a bright angel.”

“I don’t know what an angel is,” said Tom crossly; “but if she’s all right, why doesn’t she help me?”

“She does help you, Tom,” said the shadow; “and it was because she saw you were tempted to steal to-night that she asked me to help you. She cannot speak as I do, because she is not a shadow.”

“Well, help me if you’re able,” said Tom defiantly; “but I don’t believe you can.”

The candle on the floor had burnt very low, and as Tom said the last words his shadow bent nearer and nearer, until he again saw those mournful eyes, which sent a shiver through his whole body. It stretched out its arms, and Tom felt them close round him like soft, clinging mist; the candle flared up for a moment, and then went out, leaving Tom in darkness altogether. But he did not feel a bit afraid, for the soft arms of the shadow were round him, and he felt that it was carrying him through the air

They journeyed for miles and miles, but Tom knew not which direction they were taking until a soft light seemed to spread all around, and Tom felt that he was in the midst of a large crowd, although he saw no one near him. Then he felt his bare feet touch some soft, cloudy ground, that felt like a sponge; the shadowy arms unclasped themselves, and he heard a voice, soft as the whispering of winds in summer, sigh,

“This is the Kingdom of Shadows.”

Then Tom’s eyes became accustomed to the subdued twilight, and he saw on every side a number of shadows hurrying hither and

thither He seemed to be in the centre of a wide plain, over which hung a pale white mist, through which glimmered the soft light. The shadows were all gliding about this plain; some thin, some fat, some tall, others short; they all appeared to have business to do, and each appeared to be intent only on his own concerns. Tom’s own shadow kept close to him, and whispered constantly in his ear of strange doings.

“These are the shadows of the past and of the future,” it sighed; “all the shadows of human beings and their doings are here; see, there is a funeral.”

And a funeral it was which came gliding over the smooth, white plain; the great black hearse, the dark horses with nodding plumes, and then a long train of mourners; all this came out of the mist at one end, glided slowly over the plain, and vanished in the veil of mist at the other. Then a bridal procession appeared; afterwards a great army, clashing cymbals and blowing trumpets from whence no sound of music proceeded; then the coronation triumph of a king, and later on a confused multitude of men, women, and children, all hurrying onward with eager rapidity. But they all came out of the mist and went into the mist, only appearing on the white plain for a few minutes, like the shadows of a magic lantern.

“The stage of the world,” whispered Tom’s shadow. “Birth, death, and marriage, triumphs and festivities, joys and sorrows, all pass from mist to mist, and none know whence they come or whither they go.”

“But what has this got to do with me?” asked Tom, who was feeling rather bewildered.

“You are a man,” said his shadow reproachfully, “and must take an interest in all that men do; but come, and I will show you what will happen if you steal the purse.”

They glided over the plain towards the distant curtain of mist, but how they travelled over the immense distance so rapidly Tom did not know, for in a moment it seemed to him that he had come many miles, and found himself suddenly before a grey, misty veil, with his own shadow beside him, and many other shadows around.

As he stood there, a whisper like the murmur of the sea on a pebbly beach sounded in his ears, and he seemed to guess, rather than hear, what the shadows said.

“Now he will see now he will see he must choose the good or the bad. Which will he choose?—which will he choose?”

Then the grey veil stirred, as if shaken by a gentle wind, and, blowing aside, disclosed what seemed to Tom to be a great sheet of ice of dazzling whiteness set up on end. As he looked, however, shadows began to appear on the milky surface which acted a kind of play and then vanished, and in the play he was always the central figure.

First he saw himself pick up the purse in the snowy street; then hide it in his bed. He saw his ragged shadow glide down-stairs from the garret to buy food; the shopman looking at him, then at the shilling; then a policeman arresting him and finding the purse hidden in the bed. Afterwards he saw himself in prison; then released, and prowling about the streets. Years seemed to pass as he looked, and his shadow became taller and stouter, but always wearing a ragged dress. After many years he seemed to see his shadow breaking into a house meet the owner of the house, and kill him. Afterwards the shadow of himself stood in the dock; then crouched in prison; and, last of all, he appeared standing under a black gallows with a rope round his neck. At length all the shadows vanished, and the surface of the ice mirror again became stainless, whilst a voice whispered in his ear, “All this will happen if you steal the purse.”

Then the shadows again came on to the mirror and acted another play; but this time it was much more pleasant.

Tom saw his shadow representative take the purse back to the poet who had lost it. Then he saw himself in a school, learning all kinds of wonderful things; and the years rolled by, as they had done in the other play, unfolding the shadows of a beautiful life. He saw himself become a great and famous poet, who wrote beautiful books to make people wise and good. Then he saw himself in church, with a woman’s shadow by his side, and he knew, in some mysterious way, that it was the daughter of the poet who had lost the purse. And as the happy years rolled on he saw himself rich and honourable, and the end of all was a magnificent funeral, taking his body to be buried in the great church wherein many famous men were laid. Then the shadows vanished, and the mirror became pure again, while over it the grey mists fell like a soft veil, and once more the voice of his shadow said,—

“All this will happen if you remain honest.”

Then the crowd of shadows around Tom looked at him with their mournful eyes, and a whispering question ran through the fantastic throng,—

“Which will he choose?—which will he choose?”

“I will choose the honest life,” cried Tom loudly. “Yes, I will give back the purse to the poet.”

At this the shadows around seemed to rejoice, and he could see beautiful faces smiling at him from amid the crowd. The shadow multitude broke in a wild dance of joy, keeping time to some aerial music which Tom could not hear; and his own shadow, with happiness shining out of its mournful eyes, threw its arms round him once more. A dark veil seemed to fall over him, and the great white plain, the glimmering mists, and the restless shadows, vanished together.

When Tom opened his eyes again, he found himself lying on the floor of his garret, cold and hungry still, but with his heart filled with a great joy, for the shilling was still clutched in his hand, and he knew he had not stolen the money. He took the purse from under the sacks, replaced the shilling, and then went out, in the bright sunshine of the Christmas morning, to give back the lost purse to its owner.

Overhead the bells rang out merrily, as if they were rejoicing at Tom’s victory over himself, and a beautiful lady, who was on her way to church, gave Tom some money to get food. He went and bought a loaf and a cup of coffee, then, thankful for his good fortune, he trudged off to the poet’s house.

The great poet received him very kindly, and, after thanking Tom for returning his purse, asked him why he had done so instead of keeping it? Whereupon Tom told the poet all about the shadow, which interested the poet very much. He also had been to Shadowland and seen strange things, which he told to the world in wonderful verse.

“This boy is a genius,” he said to his wife, “and I must help him.”

Then it all happened as the magic mirror had foretold, for Tom was put to school by the kind poet, and became a very clever man. He also wrote poems, which the world received with joy; and when he became a famous man, the kind poet gave him his own daughter in marriage, and the bells which had rang the birth of the child-Christ when Tom was a poor ragged boy, now rang out joyously in honour of his marriage.

“He has conquered,” they clashed out in the warm, balmy air; “he is the victor, and now he will be happy.”

And he was happy, very very happy, and felt deeply thankful to the shadow who had shown him the way to be happy. His own shadow never left him, but it never spoke to him again, though when Tom felt tempted to do wrong, he heard a whisper advising him to do right. Some people said that this was the voice of conscience, but Tom knew it was the voice of his dear shadow, who still watched over him.

And one day he took his wife to the garret where he had lived when a poor boy, and told her how he had been to Shadowland, and learned that to be honest and noble was the only true way to happiness. His wife laughed, and said Tom had been dreaming; but Tom shook his head, and said that it was no dream, but a great truth Now, who do you think was right Tom or his wife?

THE WATER-WITCH

I. FIRE AND WATER.

ONCE upon a time, long long years ago, there was a shepherd called Duldy, who dwelt in the forests which clothed the base of the great mountain of Kel. This mountain was in the centre of an immense plain, watered by many rivers, and dotted over with many cities, for the kingdom of Metella was a very rich place indeed, so rich that the inhabitants looked upon gold in the same way as we look upon tin or iron, as quite a common thing. The plain was very fertile by reason of the great rivers which flowed through it like silver threads, and all these rivers took their rise in the mountain of Kel, a mighty snow-clad peak which shot up, white and shining, to the blue sky from amidst the bright green of its encircling forests

There were old stories handed down from father to son, which said that the mountain was once a volcano, which, breathing nothing but fire, sent great streams of red-hot lava down to the fertile plain, to wither and blight all the beautiful gardens and rich corn-fields. But the fires in the breast of the mountain had long since died out, and for many centuries the black, rugged summit had been covered with snow, while countless streams, caused by the melting of the glaciers, fell down its rocky sides, and, flowing through the cool, green pine forests, spread themselves over the thirsty plain, so that it bloomed like a beautiful garden.

Duldy lived in these scented pine forests, and was supposed to be the son of an old couple called Dull and Day, from whence by joining both names he got his own Duldy; but he was really a lost child whom old Father Dull had found, seventeen years before, on the banks of the Foam, one of the bright sparkling streams which flowed from the snowy heights above. Dull took the child home to his wife Day, who was overcome with joy, for she