So, here we have an official judgement by the National Institutes of Health which relies on an expectation of effects (patient intent) to define a factual presentation. In other words, intent is presumed to be present even though we know that feigning disability is a natural behavior in organisms that have no cognitive ability at all. Does that tell us that cognition is considered so important that it has to be found everywhere when humans are considered?

Alternatively, which is what I would suggest because of the sheer numbers, malingering is a natural response to the stresses imposed by the culture of obedience which reigns in the U.S.

How can we trust a public agency which opines:

Malingering is falsification or profound exaggeration of illness (physical or mental) to gain external benefits such as avoiding work or responsibility, seeking drugs, avoiding trial (law), seeking attention, avoiding military services, leave from school, paid leave from a job, among others. [1][2][3]It is not a psychiatric illness according to DSM-5 (Diagnostic and Statistical Manual of Mental Diseases, Fifth edition). The DSM-IV-TR failed to provide any precise criteria because malingering is not considered a psychiatric diagnosis,…

Note the word “failed” in that definition. It tells us that there are expectations, prejudices which are supposed to guide determinations. It almost seems like diagnosis is the god of health care.

Albeit not overtly admitted in the article, malingering seems to be recognized as responding to coerced behavior. Which probably accounts for the caution against disagreeing with the patient or making a referral to another physician lest there be a lawsuit or violence. In other words, it is recognized that malingering may well be evidence of resentment and repressed violence to get revenge.

“Man prefers leisure and must be bribed to work.” On what basis is compensation for labor logically considered a bribe? The presumption that exercising authority is a natural right.