When Illness Becomes a Tool

A pattern seen in factitious disorders, but found far beyond them

One of the most disturbing lessons from cases involving factitious disorders is not the diagnosis itself. It is the pattern that sits underneath it.

Professionals are often trained to look for illness, vulnerability and need. Most enter their professions because they want to help people. They are naturally drawn towards those who appear vulnerable and in need of support.

The problem is that vulnerability can be manufactured, exaggerated or exploited.

In some cases, illness is fabricated. In others, symptoms are exaggerated. In others still, genuine vulnerabilities are manipulated for personal gain.

The underlying mechanism remains remarkably similar.

The individual at the centre of the story gradually becomes defined by their vulnerability. Their identity becomes tied to illness, incapacity, dependence or crisis. Around them, a narrative develops which is accepted by professionals, family members and the wider community.

Questions become discouraged.

Alternative explanations are dismissed.

Those who challenge the narrative risk being portrayed as uncaring, abusive, ignorant or dangerous.

The result is a form of reality control.

The focus shifts away from what is actually happening and onto the story that has been constructed around the vulnerable person.

This pattern is not confined to factitious disorders.

It can be found in coercive control, elder abuse, predatory relationships, financial exploitation, parental alienation and many other forms of abuse.

The details change.

The mechanism does not.

The abuser becomes the gatekeeper of information.

They speak for the victim.

They manage access to the victim.

They influence professionals.

They control what information is shared and what information is withheld.

Over time, the victim’s own voice becomes increasingly difficult to hear.

The question that safeguarding systems often ask is:

“Is this person vulnerable?”

The more important question may be:

“Who benefits from this person being perceived as vulnerable?”

That single question has the potential to expose patterns that otherwise remain hidden.

A person who appears confused may have been over-medicated.

A person who appears incapable may have been isolated.

A person who appears dependent may have had their independence systematically removed.

A person who appears mentally unwell may be reacting entirely normally to an abnormal situation.

The vulnerability may be genuine.

The exploitation of that vulnerability may be hidden in plain sight.

The challenge for professionals is therefore not simply to identify vulnerability.

It is to identify who controls it, who shapes the narrative around it and who benefits from it.

That is where many systems fail.

They focus on the vulnerability.

The perpetrator focuses on the opportunity.