Our Gemara on Amud Aleph refers to a pardakhas, which is an idle person. Rashbam describes this person as follows:

 

A person who is idle from work, learning, derech eretz, and is not involved with settlement of the world at all.

 

In the style of the Gemara at times, there is no commentary or moral assessment about this person. The focus is the practical halacha, no judgements. Yet, what are we to make of this person? Is he depressed, or is he lazy? This is often the conundrum of friends and family of individuals who seem to be in a cycle of disengagement from life. Should we show compassion, because the person is unwell? Even if the person is depressed but refuses treatment, should we remain empathic and supportive because, after all, it’s the depression talking, or should we come down hard with tough love?

 

According to researchers Monaro et. al. (“The Detection of Malingering: A New Tool to Identify Made-Up Depression”, Frontiers in Psychiatry 2018.):

 

• Major depression symptoms can be faked…individuals who want to feign a depressive disorder do not require any particular knowledge or specific training to produce clinically reliable depressive symptoms and signs. Furthermore, a large majority of both symptoms and signs easy to fake: lack of concentration, restlessness, lack of interest for daily life activities, feelings of guilt, and so on are easy to fake if one wanted and planned to. 
• Although it is hard to define it reliably, literature reports an estimate of the prevalence of malingering in a forensic setting as ranging from 20 to 40%. (9–11). In regards to depression, Mittenberg et al. reported that 16.08% of depressive syndromes which are diagnosed in litigation or compensation cases are feigned.

 

The researchers were discussing prevalence of faking when there were financial or legal benefits, and so the percentages in private individual circumstances may be lower.

 

There is a clinical questionnaire known as the SIMS (Structured Inventory of Malingered Symptomatology), which employs a number of strategies to flush out fraudulent claims of depression and other mental conditions. The questionnaire uses intermittent trick questions, such as ones that sound like they would be symptoms but are rarely experienced by truly depressed or mentally ill persons. The liars would reply affirmatively while the truly depressed would not. 

 

In any case, it is notoriously difficult to fully prove or disprove the level of helplessness and depression the person has versus possible laziness and avoidance. Because of this, and the frustration, embarrassment and confusion it is difficult for loved ones to respond objectively.  Often, family members are at odds with each other, with one seemingly overprotective while the other may seem too harsh. A balanced approach is required, and when motivation is lacking, family sessions may be more helpful than individual sessions. The family sessions could allow the family members and the identified patient to discuss and mediate the concerns and/or possible consequences with the identified patient. For example, if the patient is not taking any steps toward recovery, it could be a legitimate response cut off support, internet access and the like. However, that also may increase conflict or distress to the point of danger. Family sessions discussing collaboratively what to do about this serve a multiple purposes: (1) They allow for warning and discussion of alternative consequences and/or benchmarks or definitions of what is considered progress and/or what is considered beyond the person’s ability (2) The clinician can offer more objective feedback and assessment (3) By virtue of the sessions themselves, at least there is basic accountability and dialogue 

 

When a family member seems to be lazy and unmotivated, it is frustrating and confusing, and most difficult to know what is fair to expect. However, patience, love and professional guidance can make a difference in navigating this personal and familial challenge.