Dying To Be Ill: True Stories of Medical Deception

Dying To Be Ill is a collaborative effort written by Dr. Marc D. Feldman and Gregory Yates about factitious disorder. Over the course of the text, the authors discuss how people afflicted with this condition “fabricate disease and illness to reap the rewards of the sick role” (p 8), which, by their definition, included support from others, exemption from social obligations, and special allowances. In the introduction of the book, the authors note that they hope Dying To Be Ill will do for factitious disorder what The Man Who Mistook His Wife for a Hat by Oliver Sacks did for neurologic conditions. They hope to convey the “lived experiences” of the people with this condition and others who are affected by it, whether a spouse, child, friend, religious leader, or caregiver. The book primarily relates information through discussion of multiple case studies, many of which are written by the people involved (e.g., the individual with the disorder, the grown childhood victim of Munchausen by proxy, the family member initially unaware of the deception). The strength of this style of presentation is that one can learn about the condition from the voices of those who experience it. The reader obtains a sense of how individuals engage in deception and, more importantly, potential insight into what the motivations are for these individuals or how the condition often progresses. A drawback to this approach, however, is that the anecdotes start to blend together and, as noted by Feldman and Yates in the introduction, “these cases don't make for easy reading” (p 6) given their graphic (e.g., intentionally injecting oneself with feces) and disturbing nature (e.g., a parent intentionally adding salt to infant formula or smothering a child to simulate illness).

The book is broken down into 10 chapters. The first chapter is an overview of the history of medical deception and the development of the current formulation of the condition. Subsequent chapters are devoted to specific aspects or permutations of the condition, such as chapters related to factitious disorder by proxy (Chapter 2. Medical Abuse: When Deception is Maltreatment), factitious disorder by internet (Chapter 8. Cyber-Deception and Munchausen by Internet, e.g., reporting to have an illness in blogs or patient-support websites), and Munchausen by animal proxy (Chapter 10). The book also includes a chapter about the impact of erroneous diagnosis of factious disorder, as well as what happens when an individual with a past history of factitious disorder really does become ill (Chapter 9. Jumping to Conclusions: False Accusations). Chapter 3, entitled Mental Masquerades, may be of particular interest to forensic practitioners because this chapter discusses individuals with factitious disorder who simulate having psychiatric conditions rather than a more traditional somatic illness. This chapter examines questions forensic experts have to assess, such as the motivation for a faked claim of illness (i.e., is an exaggerated or factitious presentation due to malingering, to assume the sick role, or both).

Readers looking for an in-depth clinical study of factitious disorder will find that this book meets their needs. It is very good at conveying the clinical pathology (e.g., actions taken, responses when discovered, the ways in which individuals tried to avoid detection), significant elements of individual case histories (e.g., important aspects of the person's history leading to the behavior, what motivated the individual's behavior, and why it was hard to stop engaging in the behavior), and long-term impact of the condition on the individual's life and the lives of others. Dying To Be Ill is successful in humanizing those with the condition.

For professionals looking for a deeper forensic appreciation of factitious disorder, this book may or may not serve their needs. Given that the book consists primarily of anecdotal case reviews, there are few data or scientific references for the reader with a forensic focus to utilize. In addition, this book is not designed to be a convenient reference book. The chapters are often very long and dense. Although Dr. Feldman discusses aspects of his forensic experience, many of the anecdotes seem to be solely from his perspective with little to no mention of their legal application (e.g., court case citations, excerpts from judges' rulings, how to perform a forensic evaluation for someone with the disorder). There was some discussion in Chapter 7 (Conscience, Ethics, and the Law) regarding how a clinician could avoid or respond to potential legal entanglement when treating someone suspected of having factitious disorder.

Overall, this book is well written, though it can be dense and tedious at times. Dr. Feldman's experience and expertise as a clinician is clearly evident in this work. For a clinician who is looking for a text that provides a deeper understanding of factitious disorder and may allow examination of clinical experiences in a new light, I highly recommend Dying To Be Ill. For readers who may be more interested in information on the disorder as it relates to forensic work, this book, although informative, may not be the ideal resource.

• © 2019 American Academy of Psychiatry and the Law