PATIENT OR PRETENDER

An unsettling account of the pathological behavior of people who carry ``playing sick'' to bizarre extremes. Psychiatrists Feldman and Ford, writing with Reinhold (coauthor, Untamed, 1991), use their own experiences as well as case studies from the medical literature to construct a patchwork portrait of the condition known as ``factitious disorder''—a mental disorder in which physical or psychological symptoms are feigned for emotional satisfaction. Factitious disorder may become the focus of a person's life and can take an extreme, chronic form known as Munchausen syndrome. Especially troubling are cases of Munchausen by proxy, in which parents inflict harm on children to create the appearance of illness in them. The authors reveal how skilled patient-pretenders can become at fooling doctors, nurses, and other caretakers with schemes to produce symptoms and create erroneous test results by putting blood or other substances into their urine, injecting themselves with insulin, or wounding, infecting, starving, or bleeding themselves. Numerous first-person narratives include accounts by either Feldman and Ford, as well as by those suffering from factitious disorder—and their victims. The authors seem both fascinated and exasperated by the syndrome and are clearly dismayed by the harm it causes not just to its sufferers but to those around them. But while Feldman and Ford's stated aim is to increase awareness of factitious disorder in order to make diagnosis and treatment more likely, they seem more concerned with exposing and weeding out than with helping, and their account comes close to being a freak show in which the grotesqueries on display are of central interest. An interesting subject regrettably presented with more sensationalism than science.