The reader obtains a sense of how individuals engage
in deception and, more importantly, potential in-
sight into what the motivations are for these individ-
uals or how the condition often progresses. A draw-
back 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., inten-
tionally injecting oneself with feces) and disturbing
nature (e.g., a parent intentionally adding salt to in-
fant 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 med-
ical 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 dis-
order 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 dis-
order 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 presenta-
tion 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 pathol-
ogy (e.g., actions taken, responses when discovered,
the ways in which individuals tried to avoid detec-
tion), significant elements of individual case histories
(e.g., important aspects of the person’s history lead-
ing 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 fo-
rensic 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 Chap-
ter 7 (Conscience, Ethics, and the Law) regarding
how a clinician could avoid or respond to potential
legal entanglement when treating someone sus-
pected 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 disor-
der and may allow examination of clinical experi-
ences 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.
Ryan Hall, MD
Lake Mary, Florida
Disclosures of financial or other potential conflicts of interest: None.
DOI:10.29158/JAAPL.003903-19
The Act
Created and produced by Nick Antosca, Michelle Dean,
Britton Rizzio, Gregory Shephard, and Jan Peter
Meyboom; directed by Laure de Clermont-Tonnerre,
Adam Arkin, Christina Choe, Steven Piet, and Hannah
Fidell. Hulu. First aired March 20, 2019.
In this eight-episode dramatization of real events in-
volving Munchausen syndrome by proxy (MBP) and
matricide, viewers learn the story of Gypsy Rose
Books and Media
534 The Journal of the American Academy of Psychiatry and the Law
