Playing Sick?

Untangling the Web of Munchausen Syndrome, Munchausen by Proxy, Malingering, and Factitious Disorder

De: Marc D. Feldman

Narrado por: Lyle Blaker

In the classic edition of this outstanding book, originally published in 2004, Dr. Marc Feldman explores the bizarre cases of real patients who feign or even self-induce illness. Playing Sick? chronicles the devastating impact of illness hoaxes, including factitious disorders, Munchausen syndrome, Munchausen by proxy, and malingering. Based on years of research and clinical practice, Playing Sick? provides the clues that can help professionals, family members, friends, and patients themselves to recognize these diagnoses, avoid invasive procedures, and understand elusive motives. Dr. Feldman offers practical advice to get emotionally ill patients the help they need.

This classic edition is essential for physicians, social workers, and anyone interested in why and how individuals fabricate illness.

©2024 Marc D. Feldman (P)2024 Tantor Media

Understanding

I thought that people who pretended illness were very selfish and crazy. This level of understanding helps me see they have real needs that they are trying to assist the same as we all do. Very well done.

Over diagnosis isn’t helpful

A lot of people are familiar with the condition Factitious Disorder Imposed on Another (FDA) known colloquially as Munchausen’s Syndrome by Proxy. Fewer people may know Factitious Disorder Imposed on Self(FDS). In PLAYING SICK? Dr Mark D Feldman primary discusses FDS, though also touches on FDA.

Dr Feldman’s bland storytelling works better when describing types of Factitious Disorders than in the vignettes telling people’s accounts.

The case studies Dr Feldman relays also tell a story about the history of patients’ rights. In a mid twentieth century case doctors injected their patient with a substance that would identify if the patient was infecting herself with something to make her sick (I can’t remember the names). While scanning the patient nurses inspected the room including her handbag and found hypodermic needles and the products the patient used to make herself sick. Today this would be considered assault and theft and possibly mean prison time for those involved.

My biggest criticism of PLAYING SICK? is that Dr Feldman sees theses disorders everywhere, whether or not they are symptoms of others disorders or simply typical behaviors. Kids feigning illness to stay home from school is a tradition as old as schools. A child with Separation Disorder Anxiety who plays sick isn’t a FDS patient, but a child who is using illness as a way to stay home with his mom. The behavior is a symptom of the anxiety, not the disorder. In my opinion, over attributing behaviors as FDS waters down this uncommon disorder by lowering the threshold of diagnostic criteria. Similarly a teenager making herself sick to escape her stepfather’s sexual abuse to me is resourceful, a strength albeit one that needs to be channeled into communication using her voice. I’d never diagnose her with FDS because making herself sick was a tool toward achieving safety. Schizophrenics who make themselves sick in response to hallucinatory demands aren’t FDS, they’re exhibiting a symptom of the schizophrenia.

Another criticism is that Dr Feldman repeatedly talks about patients who’ve become friends which is unethical except under strict criteria and certainly not with many former patients.

I appreciate Dr Feldman’s attempt to inform the public in a user friendly way, although I wish he made clear that not every situation is FDS and the subtlety needed to understand the difference.