THEATER OF DISORDER: Patients, Doctors, and the Construction of Illness.

THEATER OF DISORDER: Patients, Doctors, and the Construction of Illness.

Karl E. Scheibe

By Brant Wenegrat. Oxford Univ. Press. 292 pp. $35

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THEATER OF DISORDER: Patients, Doctors, and the Construction of Illness.

By Brant Wenegrat. Oxford Univ. Press. 292 pp. $35

Wenegrat, an associate professor of psychiatry at Stanford University School of Medicine, argues that many human illnesses of past and present are in fact "illness roles." Patients adopt and play out these roles for their own benefit, often with the encouragement of deluded or naive doctors. He doesn’t contend that all disorders, or even all mental disorders, qualify as illness roles. Rather, he limits his attention to those forms of suffering that have no underlying organic basis and that are relatively circumscribed in time and place. Some patients knowingly fashion their symptoms, whereas others take on their roles with utter sincerity. But Wenegrat has little sympathy for any of them. Illness roles, he maintains, are "inherently antisocial."

Despite massive detail and documentation, Wenegrat makes several careless errors—he botches a date, misconstrues the work of Anton Mesmer, and uses the obsolete term hysteria—but the book suffers from several larger problems. On the conceptual level, Wenegrat never explains what distinguishes an illness role from a true illness. While hedging about chronic fatigue syndrome and multiple chemical sensitivity, he is confident that schizophrenia qualifies as genuine, even though the incidence of diagnosed schizophrenia is a fraction of what it was a generation ago. And he avoids entirely such difficult examples as post-traumatic stress disorder.

On the methodological level, Wenegrat often generalizes from a case to a class. After telling of a therapist who seemed intent on applying the multiple personality disorder label to a patient influenced through hypnosis and outright coercion, the author declares that the disorder always develops as a way of pleasing the therapist. He similarly suggests that because 19th-century neurologist Jean-Martin Charcot molded his "grand hysterics," whose symptoms included seizures and delusions, manipulative therapists control all such patients.

Finally, the moral level: To dismiss suffering people as playing roles for gain is condescending, if not hostile. Wenegrat archly assumes that behavioral scientists can explain the whys and wherefores of human suffering better than the sufferers themselves. With his many curious anthropological examples of demonic possession and collective neurosis, he exalts the detached scientific observer while showing little sympathy for forms of psychic pain unfamiliar to our culture.

Theater of Disorder is a missed opportunity. Illness roles are pervasive and powerful, and they shouldn’t be treated as merely outlandish.

—Karl E. Scheibe

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