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Book Reviews   |    
Set This House in Order: A Romance of Souls
Reviewed by Ann L. Hackman, M.D.
Psychiatric Services 2003; doi: 10.1176/appi.ps.54.12.1660
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by Matt Ruff; New York, Harper Collins, 2003, 479 pages, $25.95

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Set This House in Order is about two people with diagnoses of dissociative identity disorder. Andy Gage, who "broke in pieces" after being subjected to horrendous abuse as a child, has been through therapy with Dr. Danielle Grey. The purpose of the therapy was to help Andy manage his condition, become more organized, avoid uncontrolled switching, and establish order. Thus at the opening of the book, Andrew, the sometimes narrator, explains that he was born two years previously to "run the body" after his father, Aaron, built a house in Andy's head for the personalities, or "souls."

A number of souls live fairly cooperatively in the house, including Adam, Jake, Aunt Sam, and Seferis. Julie, who is Andy's employer at a small computer firm specializing in virtual reality software, introduces Andy to Penny. Penny also has dissociative identity disorder—and brings with her another complete set of characters—but she has limited understanding of her situation and eventually asks Andy for help. What follows involves Andy's and Penny's getting to know each other's various personalities and then taking a trek halfway across the country to uncover events from Andy's past.

As a psychiatrist, I had some concerns about this book. I was bothered by the consistent use of the term "multiple personality disorder," although a parenthetical note indicates that the diagnosis is now referred to as dissociative identity disorder. I was also somewhat dismayed by the book's depiction of psychiatrists. There are two psychiatrists, who are generally portrayed as helpful, but each demonstrates a somewhat dubious understanding of boundaries. Furthermore, Andrew tells the reader that "the average multiple" sees eight psychiatrists before receiving a correct diagnosis. However, his friend Penny's diagnosis is immediately recognized by Julie, who has no mental health expertise. Andrew also briefly describes his experience in attempting treatment with a succession of psychiatrists who believed in a national conspiracy of satanic cults, past-life regression, and sexual assault by extraterrestrials. Finally, although I am not an expert in this area, the patients I have treated who meet criteria for dissociative identity disorder have been among the most tortured individuals I have ever worked with. Andy and Penny both have backgrounds of serious abuse, but the symptoms they experience during the course of the novel are often portrayed more as inconvenient than devastating.

However, as a reader of novels I found much to enjoy about Set This House in Order. It is well written, fast paced, quirky, and sometimes quite funny. Although he has clearly done some research on dissociative identity disorder, the author, Matt Ruff, is a novelist who claims no expertise in mental health. One review posted on Ruff's Web site indicates that his two previous novels are works of science fiction. Set This House in Order may best be viewed as something of a fantasy in which the realities of this illness and its treatment are revised a bit to fit the plot.

Dr. Hackman is assistant professor at the University of Maryland School of Medicine in Baltimore.

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