Reading Guides

More Than It Hurts You
A Novel
Darin Strauss
Book: Paperback
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Josh Goldin was savoring a Friday afternoon break in the coffee room, harmlessly flirting with coworkers while anticipating the weekend at home where his wife, Dori, waited with their eight-month-old son, Zack. And then Josh's secretary rushed in, using words like intensive care, lost consciousness, blood. . . .

That morning, Dori had walked into the emergency room with her son in severe distress. Enter Dr. Darlene Stokes: an African-American physician and single mother whose life is dedicated both to her own son and navigating the tricky maze of modern-day medicine. But something about Dori stirred the doctor's suspicions. Darlene had heard of the sensational diagnosis of Munchausen by Proxy, where a mother intentionally harms her baby, but had never come upon a case of it before. It was rarely diagnosed and extraordinarily controversial. Could it possibly have happened here?

As their four lives intersect with dramatic consequences, Darlene, Dori, and Josh are pushed to their breaking points as they confront the nightmare that has become their new reality. Darin Strauss's extraordinary novel is set in a world turned upside down—where doctors try to save babies from their parents, police use the law to tear families apart, and the people you know the best end up surprising you the most.



Darin Strauss Darin Strauss is the award-winning author of the national and international bestseller Chang and Eng, as well as its screenplay for Disney Films and director Julie Taymor. His work has been translated into 14 languages and he teaches at New York University and lives in Brooklyn, New York.


  1. Author Darin Strauss opens his novel with a quotation from Anton Chekhov. What do you think it means? How does this quote set the stage for what transpires in More Than It Hurts You?
  2. When you began reading More Than It Hurts You, what did you know about Munchausen syndrome by proxy? Do you believe that its origins are biological, or do you agree with the viewpoint that there is no medical evidence for such a condition and that it's a way for abusive mothers to be absolved of their actions? Is Munchausen syndrome by proxy a metaphor for something else in the book?
  3. Talk about Dori. When did you suspect that she might have harmed Zack? As she imagined someday confessing her actions, did you think she believed people would actually understand her motivations for hurting him? Did you have any empathy for her?
  4. "The question for Josh had always been, how much blindness does a happy life require?" (page 277). What does this sentiment reveal about Josh's personality? Was the fact that he loved his wife "honestly, faithfully, and blindly" the reason why Josh didn't suspect Dori sooner? Why did he feel such antagonism toward Darlene Stokes?
  5. "Maybe the truest way to know a person is to learn what she's ashamed of." (page 63). This statement refers to Darlene—what was her secret shame? How does this statement apply to other characters?
  6. Do you think it's fair for a person to be judged on actions they took years before? In what other instances are incorrect assumptions made about characters based on their pasts?
  7. What was your opinion of Darlene? If you were in her shoes, would you have done the same things she did, whether in her role as a doctor or as a woman? How do you think her life would have been different had her father stayed with the family, or had she and Leo been able to work things out? Do you think she knew joy?
  8. "Because if a woman never feels the full power of a man's affection all at once, there are ways to increase how he rations it out." (page 186). Talk about Dori's manipulations of Josh and of the people around her. Do you think she realized how much they would cost her?
  9. When Darlene heard from her father for the first time in forty years, she realized that "her strongest wish . . . was to hang up on him." (page 230). Was her reaction surprising to you? Can you understand why she would feel this way?
  10. Discuss the wrenching scene in which Zack is removed from Dori and Josh's custody by Child Protective Services. Was it difficult for you to read? What would you have done if you were Josh or Dori? Do you think CPS did the right thing in placing Zack in foster care?
  11. The author reveals certain plot twists after they've taken place. What did you think of this device? Did it enhance your reading experience? How would the novel have been different had all the events unfolded in real time?
  12. What is the role of prejudice in the book? Which characters exhibit it, or otherwise allow themselves to accept stereotypes? In Part VI, Josh refers to Darlene as a "reverse racist"; do you think there is such a thing?
  13. "When did Dr. Stokes know the public case had tipped against her?" (page 331). Did you expect the court case to end the way it did? Talk about the subsequent encounters between Darlene and Josh. Would you have acted in the ways they did?
  14. After the court case was dropped, Martin Seidel thinks to himself, "The good guys have won." Do you agree? Were there any "good guys" in More Than It Hurts You?
  15. What was your opinion of the book's ending? What do you think might have happened after Dori uttered the book's last line?