Psychiatric Soiree: Factitious Tiramisu

Factitious disorders are when medical or psychiatric symptoms are presented which are either fabricated or induced by the patient. The most famous of this category is Munchausen’s by Proxy, in which a caregiver makes a child very sick. People with this disorder know that they are giving information that is not correct, but they truly do not know why they are doing it, which qualifies this as a mental illness, as opposed to just lying.

To represent the idea, I knew a trompe l’oeil item would be needed. I chose to do a savory-dressed-as-sweet take on Tiramisu, but made with duck liver pate instead of chocolate, coffee or liqueur. This was actually really delicious and was several people’s favorite item.


  • 2 tablespoons butter
  • 1 finely diced white onion
  • 1-2 small pears, finely diced
  • 1/3 cup brandy
  • 1 pound duck livers
  • 12 oz whole milk
  • salt and pepper
  • 2 cups cream
  • 1 cup mascarpone
  • 1 round challah
  • nutmeg


  • Ahead: soak livers in the whole milk for at least 1 hour or up to overnight
  • In a sautee pan over medium heat, add butter and onions and sweat, then add pears, cook until soft
  • Add the brandy and cook until it has mostly cooked off, about 10 minutes
  • Drain livers and add them, stir together, until livers are cooked through, 3-5 minutes
  • Take off the heat, and allow the mixture to cool
  • In a food processor, blend until fully smooth, up to 10-15 minutes on high
  • Taste and re-season, then allow to fully cool in the refrigerator
  • Whip the cream, then whip the mascarpone into the whipped cream
  • Slice the challah horizontally into 3 layers
  • Layer challah, then pate, then cream
  • Sprinkle nutmeg on the top
  • Serve and don’t tell!
  • factitious tiramisu

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