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Mount Misery: A Novel
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Review
"Successfully parodies the counterintuitive, Alice-in-Wonderland quality that can characterize psychoanalytic theorizing.""Fueled with manic energy and hilarious characters.""An engrossing read...Darkly entertaining."
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From the Inside Flap
From the Laws of Mount Misery: There are no laws in psychiatry. Now, from the author of the riotous, moving, bestselling classic, The House of God, comes a lacerating and brilliant novel of doctors and patients in a psychiatric hospital. Mount Misery is a prestigious facility set in the rolling green hills of New England, its country club atmosphere maintained by generous corporate contributions. Dr. Roy Basch (hero of The House of God) is lucky enough to train there *only to discover doctors caught up in the circus of competing psychiatric theories, and patients who are often there for one main reason: they've got good insurance. From the Laws of Mount Misery: Your colleagues will hurt you more than your patients. On rounds at Mount Misery, it's not always easy for Basch to tell the patients from the doctors: Errol Cabot, the drug cowboy whose practice provides him with guinea pigs for his imaginative prescription cocktails . . . Blair Heiler, the world expert on borderlines (a diagnosis that applies to just about everybody) . . . A. K. Lowell, nee Aliyah K. Lowenschteiner, whose Freudian analytic technique is so razor sharp it prohibits her from actually speaking to patients . . . And Schlomo Dove, the loony, outlandish shrink accused of having sex with a beautiful, well-to-do female patient. From the Laws of Mount Misery: Psychiatrists specialize in their defects. For Basch the practice of psychiatry soon becomes a nightmare in which psychiatrists compete with one another to find the best ways to reduce human beings to blubbering drug-addled pods, or incite them to an extreme where excessive rage is the only rational response, or tie them up inFreudian knots. And all the while, the doctors seem less interested in their patients' mental health than in a host of other things *managed care insurance money, drug company research grants and kickbacks, and their own professional advancement. From the Laws of Mount Misery: In psychiatry, first comes treatment, then comes diagnosis. What The House of God did for doctoring the body, Mount Misery does for doctoring the mind. A practicing psychiatrist, Samuel Shem brings vivid authenticity and extraordinary storytelling gifts to this long-awaited sequel, to create a novel that is laugh-out-loud hilarious, terrifying, and provocative. Filled with biting irony and a wonderful sense of the absurd, Mount Misery tells you everything you'll never learn in therapy. And it's a hell of a lot funnier. "From the Hardcover edition.
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Product details
Paperback: 576 pages
Publisher: Ballantine Books (July 1, 2003)
Language: English
ISBN-10: 034546334X
ISBN-13: 978-0345463340
Product Dimensions:
5.5 x 1.2 x 8.2 inches
Shipping Weight: 1 pounds (View shipping rates and policies)
Average Customer Review:
3.9 out of 5 stars
57 customer reviews
Amazon Best Sellers Rank:
#134,569 in Books (See Top 100 in Books)
I think that this book is a pretty accurate description of psychiatry in the late 70's/early 80's which, is when Roy Basch would have been doing his psychiatric residency if following the timing of House of God. But for some unknown reason, Shem chose to set it in the early 90's use names of medications that were not around in the 70's and 80's and make cultural referances to the Clintons. Some of the patients Basch struggles to diagnose seem to be pretty clear PTSD to me, PTSD being a diagnosis that was not included in the DSM until 1980, with the DSM III, the diagnosis was clarified in the DSM III-R in 1987. More confusion to the choice of the early 90's setting of the story.It may seem like a small issue, but I think it is actually very important. Psychiatry is not the same as it was in those days. I would not want a layperson to read this book and believe that it is indicative of such recent history. Psychiatry has grown in some ways and regessed in others. Patient advocates and laws are in place so as to prevent inhumane treatment of patients (Bacsh would not have been helpless to do anything today). On the downside, Psychiatry has gone very much the way the book presents its direction towards the end - pill pushers. Psychiatrists do not learn the art of therapy anymore, they learn the art of psychopharmocology. A psychiatrist once told me, "Psychiatrists, study medical treatment, but don't practice it and practice therapy but don't study it." Funny, but only partially true. I don't know many psychiatrists who are in the practice of therapy (I do know a handful) most of them see 4 patients per hour and I even know of some who see 8 patients an hour!!!Sounds like I didn't like this book, I know. But I did.I am a Licensed Clinical Social Worker. One of those who does the "placebo talk therapy" mentioned in the book. This story brought me back to my training days and shed more light on that time in my life. I had many supervisors who were attempting to show me the "correct" way of therapy. Each had his or her opinion of the best theory, and insisted that their way was the only correct way. This left me confused and unsure of myself in session. Through reading and consultation, I have settled into a humanistic style that is more "me" but from time to time I get to feeling like I am being lazy by not using the so-called wisdom of the master's. I need a boost like this book every once in a while to remind me of who I am.
This book is a bit long with a reoccurring theme of Roy (the main character) being unable to stand up for himself. Just as in "The House of God" Roy all of a sudden becomes empowered in the last few chapters and finally stands up for himself and to the entire establishment. It was too frustrating seeing Basch be run over for 450 pages for me to feel for the character, I began not to feel for him since he repeatedly did not stick up for himself. Not a horrible book, but by no means comparable to the original.My thoughts of Berry and Basch's relationship is that it is ridiculous. How many times does he cheat on her? Jill, Gloria, and I cannot remember the names from the first book. The blind eye Berry turns to his promiscuity is unreal, give me a break.
Mount Misery starts out as a great parody of psychiatry's excesses, from drug-pushing to diagnostic mania to Freudian psychoanalysis. First-year resident Roy Basch gets multiple doses of brainwashing as he makes the rounds of Mount Misery, with each theoretical school working overtime to indoctrinate him into its orthodoxy. The caricatures are over-the-top hilarious as Basch, like a military boot camp inductee, falls deeper and deeper, becoming all the while more miserable. Until...... we hit page 439 and it's like Shem (the pseudonym of author-psychiatrist Stephen Bergman) switched personalities, or another author took over the writing. No more Joseph Heller-style social parody, no more witty insights into psychiatric destructiveness masquerading as treatment (such as the keen observations on psychoanalytic use of silence as a weapon). Basch's epiphany consists of a trite, 12-steppish philosophy that eschews formal theory in favor of being in the present ("breathe," his mentor repeatedly tells him) and connecting with others' suffering. Hardly new concepts, these form the backbone of many theories of psychological treatment. And I would vehemently argue with Shem's simplistic claim that the only purpose of psychiatric theory is to create distance between "expert" and patient; for just one contemporary example of a psychiatrist's use of theory to inform humane treatment (of severely traumatized children, in this case), check out Bruce Perry's The Boy Who Was Raised as a Dog: And Other Stories from a Child Psychiatrist's Notebook Child Psychiatrist's Notebook--What Traumatized Children Can Teach Us About Loss, Love, and Healing.Basch's 180-degree character transformation, from confused and searching to seamless and sanctimonious, is jarring and unbelievable. It is also boring. The irony of this sudden transformation -- in a character who was being blown around by competing psychiatric theories -- seems to escape author Samuel Shem. It's as if he ran out of inspiration before he could come up with an ending. The final 100-plus pages are preachy and drawn-out, with a disappointing fairytale ending to what had been razor-sharp social critique. Odd.In summary, the first three-fourths of the book gets an enthusiastic thumbs-up, but the book is too long, the characters too flat, and the ending too ho-hum for me to give more than 3 stars overall. I still recommend it, especially for anyone entering the mental health field or working in a psychiatric hospital (where psychiatrists like the ones depicted here really do exist, in only slightly less exaggerated form, I can tell you from personal experience - although, as another reviewer commented, the time periods are squished together in that psychotropics and Freudianism were in different eras). The book does get you thinking, about the nature of treatment and about keeping it real in therapy. And satire can help keep you sane if you have the misfortune of being in such an insane environment.
I first read it as a psych resident and now that I am an attending hand it to residents, students and staffThis still describes particular angst and Sturm and Drang of being a psych residentDuring my own residency it made me laugh rather than cry and helped me become a better doctor to my patients
I got interested in McLean Hospital and in creating my reading list, I read Gracefully Insane, (Great!). Through that book, I found out about this one, written by a doctor named Stephan Bergman under the pseudonym, Samuel Shem. If you are interested in the treatment of mental health, and how it is evolving, then it is an important read. Written as fiction, by a doctor who trained there (at McLean), it is a very absorbing read.
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