From Library Journal
Harvard Medical School professor Stephen Bergman penned House of God (about a bunch of sleep-deprived interns) under the pseudonym Samuel Shem?and sold over a million copies. Now he's turned his attention to a psychiatric hospital.
Copyright 1996 Reed Business Information, Inc.
From The New England Journal of Medicine
A roman a clef -- from the French, "novel with a key" -- is a novel that thinly disguises real people and real situations. It is a fictional representation of reality, first popular in 17th-century France, that is still often used to emphasize a social point. Stephen Bergman, an accomplished author whose pen name is Samuel Shem, is a practicing psychiatrist in the Boston area. Mount Misery is his most recent roman a clef -- a farcical novel about Dr. Roy Basch's first year of psychiatric residency. The thinly disguised Boston psychiatry scene, in which famous and infamous physicians, hospital staff, and administrators are portrayed, is made even more plausible by interspersing the names of real (nonfictitious) people such as Otto Kernberg and Alan Dershowitz, thus making this novel appear genuine. Shem is a gifted writer, psychologically insightful, often hilarious, and judging by his sensitive portrayal of some of the patients in Mount Misery an effective psychotherapist in his other profession. Unfortunately, the black humor and hyperbole with which he describes doctors, mental patients, psychiatry residents, and staff at Mount Misery is often cruel, misleading, and only occasionally sensitive. Clearly, these distortions are fair game for a novel that is, by definition, fiction. Unfortunately, because of the stigma and myths surrounding psychiatry and its patients, the use of the roman a clef technique makes Mount Misery easily mistaken for truth. Does Shem have a cause? The answer is found in the March 31, 1997, Boston Globe, which quotes Shem as saying, "I feel the same sense of outrage about psychiatry as I felt about medicine when I wrote House of God." The blurbs that adorn the book jacket add to this illusion: "When a psychiatrist speaks the truth we have an exceptional book."
The book would be hilarious if it weren't for the patients who suffer from psychiatric illnesses. Sadly, Mount Misery takes another whack at such patients, their illnesses, and those who try to help them. Stigma continues to plague psychiatry, and it is unfortunate that, however unintentionally, Mount Misery perpetuates this. Unrealistic limits on insurance coverage for psychiatric care have now become the standard. Every form of treatment, be it psychotherapy, pharmacotherapy, behavior and somatic treatments, or combinations of these, is restricted and has yearly as well as lifetime limits that are unrealistically low. Psychiatric care is carved out, carved in, and carved up. Chronically ill psychiatric patients are rarely afforded the medical coverage that patients suffering from other chronic diseases are. Even some religious and social movements single out psychiatry and psychiatric patients for special attack. Yet, the prevalence of psychiatric illness is high by any standard, and the cost to society is immense.
The National Alliance for the Mentally Ill (NAMI) has targeted stigma as its principal challenge. The existence of large citizen organizations, such as NAMI, the National Association of Research in Schizophrenia and Depression, and other lay organizations is a relatively new phenomenon and may help dispel the myths that surround psychiatry. Books like Mount Misery do much to undercut these efforts. After the novel One Flew over the Cuckoo's Nest (by Ken Kesey. New York: Viking Press, 1962) was released, it was only with extreme effort that psychiatrists were able to convince severely depressed patients to agree to undergo electroconvulsive therapy. This often life-saving treatment was shunned by many, and legislation was even introduced in at least one state to ban the treatment altogether. Mount Misery manages through hyperbole to trash all forms of psychiatric treatment except "connectedness."
The book follows Roy Basch, M.D., as he rotates through the various buildings of Mount Misery. Each building represents a different psychiatric treatment that Basch is to master. This block-rotation model is in itself an antiquated model of training. Most good programs now follow a more integrated longitudinal approach that emphasizes continuity of care. Basch's training is even more distorted because treatment is determined by the attending psychiatrist, whose force of personality and rigid adherence to one type of treatment, no matter what the patient's diagnosis, determines the therapy. Force of personality rather than scientific evidence carries the day. Shem even depicts the psychotherapy of Basch's outpatients as evolving from rigid nonsense to more of a discussion between chums than a physician-patient relationship. Boundary violations are rampant. Even the patients do not escape Shem's wit: he writes of "the... skipping manics, the herds of trudging depressives, the paranoids darting and peering, tree to tree.... "
The book itself seems to be presented in two parts. The first part is hilarious, with Shem painting effective pictures of the Hitler-like Heiler, the mute psychoanalyst (A.K.), the pharmacology police (Cabot and Winthrop), and the wise blue-collar switchboard operator (Viv), the array of bizarrely crazy patients (the lady who eats metal objects), the predatory administrators (Lloyal von Nott and Nash Michaels), and the very confused and disturbed psychiatric residents -- a collection of characters worthy of Nathaniel West. Shem, however, quickly turns to describing what can only be considered a slaughterhouse. The humor turns to violence and horror. Brain surgery is performed on living dogs by trainees holding a scalpel in one hand and the anatomy book in another; suicide, murder, and natural deaths abound; and sexual bacchanals are the theme for the staff, faculty, and trainees. Psychiatrists are portrayed as heartless Freudians, money-grubbing, sex-crazed analysts, and maniacal psychopharmacologists who would make Nazi physicians proud. Social workers are depicted as ineffectual, and behavioral therapists as perseverating; even treating children with medication for severe attention deficit disorder is trashed.
And so the myths surrounding psychiatry continue, the stigmatization of psychiatric patients gets another boost, and "connectedness" replaces common sense. Thank you, Dr. Samuel Shem.
Reviewed by Peter M. Silberfarb, M.D.
Copyright © 1998 Massachusetts Medical Society. All rights reserved. The New England Journal of Medicine is a registered trademark of the MMS.
ER goes psycho in the latest entertaining novel by the author of the best-selling House of God (1981). As in that popular television series, the world of medicine is presented with all of its crises, heartbreak, human-interest stories, and offbeat humor. Dr. Roy Basch is in his first year of residency in a three-year training program at a famous psychiatric hospital, Mount Misery. He is supposed to learn by the apprentice method: gathering all he will have to know from one of the senior staff members. As it turns out, what he needs to know is that some patients have incredibly difficult mental problems that he will often be at a loss to resolve; indeed, some on the hospital staff are only this side of sanity themselves, and to top it off, his love life is nothing less than complicated. Shem, who is on the faculty of Harvard Medical School and maintains a private psychiatric practice, knows about what he writes in this alternately funny and frightening exposethat is certain to keep readers engrossed to the very end. Brad Hooper
From Kirkus Reviews
Sequel to Shem's widely read House of God (1981, not reviewed), about the horrors of med school. This time, he broadsides the profession of psychiatry. Dr. Roy Basch (protagonist of Shem's earlier novel) has decided to become a psychiatrist and is taken on at the prestigious Mount Misery, where, he quickly learns, ``psychiatrists specialize in their defects'' and ``the worst psychiatrists charge the most, and world experts are the worst.'' Shem rotates Basch, and various patients, through wards demonstrating the cult of the self, Freudian therapy, and drug treatment, where, despite himself, Basch succumbs to each wrongheaded and harmful method. He grows brutal, assured by his superiors that when his patients worsen they're actually getting better; meanwhile, using Freudian techniques, he becomes convinced that ``everything is penis''; and, as a drug guru, he prescribes until his patients are comatose. Luckily, there's one fine psychiatrist at Misery, Leonard Malik, who shows Basch that the only treatment that works is to connect with patients as human beings and share their sorrows. Shem's send-up of Freudianism, while hilarious and provocative, is a bit of a straw man, since Freud, these days, is an influence rather than a dominant force. Still, Shem is razor-sharp, evoking the dark, circular humor of a Joseph Heller in his critique of doctors eager to be funded by drug companies and in portraying the cycle of questionable research leading to questionable treatment leading to more research funded by--drug companies. Shem's portrait of a profession reeling from the assaults of the insurance industry is also right out of Catch-22: When practitioners discover that reimbursements are up for disassociative patients, down for borderlines, they systematically change their diagnoses. Still, the denouement here--the various ``good'' doctors leave Misery to contemplate the mysteries of the Anasazi or to seek Oneness in Tibet--is ridiculous. Shem begins as an angry satirist and ends in a kind of blissed-out parody of Kahlil Gibran. -- Copyright ©1997, Kirkus Associates, LP. All rights reserved.
Review
Reading Mr. Shem's book, I was reminded of E. M. Forster's often quoted phrase, "Only Connect." If you want an achingly understated novel about the need for connection and the pain of disconnection, I suggest you read Howard's End. On the other hand, if you want a broad sendup of the psychiatric community, with a heavy dollop of sermonizing, Mount Misery may be the book for you. -- The New York Times Book Review, Anna Fels From the Inside Flap
s 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 . . . Blai
About the Author
Samuel Shem (Stephen Bergman, M.D.) graduated magna cum laude and Phi Beta Kappa from Harvard College and earned a Ph.D. in physiology from Oxford University, where he was a Rhodes Scholar. He graduated from Harvard Medical School. He is the author of the novels The House of God and Fine and seven plays, including, with Janet Surrey, Bill W. and Dr. Bob. He is on the faculty of Harvard Medical School and the Stone Center, Wellesley College. He lives with his wife and five-year-old daughter near Boston.
From the Paperback edition.
Excerpt. © Reprinted by permission. All rights reserved.
1
WASPs, I’d discovered in my month of being a shrink, are notoriously hard to read. Their body language borders on mute, and their language itself is oblique, like those masters of obliqueness the English who, I had learned in my three years at Oxford, when they say “Yes, actually” mean “No,” and when they say “No, actually,” may mean anything.
Now, try as I might, coming at him from various different interviewing angles, much as my father the dentist would come at a recalcitrant tooth, Cherokee Putnam remained a mystery. It was six-thirty in the morning. I was bone-tired, having been on call at the hospital all night long. Cherokee had appeared at the admissions unit without calling in advance, and had paged the Doctor on Call—me. He said he wasn’t at all sure he needed admission, but he hadn’t been able to sleep and had to talk to someone “about a delicate matter,” in confidence. The closest I had come to reading any feeling in him was when he told me how, at a dinner party at home recently, he’d gotten so furious at his wife Lily that he’d actually done the unheard of: picked up his linen napkin and thrown it down onto the tablecloth beside his plate.
To my probings, he denied that he was depressed. He denied suicide attempts, suicide gestures, suicidal ideation, and showed no signs of being crazy. He seemed like just the kind of guy the word “normal” was made for.
He looked normal enough. He was my age—thirty-two—my height and build—six-three and slightly fallen from slender. But while I was a lapsed Jew, he was a cornered WASP, in buttoned-down pink shirt and pressed khaki pants, with an excellent blade nose and blue eyes, a charming mole on one boyish cheek, and strawberry-blond hair combed back and parted off center. Tan and handsome, he looked like the young Robert Redford. He was rich, the father of two young girls—Hope and Kissy—and he admitted sheepishly to being a lawyer. A Yale graduate, he’d made a small fortune working for Disney in California, before coming back to his roots in New England eighteen months before.
“But you kill yourself at Disney,” he said. “There’s a saying out there, ‘If you don’t come in on Saturday, don’t bother to come in on Sunday.’ ”
His wife Lily was also from New England. He’d spent “a million two” to buy a foothill and a horse farm nearby. He and his wife were into horses, she into show-jumping, he into polo. After a year of leisure he was now trying to figure out what to do next with his life.
“Is that what’s troubling you?” I asked.
“No, no, not at all,” he said, “but once in a while I wake up at three in the morning comparing myself to other people, successful people. I turn to my wife and say, ‘I’m a failure.’ That used to get her right up, but now she’s so used to it she barely wakes up. She just murmurs, ‘Take a Halcyon and go back to sleep.’ Lily’s heard it too many times.”
“So there are problems in the marriage?”
“Oh no, no. Things are fine, actually. The normal disagreements, mostly around her being so neat, and me, well, y’see how neat I seem?”
“Very nice, um hm.”
“Very. But in private I’m pretty messy. Nothing big, just socks on the floor, nothing hung up. She’s very neat. We had a big tiff last week, when the help was off—I emptied the dishwasher and just threw the silverware into the drawer. Lily nests the spoons! Just the other day I said, ‘Please, I beg you—give me the dignity of living like a pig.’ ” I laughed. He smiled, barely. “Lily’s a stunning woman. If she were here, you couldn’t take your eyes off her. She did the whole debutante thing, cotillion, the works. Even after two kids, dynamite body. Incredible, really. You should see her on a horse.”
“It must be a great feeling,” I said, stifling a yawn—thinking, Enough of this bullshit, how can I get rid of him and get some sleep?—“to wake up early in the morning and go for a horseback ride with your wife.”
“She’s never there early in the morning.”
“Why not?”
“Lily’s in psychoanalysis. Actually . . . her doctor is on the staff here. That’s why I came here. A Dr. Dove. Do you know him?”
“I do.”
“She sees him every morning at six a.m.” He glanced at his watch, one of those mariner’s, with nineteen dials. “She’s there right now.” His eyes met mine and then skittered away, as men’s eyes do when they are about to try to make contact. “Look, I half think I’m crazy for thinking this, and as a lawyer I will deny that I ever said it to you, but . . . well . . . I think . . . no, it’s crazy.”
“Go on.”
“I think . . . think that my wife is having an affair with Dr. Dove.”
My mind recoiled. Talk about pigs. Schlomo Dove was one of the most unattractive and unappealing men I’d ever met. He was a man who, in the parlance of these times, would have to be referred to as “Beautifully Challenged.” A fiftyish, short—five-five, maybe—fat Jewish man with thick, curly chestnut hair coming down over his brow like a helmet, tiny eyes sunken into slitty sockets, snaggly teeth still hoping for braces, and a nose that didn’t look happy, he seemed to take pleasure in flaunting his homeliness, wearing suits that were rumpled and ties that were stained and loose around his neck like a series of slack, secondhand nooses. Despite this, or perhaps because of it—in the counterphobic way that some people, afraid of heights, become bridge painters—Schlomo was a performer. The fat little guy was always in your face, always dancing up to you bigger than life, in academic seminars or private supervisory sessions always rising up onto his tippy-toes like a bingeing ballerina to present some goofy Freudian stuff in the voice and gesture of a Borscht Belt comic, self-mocking in the extreme. Schlomo had a large private practice, and also was well known as one of a small number of psychiatrists you went to for a consultation to get yourself matched up with just the right therapist. He was an eminent psychoanalyst, on top of the Freudian pile in the institute down in the city, and Director of the Misery Outpatient Clinic, which lay at the swampy, reed-clogged end of a sausage-shaped lake that roughly split the hos- pital’s campus.
Eminent, yes; appealing, no. How could any woman, especially a gorgeous WASP Ice Princess, go for Schlomo Dove?
So looking at Cherokee, I thought, No problem, this guy’s crazy. Yet one thing I’d learned in my life so far, especially this past year traveling around the world as a doctor: as in human achievement, where no matter what you do there is always someone who has done it more, so in human degradation, there is always someone hurtling on down past you, down past what you can even imagine. And so I said only, “Really?”
“Yeah. It’s been over a year now that she’s been in therapy with him. We came back East, it was our dream. To take time off, together, to be with our kids, after the phoniness of Hollywood. Everything was in place. And then she feels a little down, you know, and goes to him for a consultation.” He sighed. “She sees him every weekday morning, sometimes on Saturday, occasionally on Sunday too. Our sex life has dried up. But she looks more and more sexy. Not only to me, but to my friends too. Buys sexy underwear. Lotta color, lace, you know?” I nodded, my mind rolling into fantasies of lace and color and my girlfriend, Berry, and thanking God that one perk of being a shrink is that you hear some pretty hot sexy stuff. “It’s not like her. Not since the kids. And she cut her hair short, like a boy. Really strange, that. Her long hair was her pride. Not like her at all.”
“Have you asked her about this?”
“I’ve got no solid evidence. I ask her what goes on in therapy, but she says that Dr. Dove says it’s confidential.”
“But it’s driving you crazy. You might just—”
“You think I’m crazy?”
There was a hint of crazy in this, given the reality of Schlomo, but just a hint. “No, no, you are not crazy.”
“Oh. Good. You believe that he’s . . . you know, screwing her in therapy?”
“I believe that you believe it.”
“I don’t, totally, I mean. But you say I’m not crazy?”
“Suspicious yes, crazy no.”
“Not even, maybe . . . I don’t know . . . a little paranoid?”
“Have you ever seen Dr. Dove?”
“No, why?”
“Look,” I said, “you don’t know the truth. You’ve got nothing to go on.”
“And it’s driving me crazy! Do I need hospitalization?”
“No.”
“Can I come talk to you?”
“To start therapy?”
He grimaced, as if I’d just suggested we try a few root canals. “I wish you wouldn’t call it that. Father—none of my people—believe in psychiatry. ‘Stand tall,’ they always say, if there’s any trouble, ‘stand tall, and call your lawyer.’ Therapy’s for . . . others.”
“Too ‘messy,’ eh?”
He blinked, as if in strong light. He sighed. “You got me. Shit.”
“I’d be glad to see you.”
He paused. I felt him struggle with it. Then he loosened his tie and ...
