Mount Misery (Paperback)

Now, Shem (and the pseudonym's understandable, if not forgiveable) takes on the psychiatric establishment. Anybody who has worked in psychiatry, anywhere in the world, will find elements of truth in Mount Misery, and anyone who has fought against a lot of the stupidity and dogma portrayed so starkly in this book and carried on regardless, will find that the novel's central ethos, expressed particularly in the last few chapters, will get right up his or her nose. Shem tackles various theoretical viewpoints, artfully portrayed as the hero, Dr Roy Basch, whom many of us encountered in the first book, rotates through different placements in his first year as a psychiatric resident (equivalent in most respects to the senior house officer or SHO grade in Britain). The author systematically and vividly rips apart the thinking underlying the blind adherence of so many psychiatrists to two of the most pervasive doctrines, namely the psychodynamic (broadly, Freudian) and phenomenological (mainstream or Diagnostic and Statistical Manual (DSM)). He concludes that effective psychiatry consists of 'connecting' with the patient in a way that he leaves relatively undefined.

The strengths of this novel are its hilarious portrayal of modern psychiatric practice and its showing up of much psychotherapy as based on empirically dubious thinking, with the accompanying defensiveness and resistance to criticism that most of us have encountered in Freudian dogmatists. Pigeonholing people with regard to diagnosis and pig-headedly sticking to treatment protocols in books are obviously idiotic strategies. Where Mount Misery falls down, however, is in its acceptance of the ideology it seeks to refute, namely that 'mental illness' is a unitary term. Shem skirts over the subject of schizophrenia, and psychosis in general, briefly portraying a ward of people who are locked away and doped up with medication, and thereby ignores a group of patients who, according to the weight of current scientific evidence, have a serious neurological/psychiatric illness which does NOT respond to 'connection' alone (and I speak as a psychiatrist myself). Agreed, the medications available at present aren't perfect, and have potential side effects. So do the drugs for cancer, hypertension and arthritis. But in an imperfect world, they're the best we've got, and can alleviate the symptoms of conditions that cause untold misery to millions of people.

I recommend this novel as a work of art in itself, and as a caution to anyone who enters psychiatry (or is currently practising) with the view that the complexities of human thought, feeling and behaviour can be reduced to a menu in a textbook; but I'd warn against taking the book's own dogma as gospel, coming as it does from a doctor with his own experiences, prejudices and axe to grind.

Dr Roy Basch, shell-shocked and battle scarred from his stint in the House of God hospital decides to specialise in psychiatry, hoping for a quieter life and a chance to regain his shattered faith in the medical profession. The novel charts his journey through the fairground hall of mirrors that is Mount Misery mental hospital.
Fasten your seatbelts, and prepare for a wild ride through the crazy world of the head-doctors who are truly mad, bad and dangerous to know!

Mount Misery is a gem, luring you in with laugh-out-loud gallows humour, then hitting you over the head with what really goes on in modern psychiatry, and the outrages against humanity perpetuated daily on the most vulnerable amongst us.
As someone who has a fair amount of insider knowledge, I was delighted that Shen chose to reveal and condemn some of the more distasteful habits some shrinks choose to indulge in- it certainly cheered me up no end!

Highly effective is Shen's enthusiastic depiction of many of the faintly ridiculous theories that abound within the profession, creating scenarios both surreal and absurd, a kind of psychiatric Magical Mystery Tour, which manages to be shocking and blackly entertaining in equal measure.

I found the concluding passages slightly irritating, but that is a minor issue, and does not detract in the least from the book as a whole.

Mount Misery is a heady mix of wild comedy and dark truths, and a thoroughly enjoyable read. Stuck for a present to give the shrink in your life? Look no further!

Anyone who is interested in exploring the issues Shen tackles here may want to read "Making us Crazy: DSM- The Psychiatric Bible and the Creation of Mental Disorders" by Kirk/Kutchins/Rowe. Scary stuff!

MOUNT MISERY is billed as a dark comedy. And perhaps the first half of the book is just that. Then it becomes decidedly more serious - Bergman's indictment of what he perceives as the flaws, and indeed malpractice, within institutionalized mental health care: assembly line admissions with diagnoses designed to mine the maximum in insurance payments, over-reliance on unproven drug regimens to make patients "better", the emphasis on fund raising rather than medicine, the superegos of the "experts" that focus on appearances in medical journals and at international seminars instead of compassionate patient care, and the total hogwash (to Bergman, apparently) of Freudian analysis. Indeed, the author's criticism of institutional psychiatry evolves to a very sharp point, i.e. the sexual abuse of patients by their physician therapists, and the protection of the latter by the medical establishment. This is not the stuff of humor, dark or otherwise.

I still might have given MOUNT MISERY four stars but for several reasons. First, at 527 paperbacked pages, the book is way too long; the point could've been made in a shorter span of text. Second, once Bergman makes his case against the failures of the system, he, through the intrepid Dr. Roy, gets too preachy. (I hate being lectured in any medium designed to extract my dollars ostensibly to provide me with entertainment.) Finally, the author bends over backwards to tidy up the story's conclusion with relatively happy endings for the novel's major and minor protagonists. Indeed, the very last scenes involving Basch, his significant other Berry, and their adopted daughter Lizzy, were so warm and fuzzy as to almost induce the gag reflex. (OK, so I'm a curmudgeon and am in need of Prozac. But, give me a break!)

As I recall, I also rated THE HOUSE OF GOD at only three stars for similar reasons. I suspect MOUNT MISERY would appeal greatly to anti-establishment psychiatrists and other mental health caregivers, who would respond "Yup, been there, done that!". But, no more Samuel Shem stuff for me, thanks very much. Life is too short for well-intentioned rants that don't reveal anything new.