UNDER OBSERVATION

Ostensibly a slice of life inside McLean Hospital in Belmont, Mass., during a two-week period in the spring of 1993, but actually a report on the status of psychiatric treatment today. Berger first wrote about McLean in We Heard the Angels of Madness (1992), a book that she co-authored with her sister Diane, describing her nephew's descent into manic depression. Here, her co-author is a psychiatrist in charge of a unit for patients with severe psychosis. The narrator is Berger, with Vuckovic always referred to in the third person. Together they construct composites of a number of patients, who are also shown interacting in numerous group meetings. Among these composites are: Kiesha, a delusional pregnant woman whose husband insists she not be medicated; David, a suicidal man who is given electroconvulsive therapy; Glenda, a chronic paranoid schizophrenic who is switched to the latest miracle drug; and Matt, a substance abuser who has had attention deficit hyperactivity disorder since childhood. Admission and discharge notes, replete with medical jargon and abbreviations, are included for each, possibly to lend these composites a touch of authenticity. More interesting are two scientists at McLean's research center: Ross Baldessarini and Frances Benes. Descriptions of their work provide the authors with the opportunity to give some history of psychiatric diseases and their treatments and to explain current trends in neuropharmacology and neuroanatomy. Whether intentional or not, the impression is left that psychiatry is an infant science struggling to come to terms with a bewildering variety of therapies. McLean comes off as a humane treatment center providing the best care possible given the budgetary constraints of our present system and the limits of our present knowledge. The patient notes are a trifle gimmicky, and the accounts of group meetings become tiresome, but the writing sparkles when the subject is scientific research.