Klitzman, author of a highly regarded memoir of his medical internship (A Year-Long Night, 1989), offers an anecdotally rich yet critical account of his psychiatric residency. Klitzman tells war stories about working with paranoid schizophrenics, demanding and emotionally labile ``borderlines,'' and other difficult patients in the ER and several wards of a large urban psychiatric hospital. He's unsparing in profiles of his supervisors, particularly one ideologically rigid Freudian who recommends psychoanalysis for a patient who clearly needs supportive therapy (i.e., treatment that will strengthen daily functioning and decision making rather than insight-oriented therapy). When the psychoanalytic approach fails, the supervisor can only conclude that ``the patient failed the treatment''; the reverse possibility doesn't seem to merit his consideration. ``This academic environment,'' writes Klitzman, ``was the least tolerant, least intellectual, least inquiring of the several of which I had been part.'' While he begins as something of a naive idealist, Klitzman quickly comes to appreciate the extent to which tactical considerations (e.g., staff politics, insurance coverage, or another clinician's weariness of a particular patient) often trump therapeutic ones. His perspective is broadened by visits to a kind of psychiatric shaman in Papua New Guinea and a psychiatric hospital in China (where the patients wear numbered uniforms and the nurses do most of the psychotherapy). Klitzman's prose is less than sparkling (particularly in his too brief and controlled account of his own therapy). It's also unclear how he managed to remember or record long exchanges with patients and colleagues. But these flaws are more than offset by the many anecdotes that attest to Klitzman's considerable compassion for patients and admirable ability to mediate between therapeutic and institutional needs. A thorough diagnosis of contemporary psychiatry's intellectual lacunae, as well as its personal and institutional warts.