MOUNT MISERY

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.