Customer Reviews

Mount Misery

5 star:		(12)
4 star:		(6)
3 star:		(9)
2 star:		(4)
1 star:		(4)

 

 

In sharp contrast to this books older and more famous brother "The house of God" this one is much less hilarious and much more thought provoking and disturbing. Dr Baschs catastrophic and nearly fatal first year of residency in a prestigious psychiatric institute is depicted in all its gloomy details. The characters in this book are quite extreme each in its own positive or negative way and shems witty and clever description of them (even for the better ones) is merciless. a word of warning - don't get to attached to any of the characters, Shem has a tendency to eliminate some of them in various stages of the book. I am a medical student, and I first read this book In my first year after reading the "House of God" - it was mildly amusing. However, I reread it this year (my fifth) after doing my rotation in a psychiatric hospital and this book is right on target. It made me think very hard about the patients, the doctors and all that's in between. A must book for everyone who is interested in medicine, psychiatry or just plain human nature.

I eagerly anticipated this sequel. Unfortunately it is merely a formulaic attempt to duplicate the original in a different setting. Roy Bash is to goes through the same ups and downs, corrupting cynical attitudes, and, finally, redemtion. The "mentor" figure is a duplicate of the HOG's "fatman". It is as if Roy didn't learn anything at the HOG, thus we are sentenced to watch him live through the exact same story again. When will the cycle end? I stopped reading this book when it became clear that it was going to harm my relationship with the original. Good-twin vs bad-twin syndrome?

Shem's new book is not what I expected. What I basically thought I'd get was a mere follow up to "The House of God", his 15 year old outstanding novel about medicine and internships. Mount Misery describes one year of residency training in a psychiatric hospital. While not remotely as funny as "House of God" this piece of work is more mature and goes much deeper. Shem doesn't leave too much good on psychoanalysis and Freud. This book really got to me and will keep me thinking for a while. Another masterpiece of medical novels

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~ ~ As an MD who spent lots of time in 3rd and 4th year doing clerkships studying Psychiatry, at about the time this novel takes place, I have to admit it is an entertaining and frighteningly accurate illustration of the confusion that reigned in most Psychiatry training programs in the 70's and 80's.

~ ~Readers of "House of God" will enjoy this semi-autobiographical story. It is continuation of the story of the young doctor who spent a disillusioning year in a medical Internship in a prominent Boston training hospital, took a year off, and decided to leave the physical Medicine for Psychiatry.

~ ~Friends who have worked "M. Hospital" the prominent mental hospital (outside Boston), that Mount Misery is clearly modeled after, tell me that the characters in the book are also very thinly disguised versions of real life prominent Doctors in the training program.

~ ~It's not necessary to have much medical knowledge to enjoy the cutting humor of the book. The story will probably be more entertaining, the more knowledge you have of the field of Psychology. Be prepared though, this book isn't one you want to read to give you confidence in your Psychiatrist!

Mount Misery starts out as a great parody of psychiatry's excesses, from drug-pushing to diagnostic mania to Freudian psychoanalysis. First-year resident Roy Basch gets multiple doses of brainwashing as he makes the rounds of Mount Misery, with each theoretical school working overtime to indoctrinate him into its orthodoxy. The caricatures are over-the-top hilarious as Basch, like a military boot camp inductee, falls deeper and deeper, becoming all the while more miserable. Until...

... we hit page 439 and it's like Shem (the pseudonym of author-psychiatrist Stephen Bergman) switched personalities, or another author took over the writing. No more Joseph Heller-style social parody, no more witty insights into psychiatric destructiveness masquerading as treatment (such as the keen observations on psychoanalytic use of silence as a weapon). Basch's epiphany consists of a trite, 12-steppish philosophy that eschews formal theory in favor of being in the present ("breathe," his mentor repeatedly tells him) and connecting with others' suffering. Hardly new concepts, these form the backbone of many theories of psychological treatment. And I would vehemently argue with Shem's simplistic claim that the only purpose of psychiatric theory is to create distance between "expert" and patient; for just one contemporary example of a psychiatrist's use of theory to inform humane treatment (of severely traumatized children, in this case), check out Bruce Perry's The Boy Who Was Raised as a Dog: And Other Stories from a Child Psychiatrist's Notebook Child Psychiatrist's Notebook--What Traumatized Children Can Teach Us About Loss, Love, and Healing.

Basch's 180-degree character transformation, from confused and searching to seamless and sanctimonious, is jarring and unbelievable. It is also boring. The irony of this sudden transformation -- in a character who was being blown around by competing psychiatric theories -- seems to escape author Samuel Shem. It's as if he ran out of inspiration before he could come up with an ending. The final 100-plus pages are preachy and drawn-out, with a disappointing fairytale ending to what had been razor-sharp social critique. Odd.

In summary, the first three-fourths of the book gets an enthusiastic thumbs-up, but the book is too long, the characters too flat, and the ending too ho-hum for me to give more than 3 stars overall. I still recommend it, especially for anyone entering the mental health field or working in a psychiatric hospital (where psychiatrists like the ones depicted here really do exist, in only slightly less exaggerated form, I can tell you from personal experience - although, as another reviewer commented, the time periods are squished together in that psychotropics and Freudianism were in different eras). The book does get you thinking, about the nature of treatment and about keeping it real in therapy. And satire can help keep you sane if you have the misfortune of being in such an insane environment.

This book is much deeper than House of God. It does not focus as much on the physical aspects of the Medical training like the former, it is more focused on Dr. Basch's personal changes and growth. The characters are all very interesting, and it is more entertaining for a non-medical related person than House of God in my opinion.

Though overall House of God was better, this book makes you think more.

Samuel Shem's book has some funny and insightful moments. Overall, however, the reader gets the point after 50-100 pages and, although there are a few surprises at the end, it plods along repeating itself for hundreds more. One wonders why it takes the supposedly bright protagonist so long to catch on to what's going on around him. Probably the biggest problem this book has is in the writing itself. If Shem's characters and situations were portrayed with more subtlety and depth (rather than as caricatures) the reader might find them more believable and interesting. Also, there's something fishy about the time frame. While there's much discussion of new medications (SRI's, for example) and managed care, there's also a heavy dose of Freudian proselytizing from some of the key characters. Somehow the talk therapy in this book sounds outdated-- like Shem took two eras in psychotherapy and smushed them together into his novel's timeframe. Overall, this book will probably be of interest to those who hang around in therapeutic settings. For the rest of us lay readers, it's a mildly interesting read for long, hot summer afternoons.

Dr. Stephen Bergman, aka Samuel Shem, did his medical internship at a large, academic hospital in Boston after graduating from Harvard Medical School. The experiences of his internship served as the basis for his 1984 novel, House of God, starring his alter ego, Dr. Roy Basch. In Gracefully Insane: Life and Death Inside America's Premier Mental Hospital, a narrative history of McLean Hospital, the mental health facility traditionally serving Boston's upper crust, author Alex Beam notes that Bergman did his psychiatry residency at McLean. Presumably, this and subsequent experiences in the field, enabled Bergman to write MOUNT MISERY, the further adventures of Dr. Basch during his first year of training at the fictional Mount Misery psychiatric hospital.

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.

I think that this book is a pretty accurate description of psychiatry in the late 70's/early 80's which, is when Roy Basch would have been doing his psychiatric residency if following the timing of House of God. But for some unknown reason, Shem chose to set it in the early 90's use names of medications that were not around in the 70's and 80's and make cultural referances to the Clintons. Some of the patients Basch struggles to diagnose seem to be pretty clear PTSD to me, PTSD being a diagnosis that was not included in the DSM until 1980, with the DSM III, the diagnosis was clarified in the DSM III-R in 1987. More confusion to the choice of the early 90's setting of the story.
It may seem like a small issue, but I think it is actually very important. Psychiatry is not the same as it was in those days. I would not want a layperson to read this book and believe that it is indicative of such recent history. Psychiatry has grown in some ways and regessed in others. Patient advocates and laws are in place so as to prevent inhumane treatment of patients (Bacsh would not have been helpless to do anything today). On the downside, Psychiatry has gone very much the way the book presents its direction towards the end - pill pushers. Psychiatrists do not learn the art of therapy anymore, they learn the art of psychopharmocology. A psychiatrist once told me, "Psychiatrists, study medical treatment, but don't practice it and practice therapy but don't study it." Funny, but only partially true. I don't know many psychiatrists who are in the practice of therapy (I do know a handful) most of them see 4 patients per hour and I even know of some who see 8 patients an hour!!!

Sounds like I didn't like this book, I know. But I did.
I am a Licensed Clinical Social Worker. One of those who does the "placebo talk therapy" mentioned in the book. This story brought me back to my training days and shed more light on that time in my life. I had many supervisors who were attempting to show me the "correct" way of therapy. Each had his or her opinion of the best theory, and insisted that their way was the only correct way. This left me confused and unsure of myself in session. Through reading and consultation, I have settled into a humanistic style that is more "me" but from time to time I get to feeling like I am being lazy by not using the so-called wisdom of the master's. I need a boost like this book every once in a while to remind me of who I am.

This book is a bit long with a reoccurring theme of Roy (the main character) being unable to stand up for himself. Just as in "The House of God" Roy all of a sudden becomes empowered in the last few chapters and finally stands up for himself and to the entire establishment. It was too frustrating seeing Basch be run over for 450 pages for me to feel for the character, I began not to feel for him since he repeatedly did not stick up for himself. Not a horrible book, but by no means comparable to the original.

My thoughts of Berry and Basch's relationship is that it is ridiculous. How many times does he cheat on her? Jill, Gloria, and I cannot remember the names from the first book. The blind eye Berry turns to his promiscuity is unreal, give me a break.