Mount Miseryby Samuel Shem
From the Laws of Mount Misery:
There are no laws in psychiatry.
Now, from the author of the riotous, moving, bestselling classic, The House of God, comes a lacerating and brilliant novel of doctors and patients in a psychiatric hospital. Mount Misery is a prestigious facility set in the rolling green hills of New England, its country club atmosphere… See more details below
From the Laws of Mount Misery:
There are no laws in psychiatry.
Now, from the author of the riotous, moving, bestselling classic, The House of God, comes a lacerating and brilliant novel of doctors and patients in a psychiatric hospital. Mount Misery is a prestigious facility set in the rolling green hills of New England, its country club atmosphere maintained by generous corporate contributions. Dr. Roy Basch (hero of The House of God) is lucky enough to train there *only to discover doctors caught up in the circus of competing psychiatric theories, and patients who are often there for one main reason: they've got good insurance.
From the Laws of Mount Misery:
Your colleagues will hurt you more than your patients.
On rounds at Mount Misery, it's not always easy for Basch to tell the patients from the doctors: Errol Cabot, the drug cowboy whose practice provides him with guinea pigs for his imaginative prescription cocktails . . . Blair Heiler, the world expert on borderlines (a diagnosis that applies to just about everybody) . . . A. K. Lowell, née Aliyah K. Lowenschteiner, whose Freudian analytic technique is so razor sharp it prohibits her from actually speaking to patients . . . And Schlomo Dove, the loony, outlandish shrink accused of having sex with a beautiful, well-to-do female patient.
From the Laws of Mount Misery:
Psychiatrists specialize in their defects.
For Basch the practice of psychiatry soon becomes a nightmare in which psychiatrists compete with one another to find the best ways to reduce human beings to blubbering drug-addled pods, or incite them to an extreme where excessive rage is the only rational response, or tie them up in Freudian knots. And all the while, the doctors seem less interested in their patients' mental health than in a host of other things *managed care insurance money, drug company research grants and kickbacks, and their own professional advancement.
From the Laws of Mount Misery:
In psychiatry, first comes treatment, then comes diagnosis.
What The House of God did for doctoring the body, Mount Misery does for doctoring the mind. A practicing psychiatrist, Samuel Shem brings vivid authenticity and extraordinary storytelling gifts to this long-awaited sequel, to create a novel that is laugh-out-loud hilarious, terrifying, and provocative. Filled with biting irony and a wonderful sense of the absurd, Mount Misery tells you everything you'll never learn in therapy. And it's a hell of a lot funnier.
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 bydrug 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 herethe various "good" doctors leave Misery to contemplate the mysteries of the Anasazi or to seek Oneness in Tibetis ridiculous. Shem begins as an angry satirist and ends in a kind of blissed-out parody of Kahlil Gibran.
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Read an Excerpt
WASPs, I’d discovered in my month of being a shrink, are notoriously hard to read. Their body language borders on mute, and their language itself is oblique, like those masters of obliqueness the English who, I had learned in my three years at Oxford, when they say “Yes, actually” mean “No,” and when they say “No, actually,” may mean anything.
Now, try as I might, coming at him from various different interviewing angles, much as my father the dentist would come at a recalcitrant tooth, Cherokee Putnam remained a mystery. It was six-thirty in the morning. I was bone-tired, having been on call at the hospital all night long. Cherokee had appeared at the admissions unit without calling in advance, and had paged the Doctor on Call—me. He said he wasn’t at all sure he needed admission, but he hadn’t been able to sleep and had to talk to someone “about a delicate matter,” in confidence. The closest I had come to reading any feeling in him was when he told me how, at a dinner party at home recently, he’d gotten so furious at his wife Lily that he’d actually done the unheard of: picked up his linen napkin and thrown it down onto the tablecloth beside his plate.
To my probings, he denied that he was depressed. He denied suicide attempts, suicide gestures, suicidal ideation, and showed no signs of being crazy. He seemed like just the kind of guy the word “normal” was made for.
He looked normal enough. He was my age—thirty-two—my height and build—six-three and slightly fallen from slender. But while I was a lapsed Jew, he was a cornered WASP, in buttoned-down pink shirt and pressed khaki pants, with an excellent blade nose and blue eyes, a charming mole on one boyish cheek, and strawberry-blond hair combed back and parted off center. Tan and handsome, he looked like the young Robert Redford. He was rich, the father of two young girls—Hope and Kissy—and he admitted sheepishly to being a lawyer. A Yale graduate, he’d made a small fortune working for Disney in California, before coming back to his roots in New England eighteen months before.
“But you kill yourself at Disney,” he said. “There’s a saying out there, ‘If you don’t come in on Saturday, don’t bother to come in on Sunday.’ ”
His wife Lily was also from New England. He’d spent “a million two” to buy a foothill and a horse farm nearby. He and his wife were into horses, she into show-jumping, he into polo. After a year of leisure he was now trying to figure out what to do next with his life.
“Is that what’s troubling you?” I asked.
“No, no, not at all,” he said, “but once in a while I wake up at three in the morning comparing myself to other people, successful people. I turn to my wife and say, ‘I’m a failure.’ That used to get her right up, but now she’s so used to it she barely wakes up. She just murmurs, ‘Take a Halcyon and go back to sleep.’ Lily’s heard it too many times.”
“So there are problems in the marriage?”
“Oh no, no. Things are fine, actually. The normal disagreements, mostly around her being so neat, and me, well, y’see how neat I seem?”
“Very nice, um hm.”
“Very. But in private I’m pretty messy. Nothing big, just socks on the floor, nothing hung up. She’s very neat. We had a big tiff last week, when the help was off—I emptied the dishwasher and just threw the silverware into the drawer. Lily nests the spoons! Just the other day I said, ‘Please, I beg you—give me the dignity of living like a pig.’ ” I laughed. He smiled, barely. “Lily’s a stunning woman. If she were here, you couldn’t take your eyes off her. She did the whole debutante thing, cotillion, the works. Even after two kids, dynamite body. Incredible, really. You should see her on a horse.”
“It must be a great feeling,” I said, stifling a yawn—thinking, Enough of this bullshit, how can I get rid of him and get some sleep?—“to wake up early in the morning and go for a horseback ride with your wife.”
“She’s never there early in the morning.”
“Lily’s in psychoanalysis. Actually . . . her doctor is on the staff here. That’s why I came here. A Dr. Dove. Do you know him?”
“She sees him every morning at six a.m.” He glanced at his watch, one of those mariner’s, with nineteen dials. “She’s there right now.” His eyes met mine and then skittered away, as men’s eyes do when they are about to try to make contact. “Look, I half think I’m crazy for thinking this, and as a lawyer I will deny that I ever said it to you, but . . . well . . . I think . . . no, it’s crazy.”
“I think . . . think that my wife is having an affair with Dr. Dove.”
My mind recoiled. Talk about pigs. Schlomo Dove was one of the most unattractive and unappealing men I’d ever met. He was a man who, in the parlance of these times, would have to be referred to as “Beautifully Challenged.” A fiftyish, short—five-five, maybe—fat Jewish man with thick, curly chestnut hair coming down over his brow like a helmet, tiny eyes sunken into slitty sockets, snaggly teeth still hoping for braces, and a nose that didn’t look happy, he seemed to take pleasure in flaunting his homeliness, wearing suits that were rumpled and ties that were stained and loose around his neck like a series of slack, secondhand nooses. Despite this, or perhaps because of it—in the counterphobic way that some people, afraid of heights, become bridge painters—Schlomo was a performer. The fat little guy was always in your face, always dancing up to you bigger than life, in academic seminars or private supervisory sessions always rising up onto his tippy-toes like a bingeing ballerina to present some goofy Freudian stuff in the voice and gesture of a Borscht Belt comic, self-mocking in the extreme. Schlomo had a large private practice, and also was well known as one of a small number of psychiatrists you went to for a consultation to get yourself matched up with just the right therapist. He was an eminent psychoanalyst, on top of the Freudian pile in the institute down in the city, and Director of the Misery Outpatient Clinic, which lay at the swampy, reed-clogged end of a sausage-shaped lake that roughly split the hos- pital’s campus.
Eminent, yes; appealing, no. How could any woman, especially a gorgeous WASP Ice Princess, go for Schlomo Dove?
So looking at Cherokee, I thought, No problem, this guy’s crazy. Yet one thing I’d learned in my life so far, especially this past year traveling around the world as a doctor: as in human achievement, where no matter what you do there is always someone who has done it more, so in human degradation, there is always someone hurtling on down past you, down past what you can even imagine. And so I said only, “Really?”
“Yeah. It’s been over a year now that she’s been in therapy with him. We came back East, it was our dream. To take time off, together, to be with our kids, after the phoniness of Hollywood. Everything was in place. And then she feels a little down, you know, and goes to him for a consultation.” He sighed. “She sees him every weekday morning, sometimes on Saturday, occasionally on Sunday too. Our sex life has dried up. But she looks more and more sexy. Not only to me, but to my friends too. Buys sexy underwear. Lotta color, lace, you know?” I nodded, my mind rolling into fantasies of lace and color and my girlfriend, Berry, and thanking God that one perk of being a shrink is that you hear some pretty hot sexy stuff. “It’s not like her. Not since the kids. And she cut her hair short, like a boy. Really strange, that. Her long hair was her pride. Not like her at all.”
“Have you asked her about this?”
“I’ve got no solid evidence. I ask her what goes on in therapy, but she says that Dr. Dove says it’s confidential.”
“But it’s driving you crazy. You might just—”
“You think I’m crazy?”
There was a hint of crazy in this, given the reality of Schlomo, but just a hint. “No, no, you are not crazy.”
“Oh. Good. You believe that he’s . . . you know, screwing her in therapy?”
“I believe that you believe it.”
“I don’t, totally, I mean. But you say I’m not crazy?”
“Suspicious yes, crazy no.”
“Not even, maybe . . . I don’t know . . . a little paranoid?”
“Have you ever seen Dr. Dove?”
“Look,” I said, “you don’t know the truth. You’ve got nothing to go on.”
“And it’s driving me crazy! Do I need hospitalization?”
“Can I come talk to you?”
“To start therapy?”
He grimaced, as if I’d just suggested we try a few root canals. “I wish you wouldn’t call it that. Father—none of my people—believe in psychiatry. ‘Stand tall,’ they always say, if there’s any trouble, ‘stand tall, and call your lawyer.’ Therapy’s for . . . others.”
“Too ‘messy,’ eh?”
He blinked, as if in strong light. He sighed. “You got me. Shit.”
“I’d be glad to see you.”
He paused. I felt him struggle with it. Then he loosened his tie and through gritted teeth said, “Fuck ’em. Let’s make an appointment.”
We set up an appointment for the next week. He stood, crunched my hand, and walked out as gracefully as, well, as a horse. I liked him and felt for him, and if I could get him to come to therapy, I could help him. Schlomo? Do I tell him about this? Better talk to my supervisor, Ike White, first.
My on-call night was over. I walked over to the administration building, the Farben, handed in my beeper, and walked on past the grand front stairway with its rosewood banister that curled up overhead to the right and left. On the landing two antique Chinese vases filled with silk flowers framed a landscape painting of fields and cows and a proud, lone tree. My feet sank into the carpet as if I were in slippers. As I opened the front door and went from air-conditioning to reality, the damp heat hit me like the fat palm of a Turkish masseur slapping me around in a steam bath in Istanbul. Squinting in the russet morning, I stood on the front steps, perched on the crest of a high hill overlooking the city. Feet on granite, head between soaring pillars, I felt like I was standing in the doorway of a bank.
Mount Misery was the name of this hill, and of the hospital built upon it. The hill had been christened first, in the early eighteenth century, by a band of hardy Puritan farmers tormented by the nor’easters that would whip the rough rock for four days at a time. The hospital had been founded later, in 1812, by a group of civic-minded Yankees who, having built a hospital in the city to treat diseases of the body, decided they wanted a matching set, and built one far out in the countryside, in the shadow of the mountains, for diseases of the mind. Their keeping the name Misery showed a measure of obvious delight, that perverse delight which comes with ironic resignation. By the late nineteenth century there were many of these elegant farmlike mental institutions, some of which still survive: Austin Riggs, McLean, the Brattleboro Retreat, Shepard Pratt, and Chestnut Lodge. The principle in the construction of asylums was denial: “Out of mind, out of sight.” Misery had been protected from suburban sprawl by its natural boundaries: the high hill, several ominous ravines, and the swamp at the end of the lake. Its dozen or so separate buildings were surrounded by eighty acres of fields, woods, and streams, all rimmed by a high, iron-spiked fence.
Mount Misery soon became a teaching hospital affiliated with what was nicknamed “the BMS”—the “Best Medical School” in the world. Throughout its history Misery had been in the forefront of the latest red-hot treatment for mental illness. At first this consisted of shackles, purges, bleedings, and teaching proper table manners. Now Misery offered all the different treatments of late-twentieth-century psychiatry. Traditionally it had been the hospital of the unstable wealthy—it was at one time fashionable to be able to announce that one had “a son at Harvard, a father buried in Mount Auburn Cemetery, and a mad cousin in Misery.” These days it attracted not only the wealthy, but also the insured. While welfare cases were rare, each of us new first-year residents in psychiatry would spend some time at Candlewood State Hospital, the state facility down the hill and across the swamp. At Misery there were artists, poets, folk singers, writers, and a steady stream of those tender young men and women cracked by the most ruthlessly prestigious colleges in America. Creative, interesting people who, it was said, made “great cases.” The unofficial hospital motto was, “There’s Sanity in Misery.”
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