Mount Misery is the sequel to Samuel Shem's first book, House of God (review here). It follows Dr. Roy Basch as he leaves the House of God and moves to psychiatric hospital Mount Misery to begin his psychiatric residency. Unfortunately, it turns out that psychiatrists are just as crazy, confused, and often detrimental as medical doctors. As Dr. Basch cycles through the various sectors of the hospital (talk therapy, admissions, Freudian Analysis, drug therapy) he is horrified to discover that it seems everything he is being taught is not only wrong, but potentially dangerous. He begins to fall into terrible patterns of behavior, mirroring the problems his patients are having. Each area is worse than the last, with one doctor who thinks the best way to treat is to be aggressively hostile, one who cares only about insurance premiums and efficiency, one who treats with silence and "regression," and one who thinks the only viable treatment is to pump every patient full of experimental drugs. Ray has few personal connections, and those he does have with fellow residents, patients, and his inexplicably supportive girlfriend Berry suffer unbearably before he finally surfaces and figures out what is going on. He loses several patients, and is forced to come to terms with what he's been able to accomplish, and what mistakes he has made.
In my opinion, this book is not nearly as good as House of God for several reasons. First, it is basically a rehash of the first book: Roy enters enthusiastic, loses confidence, meets a mentor, becomes disillusioned, is pulled nearly to the edge of a complete nervous breakdown, at his lowest point manages to turn things around with the help of his mentor, happy ending. The story--and even some of the characters--was surprisingly close. There was an attempt at the end to add in some kind of resolution--of Roy trying to fix some of the problems he sees--but it feels a bit tacked on.
Another issue is that the first book was written in the 1970s during the Nixon administration, and the feeling of that era permeated the story. This one--although allegedly taking place only a year or two later--clearly takes place in the 1990s. It mentions the Clinton administration at one point, and the doctors are all prescribing Zoloft and Paxil and ritalin. However, it's never explicitly explained that this is so much later, and it's just a very odd feeling. I was pulled out of the story by this several times, because on one hand, the characters and some of the situations are very 70s, but then the doctors start diagnosing ADD. I feel like the author started this directly after House of God, then put it aside for 20 years, until he finally decided he wanted to release the sequel.
My third issue is that this book got extremely dull for a while. The third quarter of the book is Roy's stay in the Freudian analysis area, and he spends an awful lot of time explaining and contemplating Freudian theory. This is the point at which his mental state really begins to fall apart, so it's all very jumbled. I had to reread bits of the section because I'd get to the end of the page and have no idea what I just read or how it connected to anything that came before. I was interested in Roy's interactions with his patients and colleagues, not in his masturbatory theories about his own Freudian progression.
The last thing that bothered me about this was it was not nearly as entertaining. House of God had its moments of cynicism and darkness, but there was also a lot humor. Even in the worst situations, Roy had something amusing--if cynical--to say. I felt this book was considerably darker, and didn't have the same underlying sense of humor and hope.
On the whole, I would probably not recommend this book, except perhaps to those who are in the psychiatry field and might have a better perspective on it.
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