Take two Prozac and don't call me in the morning. .

• Author: Shem, Samuel
• Position: Excerpted from Mount Misery - Fiction

Sometimes fiction can illuminate a social or political issue more clearly than the best policy writing. In 1978, The Washington Monthly excerpted Samuel Shem's first novel, The House of God, which provided a wickedly funny inside look at the world of a first-year medical intern. In his new book, Mount Misery, Shem holds the psychiatric profession up to the same probing light.

When we meet our hero, Dr. Roy Basch, he is a month into his residency at the renowned Mount Misery psychiatric facility and gradually realizing that everything he thought he knew about treating the mentally ill is wrong. (To further confuse matters, his mentor, Ike White, has just committed suicide, but the hospital administration is insisting he died of a fatal disease.) Now, Basch is learning that treating a patient to the latest psychoactive cocktail, shock therapy, talk therapy, or surgical technique--or trying to force a patient into a certain category--does more harm than good.

Emerson's high walls and locked doors seemed sinister. Noting the "Split Risk" sign, I opened the door to my new ward, Emerson 2, Borderlines, with caution, shielded the opening with my body, back-flipped in fast and threw the door closed. It shut with a tremendous "wham!"

"Dickheads Slam Doors!"

The same sandy-haired young man as before. I went into a slow burn, wanting to respond, but stopping myself. About 20 other patients were sitting around the living room, staring at me. I saw the two tennis players. The normal, older man, in a crisp summer suit, was reading The Wall Street Journal. The younger, thin man--the manic one--was reading a tabloid and eating a carrot. He took a bite. In the tense silence the crunch seemed enormous. No doctors were in sight. The patients--teen to senior citizen, dressed from high fashion to rags, many with bandages around their wrists or heads or legs, one in a neck brace riveted into her skull, one in a wheelchair--seemed like so many wounded, shell-shocked refugees, waiting for a war to end so they could move. These were the dread "borderlines."

I asked the ward secretary where I could find Dr. Malik.

"The one with the carrot. Hall meeting's just about over."

This was a surprise. I stood and watched. He was speaking: "Like I said, Ike White killed himself. Nobody knows why. Hard to take. But we gotta face reality. Game's over for him, but not for us. I'm here. You wanna talk suicide, I'll talk suicide. But do sports! Catch ya later."

Malik walked over to us. He was wearing a shortsleeve white shirt and a slender red tie, khaki trousers, and well-worn Nike running shoes. His wiry athlete's body seemed too small a container for his energy. He had jet-black hair, parted carefully and slicked up and over in front. In his long tan face, his hawk's nose was bridged by black-framed glasses whose lenses were tinted amber. We shook hands. He was large for his size and, though tight with tendons, gentle. An athlete's hand.

"I saw you playing tennis yesterday. I thought you were a patient."

"So y'think there's a big difference between doctors and patients? Sometimes your patients are better than you" He fixed me with his eyes. I had a strange sense of being seen into. He glanced at my suit. "Boy, you got it bad."

"What do you mean?"

"You know what I mean, doncha?"

"Sort of," I said, sensing him sensing my discomfort wearing a suit.

"So if you know what I mean, you don't ask what I mean. To be a shrink you still got a lot to unlearn, like all us kids who went to med school. Specially us hot-shit high-achiever Jews."

I wanted to ask what he meant but stopped myself.

"You stopped yourself. Good." He took another bite out of his carrot, dosed his eyes and chewed carefully, savoring it.

"What's with the carrot?"

"A carrot a day keeps colon cancer away" I laughed. "No joke. Studies have proved it"

"And just where is it you put the carrot?"

"Ha! Haha! Good. So. You play any sports?"

"Tennis, basketball, and golf."

"You do okay in psychiatry as long as you keep playing sports and use what you know from sports. Anything else before I show you what's what?"

"I was surprised you told them about Ike White. I've been trying to figure out what von Nott meant by a fatal disease."

"That's bullshit. Lloyal means he was biologically depressed, but depression never has to be fatal. Never. All this fatal-disease bullshit is so they don't have to admit they killed him."

"They killed him?"

"Places like this kill guys like him right and left, and a lot of the dead don't even know when they're dead 'cause their souls die first."

"That seems pretty bitter--" I started to say, but then stopped, for Malik had tears in his eyes, ambertinted wetness. One tear, escaping from under his glasses, ran down his cheek, translucent, losing form as it ran, leaving a trace behind, like a snail's. Looking away, he chomped his carrot mournfully, giving out several forlorn crunches. He gulped down sobs, his Adam's apple shuttling up and down his thin neck. I asked, "`You must've known Ike really well?"

"Nobody knew Ike well" He removed his glasses, squinted like a mole in the light, and wiped away the tears with the back of his hand. "Nobody alive knows a suicide at all."

"Why'd he kill himself? Is there some dirt, some secret? Why?"

"What can I tell you? Psychiatrists specialize in their defects."

"And Ike specialized in suicide?"

"Wrote the classic papers, yop. Maybe we'll find out more, with time, and the more you find out about a person, the more sense they make, never less. Lloyal was crushing him. He died of death." He blinked, looked around in puzzlement. "Why'm I preaching to you? Jesus! C'mon--"

"Wait" He waited. "If the other shrinks are lying about him killing himself and you're telling the truth, aren't you gonna get into trouble?"

"So what else is new? They don't like me teaching you new guys, `specially not here on Blair Heiler's ward. Eleven months of the year Heiler terrorizes these patients, so nobody else wants to deal with the mess in August when he's on vacation in Stockholm. Sucking Nobel Prize butt."

"Terrorizes!"

"Yop. So. Emerson Two. Know anything about it?"

"It's the borderline ward," I said. Ike had given me a lecture on borderlines, patients who were on the border between normals--or neurotics--and crazies--or psychotics. The lecture was based on the DSM--the Diagnostic and Statistical Manual--the bible of psychiatric diagnosis published by the prestigious American Psychiatric Association. The DSM described borderlines as suffering from a pervasive instability in interpersonal relationships, self-image, and feelings. The official diagnosis of Borderline Personality Organization, or BPO, was defined by 13 Krotkey Factors, created by the borderline world expert Dr. Renaldo Krotkey. Dr. Blair Heiler, local borderline expert, was a follower of Krotkey. Some of the Krotkey Factors were: impulsivity (BPOs were dramatically impulsive about sex, shopping, gambling, substance abuse, reckless driving, binge eating, etc.), fear of abandonment, unstable relationships, suicidal or self-mutilating acts, mood swings, feelings of emptiness, and a fierce, withering rage. Borderlines were emotionally labile, sometimes seeming completely normal...