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Mount Misery: A Novel
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.
From the Hardcover edition.
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.
From the Hardcover edition.
578 pages, Kindle Edition
First published January 1, 1997
164 people are currently reading
1840 people want to read
About the author
Samuel Shem
19 books243 followersSamuel Shem (b. 1944) is the pen name of the American psychiatrist Stephen Joseph Bergman. His main works are The House of God and Mount Misery, both fictional but close-to-real first-hand descriptions of the training of doctors in the United States.
Of Jewish descent, Bergman was a Rhodes Scholar at Balliol College, Oxford in 1966, and was tutored by Denis Noble FRS, cardiac physiologist and later head of the Oxford Cardiac Electrophysiology Group. In an address to Noble's retirement party at Balliol, he related that Noble's response to Bergman's attempt to become a writer was to ply him with copious sherry. He graduated from Harvard College and Harvard Medical School.
He was an intern at Beth Israel Hospital (subsequently renamed Beth Israel Deaconess Medical Center) ,which inspired the book The House of God.
As of 2017, Bergman is a member of the faculty of the New York University School of Medicine at NYU Langone Medical Center.
Shem's play Bill W. and Dr. Bob had an Off Broadway run at New World Stage in New York City. It ran for 132 performances and closed on June 10, 2007. The New York Times called it "an insightful new play."
Of Jewish descent, Bergman was a Rhodes Scholar at Balliol College, Oxford in 1966, and was tutored by Denis Noble FRS, cardiac physiologist and later head of the Oxford Cardiac Electrophysiology Group. In an address to Noble's retirement party at Balliol, he related that Noble's response to Bergman's attempt to become a writer was to ply him with copious sherry. He graduated from Harvard College and Harvard Medical School.
He was an intern at Beth Israel Hospital (subsequently renamed Beth Israel Deaconess Medical Center) ,which inspired the book The House of God.
As of 2017, Bergman is a member of the faculty of the New York University School of Medicine at NYU Langone Medical Center.
Shem's play Bill W. and Dr. Bob had an Off Broadway run at New World Stage in New York City. It ran for 132 performances and closed on June 10, 2007. The New York Times called it "an insightful new play."
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Displaying 1 - 30 of 101 reviews
August 24, 2008
It took me a lonnngggg time and many stops and starts to get through this book but in the end, it was okay. The book is about a doctor doing his residency in a psych hospital and all the crazy patients he deals with. Of course, the craziest people turn out to be the doctors. Some of the stuff about how the doctors would change patient's diagnoses to get the maximum from insurance is funny but also really disturbing too-I have a feeling it's not all made up.
June 1, 2010
I had never heard of Mount Misery by Samuel Shem, but my buddy EJack was giving it away in his moving "sale," and who am I to turn down a free book?
I found this review/synopsis from the School Library Journal at Amazon (which is important, I think, that it's the SCHOOL Library Journal):
Roy Basch, protagonist of House of God (Dell, 1981), has survived his internship and now begins his three-year training at the aptly named Mount Misery, a posh New England psychiatric hospital. Things get off to an ominous start when his mentor, a renowned therapist in the field of depressive disorders, kills himself. This is just the beginning of a year filled with disaster. Employing gallows humor, Basch and his fellow residents confront bureaucratic nonsense in a manner reminiscent of Richard Hooker's MASH. The tone then becomes more like that of Ken Kesey's One Flew Over the Cuckoo's Nest as patients are assaulted by the cruel words and manipulations of the powerful attendings. Shem's novel confronts some powerful themes - sexual abuse, psychosis, greed, depression, suicide - and counters them with examples of the very best the human spirit has to offer. The field of psychiatry is unflinchingly held under a microscope and its failings, limitations, and successes are relentlessly catalogued. With such ferocious intensity, this lengthy novel will not appeal to all teens, but those who persevere will find that Mount Misery's "Laws" and characters will live on in their imaginations for some time to come.
First of all: if you read that synopsis, and you have a teenager, DON'T LET YOUR KID READ THIS BOOK. Seriously, it is not for kids, not even high schoolers.
Now, on to the rest of my thoughts: I really hope I never have to go to therapy again. No, that's not true. What I mean is, I hope I never have to go to therapy with any of these jokers. So Mount Misery is a satire, right? So probably the characters needed to be over the top, more like caricatures of psychiatrists than real psychiatrists. Well, they were, all of them, even the ones I was supposed to like. I basically couldn't stand the protagonist, Roy, even though I'm sure I was supposed to feel his pain, be with him in the trenches as his patients failed and then failed some more. But I didn't give two shits about this guy. He was a sucker. He took on every problem that his patients had. Working on the depressive wing? He got majorly depressed. Drug and alcohol wing? Developed a leetle problem with phenobarbitol. As a reader, I didn't find this compelling; I found it annoying.
The sex scenes weren't that great, either. And every time the author threw in a naughty word, it felt like it was for shock value, not in a way that someone would actually use said naughty word.
And then... and then... the ending! It got all preachy and enlightened. To that, I say bah. When your protagonist, his wife, and their adopted Chinese baby daughter go to Arizona and he starts working with drunks on the res and she starts taking care of their preschoolers... I mean, are we supposed to believe that in the course of one year, this guy changed so dramastically (that's dramatically and drastically, for those of you paying attention) that now he's all one with the universe? NO.
Mount Misery is out of print. Just an FYI.
Mount Misery - D+
I found this review/synopsis from the School Library Journal at Amazon (which is important, I think, that it's the SCHOOL Library Journal):
Roy Basch, protagonist of House of God (Dell, 1981), has survived his internship and now begins his three-year training at the aptly named Mount Misery, a posh New England psychiatric hospital. Things get off to an ominous start when his mentor, a renowned therapist in the field of depressive disorders, kills himself. This is just the beginning of a year filled with disaster. Employing gallows humor, Basch and his fellow residents confront bureaucratic nonsense in a manner reminiscent of Richard Hooker's MASH. The tone then becomes more like that of Ken Kesey's One Flew Over the Cuckoo's Nest as patients are assaulted by the cruel words and manipulations of the powerful attendings. Shem's novel confronts some powerful themes - sexual abuse, psychosis, greed, depression, suicide - and counters them with examples of the very best the human spirit has to offer. The field of psychiatry is unflinchingly held under a microscope and its failings, limitations, and successes are relentlessly catalogued. With such ferocious intensity, this lengthy novel will not appeal to all teens, but those who persevere will find that Mount Misery's "Laws" and characters will live on in their imaginations for some time to come.
First of all: if you read that synopsis, and you have a teenager, DON'T LET YOUR KID READ THIS BOOK. Seriously, it is not for kids, not even high schoolers.
Now, on to the rest of my thoughts: I really hope I never have to go to therapy again. No, that's not true. What I mean is, I hope I never have to go to therapy with any of these jokers. So Mount Misery is a satire, right? So probably the characters needed to be over the top, more like caricatures of psychiatrists than real psychiatrists. Well, they were, all of them, even the ones I was supposed to like. I basically couldn't stand the protagonist, Roy, even though I'm sure I was supposed to feel his pain, be with him in the trenches as his patients failed and then failed some more. But I didn't give two shits about this guy. He was a sucker. He took on every problem that his patients had. Working on the depressive wing? He got majorly depressed. Drug and alcohol wing? Developed a leetle problem with phenobarbitol. As a reader, I didn't find this compelling; I found it annoying.
The sex scenes weren't that great, either. And every time the author threw in a naughty word, it felt like it was for shock value, not in a way that someone would actually use said naughty word.
And then... and then... the ending! It got all preachy and enlightened. To that, I say bah. When your protagonist, his wife, and their adopted Chinese baby daughter go to Arizona and he starts working with drunks on the res and she starts taking care of their preschoolers... I mean, are we supposed to believe that in the course of one year, this guy changed so dramastically (that's dramatically and drastically, for those of you paying attention) that now he's all one with the universe? NO.
Mount Misery is out of print. Just an FYI.
Mount Misery - D+
January 22, 2020
A young resident psychiatrist who has a lot of ambitions and also he had decided during his internship that this one medical speciality is the easiest or the most suitable for him. While he hits the sorrow reality in the psychiatric ward and discovers the pathways of each department, he changes himself, as a consultant. This transition seems natural facing the cruelty and selfishness of the patients and even more significant power of his superiors colleagues.
March 20, 2020
I finished this book a week ago and for some reason just started throwing together thoughts that grew beyond what probably should be a review, and won’t really be useful to anyone unless they read the book - or maybe they won’t be useful at all. For that reason, I’ll do a conventional review of the book, and then if anyone wants to read some vaguely philosophical meditations on the mental health industry, both presented in the book and out ‘there’ in the ‘real’ world, then they can.
So MISERY is a sequel to House of God, Shem’s bestselling take on the medical industry. HoG has been favorably compared to Catch-22, with the medical industry taking center stage instead of the military, and that’s an assessment I generally agree with. In HoG, Roy is a medical student whose eyes are opened to all the failings of medical school.
His mentor in that book, the Fat Man, presents a series out of counter-intuitive rules for treating patients. Misery follows Roy as, like many of his cohorts at the House of God, he’s gone into psychiatry, too damaged by working directly with the physically ill, and begins his rotations in wings of the hospital that focus, for example, on overprescribing drugs to make as much money as possible, or, elsewhere, an unquestioning worship of Freud.
The general structure of the book mirrors HoG. Roy has pals who suffer alongside him various ways, affairs with women he probably shouldn’t have affairs with, and a series of mentor figures who largely lead him astray with the ‘conventional’ wisdom of the establishment. Luckily, Roy has people like Malik, this novel’s Fat Man, who provides a regular dose of humanity to what Roy discovers is a tremendously inhuman, and sometimes dangerous, psychiatric industry.
The book presciently exposes failings in the mental health industry that were just blossoming then, but are now full blown crises: the strangle hold big pharma has on the mental health of the nation and how those in need are treated to serve the needs of Big Pharma; the increasing dehumanization of patients by algorithms, data points, and the presence of a cold, technocratic digital overlord; the endless proliferation of esoteric, postmodern theoretical approaches to the human psyche that become increasingly divorced from any sense of reality; and, of course, the demolition of any sacred cow presented as fact.
The book’s a bit unfortunate when it comes to its sexual politics, with more than a smattering of Roth’s Portnoy in Roy, but that’s forgivable. Satire like this isn’t vogue anymore, since it relies a on occasional caricature which, in turn, sometimes relies on hyperbolically working with stereotypes that we’d probably not put up with today. And ultimately the book is perhaps too long. But it’s a damning take on the mental health industry, and I felt like shaking my head from the future and telling Roy, wait a few decades, buddy. You think it’s bad now? Just wait.
/end conventional review
I don’t usually underline books I read for pleasure, but since I have a layman’s interest in the mental health industry, I found myself underlining passages to return to later.
A lot of them center around the disconnect between theory and practice, and the best doctors in MISERY, as in HoG, rely more on the former and less on the latter. Put another way, Roy’s journey through the psychiatric industry is marked by a marked refusal of common sense and human decency.
On a technical level, Shem pulls off an interesting take on dramatic irony, where the reader knows more than the characters. Roy starts off like us, human and humane, and we follow along this Everyman as he navigates the psychiatric industrial complex. We learn as he learns. But at a certain point he falls off an ideological cliff - the ‘drinks the Kool-Aid’ and abandons things that readers recognize as fundamental truths of the human condition.
Malik represents those truths, and this split, and Roy’s arrogance [which also touches his intimate and familial relationships] transform him, midway through the novel, into one of its villains. Our hope is that he’ll realize the errors of his ways and step up to the so-called ‘authorities’ that have inexplicably gained power over the damaged, vulnerable populations under their care.
The satire here is scathing and of the best kind: while the happenings are funny, all we need to do is open our eyes in, what is it now, twenty twenty, to see that the seeds Shem sees and mocks have blossomed into a completely degenerate mental health system and a general social fabric that is, on a cultural level, incredibly mentally ill itself.
So MISERY is a sequel to House of God, Shem’s bestselling take on the medical industry. HoG has been favorably compared to Catch-22, with the medical industry taking center stage instead of the military, and that’s an assessment I generally agree with. In HoG, Roy is a medical student whose eyes are opened to all the failings of medical school.
His mentor in that book, the Fat Man, presents a series out of counter-intuitive rules for treating patients. Misery follows Roy as, like many of his cohorts at the House of God, he’s gone into psychiatry, too damaged by working directly with the physically ill, and begins his rotations in wings of the hospital that focus, for example, on overprescribing drugs to make as much money as possible, or, elsewhere, an unquestioning worship of Freud.
The general structure of the book mirrors HoG. Roy has pals who suffer alongside him various ways, affairs with women he probably shouldn’t have affairs with, and a series of mentor figures who largely lead him astray with the ‘conventional’ wisdom of the establishment. Luckily, Roy has people like Malik, this novel’s Fat Man, who provides a regular dose of humanity to what Roy discovers is a tremendously inhuman, and sometimes dangerous, psychiatric industry.
The book presciently exposes failings in the mental health industry that were just blossoming then, but are now full blown crises: the strangle hold big pharma has on the mental health of the nation and how those in need are treated to serve the needs of Big Pharma; the increasing dehumanization of patients by algorithms, data points, and the presence of a cold, technocratic digital overlord; the endless proliferation of esoteric, postmodern theoretical approaches to the human psyche that become increasingly divorced from any sense of reality; and, of course, the demolition of any sacred cow presented as fact.
The book’s a bit unfortunate when it comes to its sexual politics, with more than a smattering of Roth’s Portnoy in Roy, but that’s forgivable. Satire like this isn’t vogue anymore, since it relies a on occasional caricature which, in turn, sometimes relies on hyperbolically working with stereotypes that we’d probably not put up with today. And ultimately the book is perhaps too long. But it’s a damning take on the mental health industry, and I felt like shaking my head from the future and telling Roy, wait a few decades, buddy. You think it’s bad now? Just wait.
/end conventional review
I don’t usually underline books I read for pleasure, but since I have a layman’s interest in the mental health industry, I found myself underlining passages to return to later.
A lot of them center around the disconnect between theory and practice, and the best doctors in MISERY, as in HoG, rely more on the former and less on the latter. Put another way, Roy’s journey through the psychiatric industry is marked by a marked refusal of common sense and human decency.
On a technical level, Shem pulls off an interesting take on dramatic irony, where the reader knows more than the characters. Roy starts off like us, human and humane, and we follow along this Everyman as he navigates the psychiatric industrial complex. We learn as he learns. But at a certain point he falls off an ideological cliff - the ‘drinks the Kool-Aid’ and abandons things that readers recognize as fundamental truths of the human condition.
Malik represents those truths, and this split, and Roy’s arrogance [which also touches his intimate and familial relationships] transform him, midway through the novel, into one of its villains. Our hope is that he’ll realize the errors of his ways and step up to the so-called ‘authorities’ that have inexplicably gained power over the damaged, vulnerable populations under their care.
The satire here is scathing and of the best kind: while the happenings are funny, all we need to do is open our eyes in, what is it now, twenty twenty, to see that the seeds Shem sees and mocks have blossomed into a completely degenerate mental health system and a general social fabric that is, on a cultural level, incredibly mentally ill itself.
January 3, 2022
Segunda parte de La casa de Dios. Nuestro médico protagonista ya ha pasado su año de prácticas y es ahora residente de psiquiatría. Esto le permite al autor seguir ahondando en todo lo que cree que está mal con el sistema sanitario norteamericano. Ya la descripción del libro nos da bastantes pistas:
De nuevo la novela está muy bien escrita, nos lleva por donde quiere mientras esperamos a ver qué nueva locura nos presenta el autor. Hay ira, por supuesto, y desprecio, y se traslucen en todas las escenas que nos muestran. Pero en esta ocasión el autor opta por dejar un levísimo punto de esperanza en el horizonte, punto hacia el que nos guía el más marginado de los médicos del hospital, Malik, muy apropiadamente.
Lectura interesante, sin duda, y muy entretenida.
Roy aprenderá a examinar, diagnosticar e ingresar a un paciente exactamente en catorce minutos, incluido un dictamen sobre lo que puede pagar su seguro médico. Estudiará con Blair Heller, un aspirante al premio Nobel cuya principal técnica consiste en atacar a sus pacientes hasta que éstos se ponen rojos de furia, y que postula que cuando un paciente parece estar mejor, es porque está peor. Y luego, con Errol Cabot, quien receta Prozac y Valium como si fueran caramelos, y usa a sus pacientes como cobayas para probar una nueva droga -el futuro gran negocio de Cabot y los laboratorios-, que hará que el Prozac parezca palomitas de maíz. Y también se enterará de la peculiar manera que tiene el freudiano doctor Dove de aplicar la teoría de la seducción con sus más atractivas pacientes...
Pero afortunadamente para el joven médico, incluso entre las miserias de Prozaquistán, Freudilandia y las leyes del mercado, se puede encontrar un camino a seguir que no traicione nuestros ideales, y será el escéptico, sabio y marginado Malik, un antiguo alcohólico, quien lo guiará por los laberintos de todo lo que no se debe aprender...
De nuevo la novela está muy bien escrita, nos lleva por donde quiere mientras esperamos a ver qué nueva locura nos presenta el autor. Hay ira, por supuesto, y desprecio, y se traslucen en todas las escenas que nos muestran. Pero en esta ocasión el autor opta por dejar un levísimo punto de esperanza en el horizonte, punto hacia el que nos guía el más marginado de los médicos del hospital, Malik, muy apropiadamente.
Lectura interesante, sin duda, y muy entretenida.
June 13, 2025
It is my opinion, that everyone should read The House of God, and if you work as a doctor or study medicine, you MUST read it. A hilarious but most importantly very vulnerable and touching account on the dehumanizing effects of working as a doctor, Samuel Shem's novel about the young Doctor Roy G Basch is a timeless tale (even if it is very grounded in the '70s) and a coming-of-age novel of sorts, even if Roy is a good 10-15 years older than most bildungsroman protagonists. It's such a sweet story of a person learning to be open and honest about his feelings and weaknesses and taking responsibility for himself ending in a grand declaration of love, that I just had to assume it'd be the perfect fairytale ending of Roy and his true love Berry living happily ever after.
But wasn't I a bit foolish to assume that? For being very dramatic and a bit exaggerated for humour's sake, House of God is grounded in real experiences and real feelings, and Roy's journey as a doctor had only just begun.. So of course he'd be in for further trials, as he *SPOILER for HoG* starts his training in psychiatry at the prestigious private institution of Mount Misery.
The book is divided in five parts, each exploring a subspecialty of psychiatry as Roy is transferred to different wards for his education, and scathing critique is given to many practices of psychiatry that still don't function optimally to this day as well as the insurance companies that are more willing to pay for pills and short stabilizing admissions rather than long term healing through therapy and proper addiction rehab as well as not covering the "unwashed masses" that have to survive in the worse equipped public institutions. With his gang of loveable but troubled fellow young psychiatrists Henry and Hannah as well as guidance from the empathetic, energetic and wise Dr. Malik, Roy tries to find out how to help the patients of Misery as best as he can, notably the successful but depressed lawyer Cherokee and the young and furious rich kids Thorny and Zoe with borderline PO. Soon he starts to question if his abilities as a doctor is even an asset in this strange new world, and wonders if maybe the invincible experts in their ivory strongholds, especially the enigmatic psychoanalyst Schlomo Dove, might be running things to their own benefit rather than to the patients...
Returning to the growing up motif, I really liked to see how Roy had matured since the last novel, and while there is still some saucy sexual affairs and pranks, the struggles seem a bit deeper and more meaningful than the last time we spent with the young doctor, and he is now longer as passive a protagonist but gets the ball rolling on his own in the face of injustice. The characters are good, though not as memorable as the great cast from House of God, but the kind Dr. Malik, the spacy mistress Jill and reggae-loving "gay-latent" Henry Solini are surely standouts. The chiefs of medicines at the different wards are also good for the most part, coming off as almost saturday morning cartoon villains in the beginning (which could certainly describe a couple of senior doctors I have met) but hiding a lot more under the surface, good as well as sinister and vice versa. This makes the stakes feel higher than it did in House of God, as Roy now has the maturity and skill to fight against their tyranny, which never really felt like an option in the previous novel.
The book certainly is not as funny as House of God, even if I laughed out loud quite a lot during my read, but given the subject matter trauma, depression, anger and suicide are common guests in the narrative, with a huge catastrophe already striking early in the story to cast its shadow over the rest of the book. The pieces take a long time to fit together, but at the end, a beautiful tapestry is woven from the threads of human suffering, and Roy (if only in his own thoughts to ease his conciousness) finds meaning in the madness in a way that I found very compelling, and even at 560 pages, the book does not overstay its welcome.
Not to say that it is perfect. I have already mentioned some of the way it falls short in comparison to its amazing predecessor, but some of the other problems are some strange anachronisms, where there are references to CD's, new Microsoft PC's, the Japanese tech boom and Eisner as the president of Disney in a book that supposedly takes place in the mid 70's. I suppose it was in order to critique the psychiatric system in 1999, where the book was written, which is fine I guess but I found it a bit confusing. I also think that not all of the chapters were of even quality, some could have definitely used a bit more content, notably Roy's time on the emergency psych reception and the psychosis and addiction rehab wards. The plot really develops in these chapters and a lot of focus is put on that as well as Roy's own deteriorating mental state, so I guess it's a trade off between that and time with patients. Finally, I have some professional disagreements with Shem about certain matters relating to diagnoses and drug treatment, but there is nothing overly offensive and a lot of things have definitely changed between today and the 90's (or 70's.. seriously WTF?). What he describes would definitely be bad practice today and I certainly agree with much of his advice for delivering better psychiatric care and treatment. Finally the "villains" are definitely a bit too exaggerated, which hurts the realism that made House of God great. Where you felt like you could meet Dr. Leggo or The Fish in real life, the chiefs of medicine feels comparatively more like characters in a novel.
All in all, I definitely think this is a worthy follow up to House of God, not as funny and probably not really as shocking and real as that book, Mount Misery still delivers a great continuation of the story with fun characters, biting satire of psychiatry and psychiatrists, lots of heartfelt moments and even higher stakes. It felt shockingly relevant even today, as I was working a temp job doing admissions at a very Mt. Misery-like hospital in Denmark while the nation was shocked by a tragic shooting by a former psychiatric patient. It has many great points on learning to be with people in pain as well as ahead-of-its time comments on toxic masculinity, sexual abuse and healthcare inequality. When you're done reading House of God, definitely pick this up to continue learning about life and loss with the young Roy G Basch MD.
But wasn't I a bit foolish to assume that? For being very dramatic and a bit exaggerated for humour's sake, House of God is grounded in real experiences and real feelings, and Roy's journey as a doctor had only just begun.. So of course he'd be in for further trials, as he *SPOILER for HoG* starts his training in psychiatry at the prestigious private institution of Mount Misery.
The book is divided in five parts, each exploring a subspecialty of psychiatry as Roy is transferred to different wards for his education, and scathing critique is given to many practices of psychiatry that still don't function optimally to this day as well as the insurance companies that are more willing to pay for pills and short stabilizing admissions rather than long term healing through therapy and proper addiction rehab as well as not covering the "unwashed masses" that have to survive in the worse equipped public institutions. With his gang of loveable but troubled fellow young psychiatrists Henry and Hannah as well as guidance from the empathetic, energetic and wise Dr. Malik, Roy tries to find out how to help the patients of Misery as best as he can, notably the successful but depressed lawyer Cherokee and the young and furious rich kids Thorny and Zoe with borderline PO. Soon he starts to question if his abilities as a doctor is even an asset in this strange new world, and wonders if maybe the invincible experts in their ivory strongholds, especially the enigmatic psychoanalyst Schlomo Dove, might be running things to their own benefit rather than to the patients...
Returning to the growing up motif, I really liked to see how Roy had matured since the last novel, and while there is still some saucy sexual affairs and pranks, the struggles seem a bit deeper and more meaningful than the last time we spent with the young doctor, and he is now longer as passive a protagonist but gets the ball rolling on his own in the face of injustice. The characters are good, though not as memorable as the great cast from House of God, but the kind Dr. Malik, the spacy mistress Jill and reggae-loving "gay-latent" Henry Solini are surely standouts. The chiefs of medicines at the different wards are also good for the most part, coming off as almost saturday morning cartoon villains in the beginning (which could certainly describe a couple of senior doctors I have met) but hiding a lot more under the surface, good as well as sinister and vice versa. This makes the stakes feel higher than it did in House of God, as Roy now has the maturity and skill to fight against their tyranny, which never really felt like an option in the previous novel.
The book certainly is not as funny as House of God, even if I laughed out loud quite a lot during my read, but given the subject matter trauma, depression, anger and suicide are common guests in the narrative, with a huge catastrophe already striking early in the story to cast its shadow over the rest of the book. The pieces take a long time to fit together, but at the end, a beautiful tapestry is woven from the threads of human suffering, and Roy (if only in his own thoughts to ease his conciousness) finds meaning in the madness in a way that I found very compelling, and even at 560 pages, the book does not overstay its welcome.
Not to say that it is perfect. I have already mentioned some of the way it falls short in comparison to its amazing predecessor, but some of the other problems are some strange anachronisms, where there are references to CD's, new Microsoft PC's, the Japanese tech boom and Eisner as the president of Disney in a book that supposedly takes place in the mid 70's. I suppose it was in order to critique the psychiatric system in 1999, where the book was written, which is fine I guess but I found it a bit confusing. I also think that not all of the chapters were of even quality, some could have definitely used a bit more content, notably Roy's time on the emergency psych reception and the psychosis and addiction rehab wards. The plot really develops in these chapters and a lot of focus is put on that as well as Roy's own deteriorating mental state, so I guess it's a trade off between that and time with patients. Finally, I have some professional disagreements with Shem about certain matters relating to diagnoses and drug treatment, but there is nothing overly offensive and a lot of things have definitely changed between today and the 90's (or 70's.. seriously WTF?). What he describes would definitely be bad practice today and I certainly agree with much of his advice for delivering better psychiatric care and treatment. Finally the "villains" are definitely a bit too exaggerated, which hurts the realism that made House of God great. Where you felt like you could meet Dr. Leggo or The Fish in real life, the chiefs of medicine feels comparatively more like characters in a novel.
All in all, I definitely think this is a worthy follow up to House of God, not as funny and probably not really as shocking and real as that book, Mount Misery still delivers a great continuation of the story with fun characters, biting satire of psychiatry and psychiatrists, lots of heartfelt moments and even higher stakes. It felt shockingly relevant even today, as I was working a temp job doing admissions at a very Mt. Misery-like hospital in Denmark while the nation was shocked by a tragic shooting by a former psychiatric patient. It has many great points on learning to be with people in pain as well as ahead-of-its time comments on toxic masculinity, sexual abuse and healthcare inequality. When you're done reading House of God, definitely pick this up to continue learning about life and loss with the young Roy G Basch MD.
April 1, 2021
While it may be culturally dated, this book's message remains timeless. If you can maintain a sense of humor through the sadness of the lives of both the "professionals" and patients, the last 100 pages will bring great joy. Shem speaks to the impact of the system, theories du jour, greed, egos and power plays, and it is heart-wrenching but so real. I could easily change the setting to the public school system in the USA. In the end, however, humanity wins and "You see you."
March 29, 2023
Jau taip vargau su tuo Vargo kalnu... Dialogai kažkokie netikroviški, viskas užtempta iki begalybės, net tos išties opios problemos kažkur tame begaliniame tekste pasimeta. Kelios citatos patiko, bet šiaip - „Dievo namai“ ir „Vargo kalnas“ kaip diena ir naktis.
May 5, 2025
It was fineeeee. Introspective extraspective
September 28, 2008
HOUSE OF GOD was such a masterpiece, so accurately if cynically portraying the life of a medical resident, that it is sold in the bookshop of the medical school that I work for. I am convinced that this book was the inspiration for ST ELSEWHERE.
MOUNT MISERY follows the same main character, Roy Basch, as he persues his psychiartic specialty with all its attendant ups and downs.
I am about 400 pages into this book, and I have to say that I am sorry I didnt quit after 100 pages. The only reason I am not quitting after 400 pages is that I want to see if it all turns out OK for Roy in the end. Shem makes you like the guy, but he has made me hate just about everybody else that he works with, and I want to know that he rises above all and prevails.
I will update this once I finish the book, but as of right now, I can only say that unless you are REALLY motivated to read a follow-up to HOUSE OF GOD, dont start reading this.
EDITED TO ADD: OK, I finished it. And I have to say that the last 100 pages does reward the reader for getting through everything that came before. But Where I will probably reread HOUSE OF GOD every couple of years, odds are pretty good that I will never want to reread MOUNT MISERY again. It is very well writen, and it has an ending that I sort of hoped for, but I am done with these characters.
MOUNT MISERY follows the same main character, Roy Basch, as he persues his psychiartic specialty with all its attendant ups and downs.
I am about 400 pages into this book, and I have to say that I am sorry I didnt quit after 100 pages. The only reason I am not quitting after 400 pages is that I want to see if it all turns out OK for Roy in the end. Shem makes you like the guy, but he has made me hate just about everybody else that he works with, and I want to know that he rises above all and prevails.
I will update this once I finish the book, but as of right now, I can only say that unless you are REALLY motivated to read a follow-up to HOUSE OF GOD, dont start reading this.
EDITED TO ADD: OK, I finished it. And I have to say that the last 100 pages does reward the reader for getting through everything that came before. But Where I will probably reread HOUSE OF GOD every couple of years, odds are pretty good that I will never want to reread MOUNT MISERY again. It is very well writen, and it has an ending that I sort of hoped for, but I am done with these characters.
This entire review has been hidden because of spoilers.
November 24, 2007
Dark and heavy. Fans of The House Of God should not expect the same kind of hilarious exhuberance from the author in this sequel; there is too much real human pain and suffering here. But this novel feels more mature and is much more likely to stay with readers, I think. (It has been a decade since I read this book and I'm STILL affected by it.)
April 26, 2021
This book is a gem. Much like The House of God, this should be read by all interns starting their residency training.
The only caution I’d give would be don’t read this book if you are in a dark place.
We need more shining beacons of people’s pursuit of the “right” things.
The only caution I’d give would be don’t read this book if you are in a dark place.
We need more shining beacons of people’s pursuit of the “right” things.
November 12, 2017
I preferred The House of God, its predecessor.
April 19, 2024
PROFOUND
August 13, 2023
This book was extremely disturbing. It's supposed to be a novel, but I assume that much or most of it is based on the author's experiences as a psychiatric resident. After the first hundred pages, I mostly skimmed, as the hospital and his life were both disasters. I mean, the protagonist, Roy, tried to do things right, but he was very closed off. When his partner (or anyone else) asked anything about his feelings, he couldn't answer, and wouldn't even acknowledge that he was upset about her questions or anything else.
The psychiatrists are totally crazy, and the patients are mistreated to the point of a number of avoidable suicides. At his first ward assignment, the head doctor is on vacation, and Roy's friend Malik is in charge. Malik gives him common-sense guidelines for working with the patients, and also tries to discharge as many as possible before the crazy head doctor (who diagnoses all patients as borderline) comes back. When he does come back, Roy falls under his spell and adopts his extreme, Freudian-oriented viewpoint, which causes him to treat patients inappropriately, doing harm. When his rotation takes him to the psychosis ward, he finds that the head doctor doesn't even consider the patients human and doesn't interact with them, just prescribes excessive amounts of harmful drugs. Some people there are misdiagnosed and shouldn't be there, but the head doctor doesn't care. When it's obvious that another prominent psychiatrist in the hospital is having sex with his patients and even a younger women doctor, Roy tries to help, but the doctor is charismatic and the hospital circles its wagons around him. Meanwhile, Roy starts an affair, which is the last straw for his wonderful partner. (Yes, the book is thoroughly sexist.)
It has a happy ending for Roy, but the book is an indictment of the psychiatric establishment and mental hospitals, this model of which I don't think still exists. Also those who work with the Freudian model are much rarer now. But the issues he raises about insurance and pharmaceutical companies continue. And care for the mentally ill is woefully inadequate.
All the blurbs say the book is witty, funny, hilarious. Yes, it's written irreverently, but overall, I found it more disturbing and tragic. If I were to re-read The House of God, I wonder it I'd like it as much as I did long ago when I read it.
The psychiatrists are totally crazy, and the patients are mistreated to the point of a number of avoidable suicides. At his first ward assignment, the head doctor is on vacation, and Roy's friend Malik is in charge. Malik gives him common-sense guidelines for working with the patients, and also tries to discharge as many as possible before the crazy head doctor (who diagnoses all patients as borderline) comes back. When he does come back, Roy falls under his spell and adopts his extreme, Freudian-oriented viewpoint, which causes him to treat patients inappropriately, doing harm. When his rotation takes him to the psychosis ward, he finds that the head doctor doesn't even consider the patients human and doesn't interact with them, just prescribes excessive amounts of harmful drugs. Some people there are misdiagnosed and shouldn't be there, but the head doctor doesn't care. When it's obvious that another prominent psychiatrist in the hospital is having sex with his patients and even a younger women doctor, Roy tries to help, but the doctor is charismatic and the hospital circles its wagons around him. Meanwhile, Roy starts an affair, which is the last straw for his wonderful partner. (Yes, the book is thoroughly sexist.)
It has a happy ending for Roy, but the book is an indictment of the psychiatric establishment and mental hospitals, this model of which I don't think still exists. Also those who work with the Freudian model are much rarer now. But the issues he raises about insurance and pharmaceutical companies continue. And care for the mentally ill is woefully inadequate.
All the blurbs say the book is witty, funny, hilarious. Yes, it's written irreverently, but overall, I found it more disturbing and tragic. If I were to re-read The House of God, I wonder it I'd like it as much as I did long ago when I read it.
November 9, 2019
This is the second book of Shem's medical fiction series following The House of God when Roy Basch was an intern. Dr. Basch is now a resident psychiatrist at a psychiatric hospital called Mount Misery. My wife is a supervising RN at a psychiatric hospital and I hope she doesn't have to face some of the things Dr. Basch and his compatriots had to face in their first year as residents at Mount Misery. Suicides, diagnosis made strictly for insurance coverage, battles with insurance companies, applications of various theories of psychiatric treatment to the exclusion of all others, sexual encounters with patients and staff, the exclusive treatment of medicine, and just hard things in the life of those you work with.
This book really drug for the first half but recovered nicely in the second half with much of the story coming together in the last hundred pages or so. As I mentioned earlier, this was a followup to The House of God which takes place in the early 1970's when Roy is an intern. Yet this book is the first year of his residency and takes place in the 1990's based on references to Clinton. If the same characters are used from one book to another they should be written in the same time frame unless there is a time machine involved and I am pretty sure there wasn't one in this book.
This book really drug for the first half but recovered nicely in the second half with much of the story coming together in the last hundred pages or so. As I mentioned earlier, this was a followup to The House of God which takes place in the early 1970's when Roy is an intern. Yet this book is the first year of his residency and takes place in the 1990's based on references to Clinton. If the same characters are used from one book to another they should be written in the same time frame unless there is a time machine involved and I am pretty sure there wasn't one in this book.
August 11, 2025
Puh, was für ein Chaos! Darf man wirklich so seine Patienten behandeln? Damit meine ich nicht die sehr freigiebige Abgabe von Medikamten oder die für mich sehr willkürlichen Diagnosen. Ich meine die Art und Weise, wie mit diesen Menschen umgegangen wird. Offensichtlich sind sie nur eine Geldquelle für Versicherungen, Ärzte und Krankenhäuser. Mit jeder Station, die Dr. Basch durchläuft, wird die Geschichte chaotischer. Der dünne rote Faden sind Cherokee und Lily, die Basch als Patient bzw. als dessen Ehefrau während seiner Zeit in Mount Misery begleiten.
Erst nach ungefähr 400 Seiten Chaos, Selbstmorden, der allgegenwärtigen Diagnose Psychose und viel Prozak konnte mich Mount Misery kurz packen. Basch sprach auf einmal davon, wie sehr ihn alles belastet und wie hoch der Preis ist, den er für diese heiß begehrte Stelle zahlen muss. Plötzlich machen Dinge, die ich ganz am Anfang gelesen habe, Sinn. Doch das Ende hat dieses kurze Highlight leider wieder zunichte gemacht. Noch einmal werde ich bei Dr. Shem nicht in Behandlung gehen.
Erst nach ungefähr 400 Seiten Chaos, Selbstmorden, der allgegenwärtigen Diagnose Psychose und viel Prozak konnte mich Mount Misery kurz packen. Basch sprach auf einmal davon, wie sehr ihn alles belastet und wie hoch der Preis ist, den er für diese heiß begehrte Stelle zahlen muss. Plötzlich machen Dinge, die ich ganz am Anfang gelesen habe, Sinn. Doch das Ende hat dieses kurze Highlight leider wieder zunichte gemacht. Noch einmal werde ich bei Dr. Shem nicht in Behandlung gehen.
June 24, 2019
Wow. This is one of my Dollar Tree store finds, and boy, was it an excellent surprise. I first pick them up from the cover, & then the blurbs, so I basically had no knowledge of what I was about to read. This book reminded me, style-wise and story flow-wise, of The Goldfinch, which I truly loved. It's nearly 600 pages long, and it just moves along. The main character was both likable and annoying and a little bit stupid/naive/influenceable, which I found somewhat surprising, but in general, the characters were definitely interesting. The story takes place mostly over what I think may have been one year, with some flashbacks. It's about a young man who schooled to be a medical doctor, and is now training to be a psychiatrist at a really messed up facility, and what he goes thru along with his friends and enemies. It is actually a part two of a story beginning in 'The House of God', the bok where he goes to medical school. I highly recommend this book.
April 28, 2023
I thoroughly enjoyed this book and I would cautiously recommend it to anyone working in psychiatry, though I’m not so sure I could recommend it to anyone else. The limitations of The House of God apply to this book as well. It’s outdated, it's often sexist, it’s (mostly) satire, and the practice of psychiatry has changed so much since ~1980 that many of the characters in this book seem like caricatures. That said, this book was similar to House of God in that despite our many advances, his criticisms of the healthcare system and ideologies ring painfully true to anyone who is currently in or has been through psychiatry residency training. Though still dark and cynical and hilarious I found this book more optimistic than the House of God. He really digs into his central thesis that genuine connection between people is what heals, and that the systems we build around diagnosing/therapy modalities/pharmacology/insurance get in the way of human connection and therefore impede healing.
January 23, 2024
I feel like people either love or hate Samuel Shem’s writings. I am in the love category. He does not see medicine through rose colored glasses. His books are sort of like if worlds worst doctors all worked in the same hospital. There is humor, cynicism, sex (the protagonist is pretty much a philanderer), and just general craziness. The book is not an easy read, but it is a “coming of age” of a young doctor. Of course this book might make a person never want therapy or psychiatric drugs….but as I mentioned above, it’s sort of a “worst case scenario “. This book is not as good as “house of god”, which would be hard to to. Shem is the author whose slang has stayed in the medical community more than 40 years after House of God was published. The gomers, the Lol in nad definite a work of art :-)
September 10, 2021
“Jei psichikos ligonio būklė pasidaro kritiška, pirmiausia pasitikrink savo psichikos būklę.”
Vargo kalnas, tai “Dievo namų” tęsinys. Tik šį kartą veiksmas vyksta psichiatrijos ligoninėje, kurioje jaunas gydytojas bando atsakyti sau į esminius gyvenimo klausimus ir pagaliau atrasti save. Ligoninės užkulisių čia taip pat netrūko, tačiau monotonija jautėsi nuo pat pirmo iki paskutinio puslapio:// O tų puslapių buvo tikrai nemažai- 700😱 (pati sunkiai suvokiu kaip įveikiau). Kadangi esu medicinos studentė, tai labai vyliausi, kad knyga patiks, bet deja deja… Ir nors storų knygų tikrai nebijau, tačiau su šita storule baisiai suvargau. “Vargo kalnas” tikrąja to žodžio prasme tapo vargo kalnu😂.
Rekomenduočiau kam? Turbūt šį kartą - niekam.🤭😑
Vargo kalnas, tai “Dievo namų” tęsinys. Tik šį kartą veiksmas vyksta psichiatrijos ligoninėje, kurioje jaunas gydytojas bando atsakyti sau į esminius gyvenimo klausimus ir pagaliau atrasti save. Ligoninės užkulisių čia taip pat netrūko, tačiau monotonija jautėsi nuo pat pirmo iki paskutinio puslapio:// O tų puslapių buvo tikrai nemažai- 700😱 (pati sunkiai suvokiu kaip įveikiau). Kadangi esu medicinos studentė, tai labai vyliausi, kad knyga patiks, bet deja deja… Ir nors storų knygų tikrai nebijau, tačiau su šita storule baisiai suvargau. “Vargo kalnas” tikrąja to žodžio prasme tapo vargo kalnu😂.
Rekomenduočiau kam? Turbūt šį kartą - niekam.🤭😑
October 21, 2022
I quit reading this book at page 128.
When I bought it (thank God at a second hand bookstore for little money) and began to read it, I wondered why it seemed to me that I already knew it. I liked the beginning, and I liked the theme of the book, and I wondered why I hadn't kept it as I always keep books I liked reading. Pretty soon it became clear to me why that was.
I am convinced that reality in this field of business (which it unfortunately is: a business, with the aim to make money and not to make anyone better) is very much like described in this novel, but this is satire taken way too far. Everything is much too exaggerated, at least for my liking.
When I bought it (thank God at a second hand bookstore for little money) and began to read it, I wondered why it seemed to me that I already knew it. I liked the beginning, and I liked the theme of the book, and I wondered why I hadn't kept it as I always keep books I liked reading. Pretty soon it became clear to me why that was.
I am convinced that reality in this field of business (which it unfortunately is: a business, with the aim to make money and not to make anyone better) is very much like described in this novel, but this is satire taken way too far. Everything is much too exaggerated, at least for my liking.
May 17, 2019
I only got to a little over half way and that itself required pushing myself to sit through endless chapters of psychiatrists' mismanaging wards and then the protagonist and his peers getting much too involved with their patients. I just didn't really enjoy any of it. Maybe I'll pick it up again later.
July 13, 2021
"That’s why it’s bullshit – because it fits. Human beings are so complex, any theory fits. By fitting, the theory excludes the complexity, so you lose what’s "human." Theories that fit exclude other theories, and so don’t fit. Like religions excluding other religions, preaching peace, leading to war. What fits can’t fit. The "perfect-fits" fit the worst."
September 21, 2023
I did this on audible at 1.2 speed and was an easier listen for me that way.
I liked this better than house of god as there was more of a story line and the different people in the book were easier to follow. Working in healthcare, it is sad to read about the ways people are taken advantage of, but I don’t doubt the story one bit.
I liked this better than house of god as there was more of a story line and the different people in the book were easier to follow. Working in healthcare, it is sad to read about the ways people are taken advantage of, but I don’t doubt the story one bit.
August 13, 2025
Is anyone else confused about the time line/children in Roy’s life? He and Berry adopt a young daughter Lizzie in this novel but in Man’s 4th best hospital (I accidentally read it before this book, out of order whoops) he has a daughter named Spring? I feel as if I am missing something and the discrepancies make it hard for me to fully immerse myself in a series
This entire review has been hidden because of spoilers.
September 9, 2025
Me ha gustado mucho (no tanto como La Casa de Dios). El autor escribe muy bien y te hace reflexionar sobre varios aspectos de la vida (y de la muerte).
No deja de ser una crítica al sistema médico norteamericano un poco alejado de mi realidad actual, pero he disfrutado mucho y me ha dado pena que acabara. Ciao!
No deja de ser una crítica al sistema médico norteamericano un poco alejado de mi realidad actual, pero he disfrutado mucho y me ha dado pena que acabara. Ciao!
May 4, 2017
Stopped reading about 1/3rd of the way in. There is just too much discussion that centers around the pros and cons of different approaches to psychiatric treatment. For someone not in that field, it became unbearably boring very quickly.
September 6, 2017
A bit long but a good read
I think this book would have probably 1/3 shorter and been just as good. Other than that I enjoyed this book, not as much as the first one still interesting and a good read for anybody interested in psychiatry
I think this book would have probably 1/3 shorter and been just as good. Other than that I enjoyed this book, not as much as the first one still interesting and a good read for anybody interested in psychiatry
March 16, 2019
A bit too wordy
Read this year's ago and must have thought it was good because I kept the book but reading it again I have no understanding of why I thought it was worth keeping it for that matter reading for a second time.
Read this year's ago and must have thought it was good because I kept the book but reading it again I have no understanding of why I thought it was worth keeping it for that matter reading for a second time.
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