In this sequel to his earlier seem-autobiographical novel, House of God, Shem (this time using both his pseudonym and his real name) describes the experience of a physician in the first year of a psychiatry residency in a prestigious private psychiatric hospital. In this first hand account it is assumed that the author is the resident, Dr. Roy Basch; he describes not only his experiences with a variety of patients but also with the other doctors and the staff members of the institution. It is not a happy place and in the telling of the story there is a biting irony and a sense of the absurd.

It is obvious from the first that Dr. Basch is very serious about becoming a psychiatrist but that he is also searching for meaning and connections. He finds that colleagues may often hurt you more than your patients. Another issue addressed is that of competing psychiatric theories, particularly the competition between pharmacologic treatment and psychoanalysis. Issues about drug treatment trials and the questionable way in which they are conducted also receive attention, as does the problem of insurance coverage for hospitalization.

The fact that psychiatrists often specialize in their own defects becomes a reality to Dr. Basch. There are not many exemplary people in this book--hopefully it exaggerates the real situation. There is, surprisingly, a sort of poignant positive ending.