Novel examining the psychiatric training of doctors in the USA which takes a wry look at diagnostics, the American medical funding system and at psychotherapy. 

31-2 – “ ‘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 are suffering from a pervasive instability in interpersonal relationships, self-image, and feelings.  The official diagnosis of Borderline Personality Organisation, or BPO, was defined by thirteen 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, and stable relationships, suicide or self-mutilating acts, mood swings, feelings of emptiness, and a fierce, withering rage.  Borderlines were emotionally labile, sometimes seeming completely normal, sometimes really crazy.  They could change in an instant, seemingly for no clear reason.  Most borderlines were women. Ike had painted me a dire picture, and now I quoted Ike to Malik, ‘Borderlines are hell.  They make your life as a psychiatrist miserable.  They’re almost impossible to treat.  Borderlines are the worst patients in all of psychiatry.’

‘Yeah, well, don’t hold your breath, but borderlines don’t exist.’ I laughed, thinking he was joking. ‘No joke.  Problems with relationships, self-image, feelings, impulsivity?  We all got that!  Your job is to resist brainwashing as long as possible and just tried to help these poor people.  Being lied to about Ike’s death has got ‘em bullshit.’ ”

228 – “People flocked to Misery.  The number of admissions, already high, went higher.  My daily admissions moved up from an average of seven, to nine, then to eleven.  In response, health care insurance denials of health care payments went higher still.  Protocols were altered, loopholes in policies appeared.  The daily discharges moved up from an average of eight to ten, and then to twelve.  Like a parasite in the bowels of the hospital, health care insurance was making sure that, no matter how many of the mentally unhealthy were fed in, many more were purged out.  A voracious animal, Misery needed constantly to be fed.”