In a House of Dreams and Glass: Becoming a Psychiatrist

by Robert Klitzman

Overview

A psychiatric resident's firsthand account reveals his struggles with the homeless, suicidal, and paranoid, and his frustrations with hospital politics and the limitations of an inexact science.

Fresh from medical school, Robert Klitzman began his residency in psychiatry with excitement and a sense of mission. But he was not prepared for what he found inside the city psychiatric center where he was to spend three grueling years.

In truth, as Dr. Klitzman's absorbing account of his apprenticeship reveals, he never ceased to be surprised—by his patients, by the senior psychiatrists' conflicting advice on how to help them, and by the unpredictable results of the therapies, both psychoanalytic and biologic, that he and his fellow residents practiced.

Nights in the emergency room, professional controversy, the minefield of hospital politics, the stress of his own therapy--everything is here, in a passionate and illuminating analysis of a doctor's struggle against tremendous odds to banish his patients' demons.

Product Details

ISBN-13:	9781451684599
Publisher:	Simon & Schuster
Publication date:	01/17/2012
Sold by:	SIMON & SCHUSTER
Format:	eBook
Pages:	368
File size:	1 MB

Editorial Reviews

Klitzman, a New York City psychiatrist who described his medical internship in A Year-Long Night, now offers an involving, highly revealing look at the chaotic world of psychiatric practice in this account of his three-year residency at an unnamed psychiatric hospital, part of a sprawling university medical center. Among his patients are Nancy Steele, a suicidal artist; Ronald Bramsky, a homeless drug addict who has endured more than a dozen operations for bone cancer; Blanca Diaz, a woman with dementia who believes she is in "the House of God, the Gateway to Heaven" and numerous schizophrenics, psychotics and depressives. We watch as Klitzman wrestles over whether to use psychological approaches, which frequently disappoint him; biological, drug-based treatments, which have helped many patients more than he expects them to; or a combination of approaches. Hospital politics unfolds in a clash of physicians' personalities and therapeutic styles, to the point where each ward constitutes a different social environment. Too often, observes Klitzman, patients are pigeonholed into narrow categories, given drugs and then blamed for their failure to improve.

Publishers Weekly - Cahners\\Publishers_Weekly

Klitzman, a New York City psychiatrist who described his medical internship in A Year-Long Night, now offers an involving, highly revealing look at the chaotic world of psychiatric practice in this account of his three-year residency at an unnamed psychiatric hospital, part of a sprawling university medical center. Among his patients are Nancy Steele, a suicidal artist; Ronald Bramsky, a homeless drug addict who has endured more than a dozen operations for bone cancer; Blanca Diaz, a woman with dementia who believes she is in ``the House of God, the Gateway to Heaven'' and numerous schizophrenics, psychotics and depressives. We watch as Klitzman wrestles over whether to use psychological approaches, which frequently disappoint him; biological, drug-based treatments, which have helped many patients more than he expects them to; or a combination of approaches. Hospital politics unfolds in a clash of physicians' personalities and therapeutic styles, to the point where each ward constitutes a different social environment. Too often, observes Klitzman, patients are pigeonholed into narrow categories, given drugs and then blamed for their failure to improve. (Mar.)

Publishers Weekly - Publisher's Weekly

Having described his first-year medical residency in A Year-Long Night (LJ 2/1/89), Klitzman continues with this account of his three-year psychiatric internship in a New York City university teaching hospital. Assigned rotations in short-term in-patient wards, emergency rooms, and out-patient clinics, Klitzman learned to diagnose mental disorders and administer treatment ranging from psychodynamic therapy to electric shock. He is a deft observer of the interactions between patients, residents, supervisors, and hospital staff, Klitzman makes us equally aware of his personal struggles to deal with the pressures to conform to training that discourages questioning and to understand an institutional system that appears to benefit staff rather than patients. Reminiscent of Mark Warren's The Making of a Modern Psychiatrist (Doubleday, 1986), this insightful memoir is recommended for public libraries.-Lucille Boone, San Jose P.L., Cal.

Library Journal

Klitzman affords a highly personal look at his four-year psychiatric residency. Not the usual first-year resident, Klitzman had spent time at the National Institutes of Health and in Papua New Guinea studying kuru. On his first night on call, he was abruptly exposed to a violent patient requiring physical restraints and the quiet room. His at first fumbling but increasingly more comfortable experiences with outpatients, inpatients, and ultimately his own patients gave him opportunities to mature as an individual and as a practicing psychiatrist. He learned from street person Ronald Bransky as well as from a variety of neurotic, borderline, and psychotic patients and was able to help some of them in making sense of their torn lives. One of the hardest things to learn was knowing when to question the authority, even domineering, of his supervisors and administrators. Klitzman concludes his story with pleas for more openness and flexibility in psychiatric education and for greater understanding of the relevance of social problems to psychiatry.

William Beatty