In a House of Dreams and Glass: Becoming a Psychiatrist

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.)