Samuel Shem

aka Stephen Bergman

author - the horrors of Professional medicine/psychiatry - theory (Model) is just an excuse to avoid actually connecting with a patient - lessons for Project Management

House Of God about hospital 1st-year residents - ISBN:0440133688 - Mount Misery ISBN:0449911187 - sequel, psychiatric residency

Fine ISBN:0440125103

Play Bill W And Dr Bob about AA

We Have To Talk ISBN:0465091148 about Men And Women

Interview I'm copying because the site is disappearing.

Interview with author Samuel Shem by Annette Sawyer

July 1997

More About The Book

"That was my job as a doctor. To use my experience with others who had suffered and my vision born of that experience to bring someone who is out on the edge of the so called "sick" into the current of the human. To take what is seen as foreign in a person and see it as native. This is healing. This is what the healing process is. This is what I signed up for, years ago. This is what Dr. Starbuck in Columbia did, taking care of the town, inviting me into medicine. This is what I had done moonlighting. This is what good doctors do. We are WITH people at crucial moments in their life, healing. How hard it had gotten, in these hellish hospitals and institutions encrusted with machines and desiccated hearts and dead souls, to get back to authentic healing. How much we have lost..." --Mount Misery pg.412

This summarizes not only Roy Basch's (the main character in Mount Misery) view of being a doctor, but also that of Samuel Shem. Both in conversation and in prose Sam Shem imparts his view of our medical and human culture with equal parts humor, thoughtfulness, and a critical eye to what in any system subtracts from our humanness, from our ability to be with and hear each other. To fully appreciate the richness of his thoughts and prose you need only to open the cover of Mount Misery. He captures both "how much we have lost" but also the promise in us all. The following are excerpts from an interview by Words Worth:

WW: Roy Basch's story began with your first book, The House Of God, which followed Roy through his medical Job Training. Why Mount Misery? Was Roy Basch's story unfinished for you?

Samuel Shem: Yes, and what I had come to realize is that I had started an "ark" and left it unfinished. I came to realize what the ark was: about this young guy in the American medical system who really wants to learn to be a doctor, how to doctor people. In The House of God he learned how to deal with people's bodies but during the course of the book he realized he wasn't learning what he came to believe was the most important thing: how to BE with people. That's a phrase I used several times in this book: "being with the patient". So at the end of the book he hasn't learned how to be with people really and like severalcharacters in the book (including 2 Irish cops) decides to become a psychiatrist. He takes a year off and comes back to start his training at this big mental hospital Mount Misery, which is also a BMS (best medical school) affiliate. What he learns this time around is not just to be a doctor, but to be a healer, and he realizes this is what he wanted to learn all along. He wanted to learn to be in good connection with people and did learn that treating physical disease, let alone medical illness, is dependent on good connections. I realized only after finishing the book that his journey is from a wish to be a doctor to a commitment to be a healer. And I think that is my journey as well. That general theme is autobiographical. That is what I've come to believe is important, and that is what I've tried to write in Mount Misery. Mount Misery, for all it's harshness - and it is harsh in terms of what is going on in psychiatry today - is mostly true. And for all it's harshness I think it is redemptive in the end.

There are two things I believe as a writer: one is that it is not enough to describe a vision of reality, it's also important to look at what is wrong. The second thing is to suggest what to do about to get through it. We've all had those moments when we've been doing something and we say hey, wait a minute, why am I doing this? What's going on here? Well, it's those hey wait a minute moments in medicine and psychiatry that have led to these two books. Now, as to what to do about it, I think you have to point out some ways of redemption for the character and the system and certainly I've tried to do that.

Mount Misery W W: Acknowledging that it is a novel, it's still pretty close to the nerve about current psychology, particularly in the big teaching hospitals. What's been the reaction in the Greater Boston Ma psychology/psychiatry community to your book?

Samuel Shem: Well, The House of God was very controversial when it came out, yet no one talked to me directly. I heard indirectly criticisms of the book by doctors and I was occasionally canceled as a speaker by various places, I was even canceled once by Beth Israel Hospital after being invited by the house staff. Imagine people thought The House of God was basedon Beth Israel!

Sort of the same thing's happening with Mount Misery. Nobody talks to me directly, any direct feedback I've gotten has been really terrific. People love this book and the most gratifying part of this response is that patients really love this really validates the experience of a lot of patients - people just doing ordinary therapy or people spending time in mental hospitals - they all have stories of weird encounters with psychiatrists.

There was a letter from the superchief of psychiatry at Harvard Medical School - it's not enough for Harvard to have just chief of psychiatry, they have a superchief, the chief of all the other chiefs - the superchief of psychiatry ..wrote a letter to the Globe and he basically said that this is all baloney and based on things that happened twenty years ago and various other nasty things about the book. So I wrote a reply which to my surprise they printed, which said that if he really thought this was twenty years out of date he ought to open his office door and walk down the street to Mc Lean where the patients are selling Mount Misery in their resource center, and ask them if it's twenty years out of date.

My feeling is that in both books, both The House of God and Mount Misery, the worst things are the truest. For instance at the beginning of Mount Misery, the director of residency training, who's an expert in suicide, kills himself and then the hospital denies it. Well, that happened in my first week of training as a psychiatrist - and they denied it.

It's important to say that Mount Misery is set in present time. Even though there's only a year between the books, there's this miracle where Roy doesn't age but the time is twenty years later. I've really made it current. It's interesting going around the country and talking about it. The themes that get the most response are drugs. You know, 10% of school children are getting Ritalin now, and 2 billion Prozacs being handed out last year, that kind of stuff. And then Managed Care - we haven't talked at all about managed care, but that's very current, and in psychiatry it's kind of farcical.

WW: And I was surprised to hear they haven't talked about sex with the therapist, since that's an issue that's really been hot, in this area anyway.

Samuel Shem: You know something, it's really interesting. Nobody really is very interested in that and I think it's a symptom of the denial about it. We've had an epidemic in this city of therapists who have been caught having sex with their patients. One of the reasons I've used that in the story is I feel very strongly about this issue and it's not a crime in this state. It's not a criminal act for a psychiatrist to have sex with a patient. It's a malpractice suit, a civil action. I think it should be a crime.

WW: Spirituality is also very much a part of your book, and it's clearly an approach of one of Roy's mentors. Spirituality and recovery is a theme in much of your work, including your play (Bill W And Dr Bob) about AA. Has this issue played a role in your life?

Samuel Shem: The House of God doesn't have much of a spiritual sense about it. There's a lot of substance abuse in The House of God, which was happening in those days. In Mount Misery Roy in fact does drink a lot, Malik is in fact in recovery as an alcoholic - and I do know a lot about that. For many years I treated alcoholics and other substance abusers. Especially out at Mc Lean, they had a really, really good four week, 30 day, inpatient unit called Appleton House there, that had a long history of treating alcoholics and more recently drug abusers. For some reason or other I got into that field and saw an awful lot of alcoholics and addicts. Some people close to me are also in the program. So I became very aware of the diseases of alcohol and also of the 12 step programs. I got to insist that no one come to see me unless they were meaningfully in a 12 step program. And then 10 years ago my wife and I were looking for a project to do together and found this story of Bill Wilson and Dr. Bob Smith and the founding of AA, and it was just an incredible American success story. We've been working on the play for 10 years and hopefully, it looks like, it will be offBroadway next fall or spring.

It's an historical play. It's mostly set in the thirties when these two guys met. And I'd never written an historical anything before, so that was tough, it was hard, and we wanted to be true to the history as well as be dramatic. It's been done - actually it was done a couple of times in Boston, the last time at the Hasty Pudding in Cambridge Ma, a full professional production. Then we took it out to San Diego and it ran during the 60th anniversary international convention of the founding of AA. There were a 100,000 alcoholics wandering around San Diego and a lot of them came to the play in its 4 week run. I don't know if this is blowing my own horn or not, but literally every night this play's been done anywhere, it gets a standing ovation.

Luckily I have one gift- I have lots of liabilities as a writer, but one of the gifts I have as a writer is I can write funny, I can make people laugh. I didn't really know that but I can. For years I was a playwright first. I really loved the theater and had plays done in New York off off Broadway, and I was at the Boston Shakespeare Company as the playwright in residence. So I've had lots of experience in theater. I've kind of given it up now. Too much psychopathology in theater I think. I get paid for it, I don't have to do it for free. But this is the last project, I'm very, very committed to seeing it through. We have a great director and great producer.

WW: I note that you reviewed Children's Books in the March New York Times. Does it change how you view your own reviews since you're a reviewer yourself?

Samuel Shem: Reviews are a very sensitive subject. I wish other people reviewed me the way I review other people. Because I really try to be as generous as possible. If I have negative things to say I don't really say them myself I let the author's words kind of hang him or her, you know. I quote something that's obviously just bad writing or out to lunch....I like doing reviews in a way. First of all you get paid to read, which is nice. But it always...well, look at John Updike, the review can be a very creative form to write in.

Reviews can make or break a book but The House of God - this should be an inspiration to anyone who wants to write - had the worst publishing history of any book ever published, I mean no ads, no reviews, no appearances. The New York Times was on strike so it didn't get reviewed there. It started to sell by word of mouth in hardcover and then all the books were destroyed by a flood in a warehouse in New Jersey. So there were no books. It had a terrible start - and it's sold over a million copies now. It's the number 7 best selling book in Germany - it's unbelievable.

WW: There are very few strong, positive and successful female role models in your book - excluding Berry. Are you making a statement concerning what the profession does to Women? I think particularly of that woman, Hannah, who was the fabulous cellist and just can't stay at Mount Misery.

Samuel Shem: Hannah... here's a woman who really, really wants to be a therapist. She's been analyzed. She loves helping people. She's rather a kind person. She's given up the cello to live her know, gone back to learn science and then medical school. But that kind of person...if that kind of person doesn't buy into the male model in the system - even today - they're not going to make it. They're going to be miserable. And so what you see in these systems, I think, is that women tend to drop out. Look in Mount Misery. There are two women who come to mind who are quite wonderful survivors if you will. One is Jill. And then there's this blind woman Geneva..but the point here..and it's a very important point, maybe the general point of all of this.. how do you heal people? You heal people by making good connections with them. Not by showing them how great you are. So, if that's true, who are the carriers in the culture of making good connections? Well they're women. Women are the ones who take care of relationships in this culture. We men, it's not that we can't, it's just that we're not valued for that. From early on. So that you have systems that are basically male created and male modelled systems. They're hierarchicalsystems; they're based on debate not dialogue; they're based on ego not connection. So in these systems someone who's looking for connection, compassion, mutuality, shared power, process - is going to be disappointed.

It's not just the women who these systems destroy, it's also men who are really interested in being good therapists and doctors. And frankly my experience is that it is a truly mediocre, conservative, ego-centered, man - almost all men in my training - who are now the professors of psychiatry in these systems. And the people who you'd really send your wife or mother or daughter or father or son to - they're not in these systems. They're (outside these systems) - day in, day out, doing good. So that I think it's important to note that it's not that people are bad, it's that systems really create a context in which it's hard to be good. It's very, very disappointing. That's the sad part of this. It's not just women. It's any caring person.

WW: Well, you hold a job, have a private practice and a family. When do you have the time to write?

Samuel Shem: I've had a kind of a weird course as a writer. I think I always wanted to be a writer but I was never encouraged and I failed the only writing course I took which was at Harvard. My teacher kept on handing back my papers and - this is no joke, this was my freshman year - with not a mark on them except at the bottom "see me". And I'd go and see her and she'd say "this is too terrible to mark, it's below F". Every time. So anyway, I've had a bad start.

I was lucky because I got a Rhodes scholarship and went to Oxford. And at that time..this was the turning point in terms of writing..I started to write when I was at Oxford...and the choice I faced was either to go back to medical school and be deferred, or go to Vietnam, or to be an expatriate which I didn't really want to be. So I went back to medical school. And the idea was that I'd go to medical school to earn my meal ticket.. because I didn't want to write for money. I wanted the freedom to write what I wanted. And I was good at medicine, I was good atscience, so it was pretty easy for me (at) medical school. And it just so happened that I discovered psychiatry at the end of my medical school. That's a perfect job for a writer because I never schedule patients until the afternoon. I would just religiously guard my mornings - I've done that to this day, for twenty years. There are some exceptions, but I would almost never answer the phone or see people in the mornings. This created some problems in my psychiatric training since they held rounds in the mornings and I wouldn't show that was a little bit of trouble. But after the training was over it was okay. I guard that.

WW: What is the future for Sam Shem. Is he going to write another?

Samuel Shem: Oh sure. I'm just coming up from under..I've really been burdened by three projects for quite a while, for years. And the three are - the play, it's had lots of rewrites and a sort of gradual road to New York, and that's done. And then Mount Misery is done. And then the third project - I notice we're three years overdue on - is this book on Men And Women. I don't know what it will be called. It's a non fiction book about using differences, about using male/female differences to create good connections, like in couples. That was a contract with Basic Books, but Basic Books has died now as of last month. So now I, thank god, will be with Harper Collins which is a good publisher. And so I'm very excited about that. We'll be done with that within the next couple of weeks.

So when that's done, my goal is I want to write a short novel. I want to write a short, simple novel. I want to write a novel, you know you read about them, that's 237 pages and it has 3 characters. That's what I want to write.

I think it's important for me now to write smaller, more often. But on the other hand I think you sort of learn what your talents are. And my talent seems to be to write more complex. My previous books are about psychiatry in one case, in the other case medicine. But now I've done that so I don't have to do thatanymore. I don't thing we'll see Roy Basch anymore....

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