Review: In a House of Dreams and Glass

This book is Klitzman's memoir of his time in residency, training as a psychiatrist. There are many memoirs of medical training in print, and this one does bear some similarities to the others, but there is plenty of original content too. Like most memoirs of residency, Klitzman's training brings into stark relief the inadequacies of the mental health system, and the inability of well-meaning practitioners to deliver the best medical care.

Some of the issues, dealing with insurance companies, nurses, and other doctors are shared across disciplines. But psychiatry presents a whole new set of issues, and Klitzman's treatment of these make this book well worth reading. While medical memoirs are full of tales of senior doctors mistreating students, the psychiatrists seemed to be using their students as experiments. Klitzman notes that residents were frequently treated like patients. Where Klitzman is at his most eloquent is in his discussion of the difficulties of treating the mind, rather than the body. Serving a patient population that does not necessarily want to get well, navigating disagreements about drug vs. behavioral therapy, these issues provide new challenges Klitzman had not faced in treating the body.

This is a well-written, passionate memoir. Much has changed in psychiatry in the fifteen years since this was published. Prozac was the new wonder drug when Klitzman was writing. This is still a book well-worth reading. The drugs may have changed, but many of the issues remain.

Robert Klitzman, In a House of Dreams and Glass: Becoming a Psychiatrist (Simon and Schuster, 1995) ISBN: 0671734504