Will Self is no friend of the psychiatric establishment. He paints psychiatrists as flawed, power crazed narcissists whose only mission in life is to use patients as guinea pigs for crazy treatment experiments. The sole aim of these experiments is to advance the fame of the psychiatrist among his equally crazy peers.

One of these caricatures is Zack Busner, a Jewish psychiatrist who dreams up various experiments such as the Concept House (where patients and therapists live together in a communal home and treat each other) or The Riddle (a puzzle of four square slabs marketed as an “enquire within” tool). These experiments enable him to appear on celebrity game shows and to buy a substantial detached house in Hampstead, but are of no benefit to patients. Dr Busner has previously appeared in “Ward 9” and “The Quantity Theory of Insanity,” two other fictional pieces by the author, and he makes a triumphant comeback here.

This time, Busner is pitted against Dr Shiva Mukti, a Hindu psychiatrist working at St Mungo's, an archetypal inner London hospital. Each tries to outdo the other by referring patients for second opinions. The rivalry is not just one of professional prestige—it has more sinister overtones, and there can ultimately be only one winner.

Despite the author's bias against psychiatry, he paints a strikingly accurate picture of the job of an inner city consultant, the “shrink of all trades,” whose sole function is to treat “schizophrenics” with medication and to forget about the more unusual psychiatric disorders. He describes wonderfully the death of idealism and innovation accompanied by the birth of honest resignation a few years into a new consultant's job, with all arguments about extra funding at departmental meetings falling on deaf ears.

Also, Self's description of Dr Shiva Mukti as a “psychiatrist of modest achievements but vaulting ambition” would ring true for a large number of ethnic minority doctors who enter the NHS with huge expectations. Most resign themselves in the end to routine jobs devoid of prestige or innovation to fit into the rigid NHS jigsaw. Dr Mukti's paranoid interpretation of Dr Busner's success being linked to his “sympathetic friends in very high places” would resonate well for some of these doctors. There is also a tongue-in-cheek description of private psychoanalysis, an area of psychiatry increasingly marginalised in the brave new NHS of evidence based medicine.

There are four other “tales of woe” in the book. In the last short story, “Return to the Planet of the Humans,” the author returns to mental health, portraying the psychotic breakdown of a painter and the help (or lack of it) that he receives from psychiatric services, another casualty of Busner. Surprise, surprise.

This book should appeal to those with a taste for sharp satire offering an alternative view of psychiatric practice.