A psychiatrist’s unorthodox methods shake up a New England mental hospital in Gregg’s lightly supernatural novel.

Dr. Patrick Denny returns to psychiatry after a successful writing career. He accepts a position at the Everston Psychiatric Hospital in Waylingbrooke, New Hampshire, and quickly turns heads—most noticeably, Patrick favors keeping patients off, or taking them off, of meds, which he believes render them “brain-dead zombie[s].” In the case of 19-year-old Samantha Perez, who’s wracked with guilt over the deaths of her long-ailing parents, Patrick gives her a 19th-century diary to read. Sam has no inkling as to how this diary will prove more effective than prescribed drugs, but it does help her overcome her guilt, as well as her insomnia, in an unexpected way. Patrick’s treatments encourage patients to face what’s troubling them, resulting in dreamlike scenes that may be all in their heads, although Patrick seems to be in them, too. Sadly, the shrink faces quite a bit of resistance. Patrick wishes to see Michael McKay, who experiences a psychotic break after claiming he’s “trapped the monster” (inspired by Patrick’s 15-year-old book The Monster), but Michael’s great aunt and legal guardian doesn’t want Patrick anywhere near her nephew. Patrick has his own personal problems to contend with; some are psychological, like the recurring dream of a cackling “old crone” threatening an expectant mother. Then there are his more commonplace miseries, such as his ex-literary agent turned not-especially-faithful girlfriend, Helen Olssen, whose latest agenda doesn’t mesh with Patrick’s.

Gregg’s story, which is intended to launch a Patrick-centric series, contains a handful of surreal moments, like Sam being “tethered” to someone with a “dreamlike cord” and Michael revisiting his past by living a scene from Patrick’s novel. Interspersed between these are signs of a more relatable Patrick as he argues with a pompous colleague from Everston or ducks into his seat at a concert while trying to avoid someone. Despite its wildly varying components, this novel is surprisingly cohesive, thanks in large part to the author’s deliberate pacing and unambiguous transitions. For example, excerpts from the old diary guide readers into the otherworldly place that Sam finds herself in, and the author makes it clear what’s happening on similar excursions (“he floated deeper and deeper into the nothingness”). The action at the hospital further grounds the narrative, as do the lively patients, including Sam and Mike; Ray Scarlatti, who’s long held a fear of death; and the complicated case of Amelia Dearborne, who has suffered violent outbursts since she was a teenager decades ago. Gregg lightly touches on the supernatural, as it’s a possible explanation for the more fantastical sequences, and rounds out the story with a probable homicide in the latter half. Many of these subplots and characters come together in an illuminating final act as Patrick resolves one of the psychiatric cases. Of course, this opening installment still leaves plenty unexplained avenues for him to explore later.

A mystifying but endlessly absorbing tale blending surreality and issues of mental health.