Kincaidian therapy involves depriving the patients of any exposure to representation of reality: nonabstract paintings, photographs, movies, and television are all banned. But Dr. Kincaid values literary work and asks our protagonist to "help the patients use language as a bulkhead against madness." Mike begins a class for the ten patients of the asylum, asking them to produce their own writings, which he then intends to be read by the patients and critiqued by him. He soon finds himself overwhelmed by hundreds and hundreds of pages of the patients "literary productions." Everything from entire treatises made up of anagrams to blow-by-blow accounts of soccer games to sadistic and sexualized material appears under his door. Each patient presented is a shallow caricature; few have redeeming characteristics, none have more than a hint of humanity, and all are portrayed with little understanding of the nature of mental illness and the pain, anguish, and torture from which such individuals suffer. The proprietors of this august establishment fare no better. Kincaid is a self-absorbed foolish buffoon, and Dr. Crow engages in regular sexual orgies with Mike—but only under the agreement that he will constantly bombard her with vulgarity, sexually explicit epithets, and play-by-play descriptions of the commingling. Believe it or not, the book goes even further downhill from there.