This novel's classification by its publisher as gay male fiction and literature appears to be a product of niche marketing. In reality, while the novel's main characters are indeed gay, the work, described as a fictional offbeat thriller, attempts to deal with the universal human condition of healthy and pathological relationships between family, friends, and lovers. The Concrete Sky is a wild and wacky ride through the darker side of human interaction, and it is well worth consideration by all mental health professionals.

The novel's protagonist, Chad Sobran, is falsely accused by his homophobic brother of trying to kill himself and finds himself hospitalized on a locked psychiatric unit for 72 hours' observation and then threatened with long-term commitment and guardianship. The author clearly captures the essence of the hospitalized person's perspective of involuntary hospitalization; Chad says, "How the hell did I end up in this place? But the most important question is, how the hell do I get myself out?" Eventually released, but not knowing whether he will face commitment at a future court hearing, he finds himself emotionally and intimately involved with a 17-year-old he met during his hospital stay. The two are then confronted with deceit, murder, and the death of almost every significant person in their lives. The reader wonders how Chad does not find himself legitimately back in the hospital where he started.

Despite the deaths and chaos swirling around him, the underlying theme of Chad's fear of commitment appears real and tracks well through the novel. The mental health aspects of the novel are convincing and free of many of the stereotypical behaviors and inaccuracies that have often plagued fiction and film. The mental health staff are portrayed in a realistic fashion, as is the hospital experience. As mental health professionals we frequently exercise our powers to commit individuals for their own protection and benefit. How often do we step back and consider the perspective of the individual? Chad expresses this idea succinctly: "I am not going to even pretend how to understand how the whole thing works; I think the system is designed to confuse people."

Chad's overall narrative voice can best be described as flip and cynical. In many ways this cynicism can easily be viewed as defensive, given the overwhelming traumas our main character faces. One would like to believe that the glimpses of compassion and caring we see reflect his true self. The author has been quoted as saying that the novel is about "having strange things happen in your life that you have no control over." Strange indeed. Chad has, in his own words, "fallen through the looking glass." He asks, "Why do we end up with lives like this? … How did this happen? … It's like it crept up on us when we weren't looking." The novel never answers these questions. Then again, how often can any of us?

Dr. Mitchell is affiliated with the department of psychiatry at the University of Massachusetts Medical School in Worcester.