Shooting the Heart is an engrossing book about a man tormented by the fear that he may have murdered the love of his life. Earl Madden, once a teacher at a private high school, is now on a locked unit of a state psychiatric hospital in Boston. The reader moves back and forth in time with Earl as he recalls his past while trying to make sense of the present. What are the circumstances that led him to this confined unit and the loss of his wife? Did he kill her? Did he drive her away with his obsession with death, serial killers, and the sordid aspects of life? Author Paul Cody draws us into Earl's struggle as he tries to piece together his past.

Through his recollections we learn of Earl's decompensation, insomnia, isolation, and self-injurious behavior. On the ward he remains confused and tortured by his thoughts. He recalls a time of happiness and normalcy: his courtship, marriage, and teaching career. How did it fall apart? He inhabits a world of voices, restlessness, and obsessions with serial killers. Did this drive his wife away, or did he murder her? Regardless of what led to his loss, he is ridden with guilt.

Reason, logic, organized thoughts, and orientation to time, place, and person do not come easily to Earl. The author allows us to glimpse Earl's frustration and weakness as he struggles to grasp reality, getting no closer to what happened to him in the past. During sleepless nights, Earl finds only slight transient comfort in the injectable medications that are available to him from the nursing staff. Mostly, he is overwhelmed by intricate delusions, a fragmented past, and memories of an unstable childhood.

Without a conclusive plot, the reader remains perplexed as to the acute precipitants to Earl's hospitalization and loss of his wife. Earl's confusion is echoed in the reader, who also is unable to make sense of Earl's life.

Nevertheless, Shooting the Heart has general reader appeal and will be of particular interest to mental health care professionals as it poignantly presents insights about suffering, confusion, and vulnerability. Cody delivers a compassionate and vivid portrayal of one chronic psychiatric patient and his struggle. As we glimpse Earl's suffering, we are puzzled and moved by this mesmerizing tale of love, psychosis, self-injury, and the need for forgiveness.

Dr. Byatt is a psychiatry resident at the University of Massachusetts Medical School in Worcester.