This is a potentially fascinating account of life in a Scottish intensive psychiatric care unit. The author was an English teacher for many years before leaving to work as a psychiatric orderly. He worked in the Locked Ward for over 7 years. The problem is that ‘the people [in the book] are fictions’, as are the staff, so this is not strictly a memoir. This detracts from the authenticity of O’Donnell's descriptions: he might have been better writing a work of fiction based on his experiences.

The book is mainly an account of the various (fictitious) patients admitted. O’Donnell punctuates the descriptions of individual cases with brief explanations of psychiatric disorders, their consequences and medication used. These are written in a much plainer style than the rest of the book, and sit slightly oddly. Most are fairly clear for a non-professional to read, although there are a few aspects that grate, such as referring to antidepressants as ‘uppers’. He also describes the symptoms and treatment (electroconvulsive therapy) of a young man with a significant depressive disorder; this man responds well to treatment, but is then said to be selfish, unpleasant and unpopular. Given the author's lack of expertise in psychiatry, this seems rather a dubious judgement to make of someone who is still an in-patient; perhaps not unreasonable to acknowledge that genuine psychiatric illness does not preclude an offensive personality, but inappropriate.

O’Donnell does maintain a sense of humour throughout – ‘Devout coward slain by madman’ is an imagined headline. By his own admission, he gets on well with patients, but at times this does come across as patronising, perhaps partly due to his rather florid style, using local dialect but throwing in rather over-the-top descriptions and quotations. The most authentic passages are the plainer descriptions of everyday life on the ward and the difficulties experienced. Ultimately, this book is certainly interesting, but seems to be more about the writing than the content, and comes across as only patchily convincing.