It's safe to say that António Lobo Antunes's novel Knowledge of Hell won't get him invited to deliver the keynote speech at any psychoanalytic conferences. Much of his captivating book is a vicious screed against the profession: "Of all the doctors I have known, psychoanalysts, a congregation of lay priests with bible, rites, and the faithful, constitute the most sinister, the most ridiculous, the most unwholesome of the species." The irony here is that Lobo Antunes himself works as a psychiatrist in Lisbon when he's not writing the many novels for which he's received international acclaim (less so in the United States)—including, rumor has it, being short-listed for the Nobel Prize in literature.

Knowledge of Hell demonstrates Lobo Antunes's impressive techniques for upsetting boundaries between past and present, reality and phantasm. Similar to his previous novels, the book dexterously shifts between various characters, scenarios, and historical moments, resulting in a narrator—a thinly veiled autobiographical stand-in—divided into "I" and "him." Dissociation in both a clinical and stylistic sense is the dominant trope. Framed by a day-long solitary drive, the narrative consists of a series of encounters, flashbacks, and near-hallucinations revolving around the narrator's job in a mental hospital, his service in the early '70s as a medic during Portugal's colonial war in Angola, and sundry memories of childhood and prior relationships.

Hell isn't other people; it's what institutions do to people. Lobo Antunes oscillates between sympathetic and nasty, even brutish depictions of almost everyone in the book, himself included: "Asylums are nothing more than gardens of human cabbages, of miserable, grotesque, repugnant human beings watered with the fertilizer of injections." Committed readers will eventually come to smile at the perverse humor and compassion underlying such an unrelentingly dark view. This mood partially dissipates past midnight, near the end of his drive after stopping for a vodka, when the narrator begins to feel a sense of tenderness, especially around thoughts of his daughter, to whom the novel is addressed. Happiness may be overrated, but the future that children embody compels the most pessimistic vision to make a place for hope.