Doctor Salt by Gerard Donovan

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With three collections of poetry to his name, Irish-born Gerard Donovan made a successful foray into fiction with his first novel, Schopenhauer's Telescope, in 2003. A pared-down, sinisterly allegorical meditation on history and atrocity with obvious echoes of Kafka and Beckett, it was composed in the form of a dialogue between a guard and his prisoner - one digging a mass grave, the other supervising, in an unnamed European country torn by a cruel civil war. The novel was included on the longlist for the Booker prize and, back in Donovan's native Ireland, won a major literary prize.

Doctor Salt, his second work of fiction, is not so austere as his debut but is still, at times, uncompromising. Set in Salt Lake City, it documents gruellingly the mental disintegration of Salt, a young man who loses his father to cancer and his mother to suicide. It's told in a tricky, refractive style that relies on flashback and the use, apparently, of dual narrators. It becomes obvious, as the novel unfolds, that it depicts the fractured outlook of a paranoid schizophrenic whose reliance on anti-depressants has fatally influenced his world view.

The first half of the novel is narrated from the point of view of a character called Sunless who, it later becomes obvious, is Salt's schizophrenic alter-ego. Sunless, a classic paranoid who views the world as a vast conspiracy of surveillance and control, attends regular psychiatry sessions at the local medical institute, Pharmalak. Here, he comes under a strict drug regime administered by the hospital's somewhat dubious official, Martin Fargoon. There are many blackly comic moments in this opening section, not least the constant stream of entirely plausible adverts for drug therapy that bombard Sunless as he journeys to his appointment. "Have you ever experienced jealousy when others succeed?" asks one. "Oversensitive to comments made about your chosen career? Envious of your partner's career progress or social contacts? You may be suffering from Acute Envy Dysfunction."

Donovan is acutely aware of - and bracingly angry with - the language of modern psychiatry and its inexhaustible urge to medicalise every trait of human character. He is also particularly adept at satirising the whole economy of modern drug research and distribution. In a particularly effective scene, Sunless finds himself in the middle of a modern business conference dedicated to the launch of a new drug developed by Pharmalak. Here, in the spiritual home of Mormonism, Donovan implies that the ultimate aim of Fargoon - to create "a pill for every mood" - is nothing short of a new religion. It might promise utopia, he argues, but its aim, rather, is to integrate the variety of human personality entirely with the needs and demands of modern, consumer-driven capitalism.

The second half of the novel is a rather more conventional exploration of the biography of the tragic Salt/Sunless character that, sometimes rather remorselessly, tracks the fraying of his identity as he grows to maturity while his family falls apart around him. His father, a victim of what Donovan labels the ultimate killer disease (lack of health insurance), and his mother, who falls under the baleful influence of Fargoon and his endless prescriptions, reflect the true human cost of the social structure embodied by Pharmalak and its acolytes.

There are times when Doctor Salt burns with an almost old-fashioned sense of outrage at the everyday injustice experienced by its characters, but in the intelligence of its perceptions, the precision of its insights and the subtlety of its realisation, it proves itself to be wholly contemporary in its critique of Bush's America.