Disch's fiction tends to be controversial and The M.D. features most of his fiction's controversial traits: a dark vision unrelieved by a happy ending; a satirical humor that lances cherished American values; and the depiction of the basest human motivations. That the novel offends some people and not others could be a good way to draw group members into a discussion of the novel's merits.

An element to pay particularly close attention to is the novel's language; how does Disch's beautiful prose affect his unpleasant subject? Another important element is the sense of humor: Why does Disch invite one to see the ridiculous in dark subjects such as bullying, theft, incest, racism, mental illness, hereditary diseases, AIDS, mass murder, and spiritual evil?

1. On Wings of Song, The Businessman, and Disch's short fiction of the 1980s and 1990s have focused on spiritual matters, consistently speculating on...