The titular “Great Man” in Kramer’s new book is a vainglorious, truth-twisting demagogue who seizes the US presidency by whipping his followers into a mob and subverting the democratic system.

The book is a work of fiction—the second for Kramer, a clinical professor emeritus of psychiatry and human behavior at Brown best known for his 1993 bestselling treatise on antidepressants, Listening to Prozac. As it happens, Kramer’s novel is not only a gripping story, but also a foray into the ethical tensions within psychiatry itself.

The story opens in a moment of crisis. The Great Man is found dead on the couch of Providence psychiatrist Henry Farber, the manner and perpetrator of death unknown. From here, the plot unspools in flashback: We see how the Great Man (who is loath to admit any weakness) comes under Henry’s therapeutic care, how Henry discovers the sordid inner workings of the Great Man’s hold on power, and how the Great Man’s malfeasance pushes Henry’s training to its limits. “To sit with the Great Man and attend to his wellbeing would be a virtuoso act of caring,” Kramer writes.

Ostensibly, the story is a classic whodunnit. But the real mystery lies in Henry’s relationship with the Great Man. How do you maintain curiosity and empathy toward a harmful person? Toward their allies? And just as importantly—in a crumbling society where people increasingly abandon their principles—should you?