Can a person really change? For good?

Can people leave the past behind and completely remake themselves?

How strong are the bonds of friendship? How far can they be tested before they snap?

Where does caution end and paranoia begin?

These are some of the questions Mark Rubinstein asks in his novel Mad Dog House, just published by Thunder Lake Press and distributed by Enfield Books.

It is the story of Roddy Dolan, a Brooklyn juvenile delinquent who catches a lucky break and manages to rise above his inauspicious beginnings to become a successful surgeon, husband and father. He maintains a lifelong friendship with his Irish schoolmate Danny Burns, and the two are living the good life in Westchester County. Nice families, nice homes, nice incomes. Until it all starts to unravel.

Then, Roddy — who was known as Mad Dog in his younger days — must make some hard decisions about how to get his life back on track, and how far into his past he has to reach to get it there.

"Everybody wants to be told a story," Dr. Rubinstein, a practicing psychiatrist, said of his desire to write a novel. This is his sixth book but his first published work of fiction. The others were all nonfiction and had medical themes.

Of writing, he said, "you draw on who you know. ... All the characters come from inside me, who I am, who I'm not, who I'd like to be."

Dr. Rubinstein certainly has a lot in common with his main character. Both grew up in Brooklyn and both knew some shady characters, but Dr. Rubinstein never crossed over to the wrong side of the law.

Both found military service to have a significant impact on their lives. For both Dr. Rubinstein and Roddy it is what drove them to careers in medicine.

Dr. Rubinstein had a business degree before he was called up and sent to Fort Bragg, where he was attached to the 82nd Airborne. He spent his hitch stateside, and as a field paramedic was trained in field surgery where he "stitched people up."

When he got out, he went to medical school, where he was exposed to psychiatry. While he found surgery was exciting, "an adrenaline rush," in psychiatry "people would tell you stories," he said.

That he found infinitely more interesting than removing gall bladders or repairing hernias.

"In psychiatry it's an endless array," he said. "We're all different but we're all somewhat the same. We all go through similar things but we all have stories to tell."

Dr. Rubinstein's method of storytelling is not as research-intensive as that of some writers.

"I drew up a little bit of an outline" before writing, he said, and he did as little research as possible, preferring to let his imagination take over.

"I may have an idea where I'm going, but no idea how I'm going to get there," he said.

"It's like dealing with patients, because you never know what a patient's going to say."

The characters in Dr. Rubinstein's book say plenty. They talk about their lives, past and present, their hopes, their fears, their ambitions.

Roddy and Danny have worked hard to take themselves from having virtually nothing to being very well off. Their lives are successful but staid. They consider adding a little glitz by becoming silent partners in a Manhattan restaurant with another denizen of the "old neighborhood," who also apparently has turned his life around. Things start out well, but then go south when a menace named Grange enters the picture and the two friends find themselves in a jam.

The rest of the novel is a measure of Roddy's inner strength to "do what needs to be done" to hold their lives together. In the following excerpt, Roddy reviews his choices.

"He's decided what to do. It's chancy, even dangerous, but there's no risk-free choice. They're in a swamp of danger, worse than anything he encountered at Fort Jackson or Fort Bragg in the Carolinas. But he knows something must be done. Because one thing's certain: we're all creatures of habit, he thinks. In a sense, we're all the same, yet a bit different, too. And that goes for Grange. Once we find a melody we like, we keep dancing to it, again and again. Habits and patterns tell the story. Therein lies the solution to Grange. Character defines us. It's a way of being."

"As a novelist and a psychiatrist, when we talk about change, we're not talking about deep, profound change," Dr. Rubinstein said. Using a geometric analogy, he said, "If you can change by four degrees, you've done a great deal.

"Freud called it the repetition compulsion," he continued. "You go back to it because you love it or it's the only thing you know."

Three-year process

The first draft of Mad Dog House took Dr. Rubinstein six to seven months, but he turned out seven or eight drafts and then let it sit for a while. It took nearly three years to fully complete. During that time he took a break and began writing two other books. His next title is Love Gone Mad, with all new characters.

"A 40-year-old surgeon falls in love with a divorced, beautiful nurse and he has no idea of the scorpion's nest he's walked into," Dr. Rubinstein said.

Dr. Rubinstein is a general adult psychiatrist who, for 25 years, has also worked as a forensic psychiatrist, which deals with psychiatry as it applies to the law.

He and his wife, Linda, have lived in Wilton 28 years, first using their home here as a weekend getaway until finally moving here full-time. Dr. Rubinstein maintained an office in Manhattan, which he eventually closed last December. He now sees patients in his office on Danbury Road.

He will give a talk — Psychiatry, Fantasy and Fiction — Monday, Dec. 3, from 6 to 7 at Wilton Library. He will donate $5 from the sale of each of his books that evening to PAWS no-kill animal shelter in Norwalk, and 20% of each book sale will benefit the library.

For information about his talk, visit wiltonlibrary.org.

For information about the book, which may be purchased on amazon.com, visit thunderlakepress.com.