We talk about psychological novels without expecting their authors to have any particular expertise in psychology. Novelists go on instinct, we understand. Henry James described a “sublime confidence” that allowed him to write about the inner lives of others, and we ask no more — and often less — of contemporary authors.

What, then, to make of a psychological novel written by a practicing psychiatrist? António Lobo Antunes, who has been in residence at Lisbon’s Hospital Miguel Bombarda since the 1970s, is no mere dilettante: Until 1998, when José Saramago collected what will probably be Portugal’s only Nobel Prize in literature for a generation, Mr. Antunes was widely considered a favorite for that prize. The author of some 20 novels, eight of which have now been translated into English, Mr. Antunes differs sharply in style from Mr. Saramago. Where the Nobel Prize winner writes universal allegories in polished, sometimes pale, prose, Mr. Antunes prefers a dense, distinctly Portuguese style, full of mnemonic crosscuts and unstinting imagery.

His attitude toward Portugal is one of wry disgust — he devoted one novel, “The Return of the Caravels” (1988), to the notion that the national heroes from the days of Prince Henry the Navigator might someday return, only to find a squalid harbor town, rather than the great nation they thought they had founded. In Portuguese literature, this attitude — not of keen regret, but of weary self-loathing — is at least as old as Eça de Queiros, the great 19th-century novelist. To this tradition, Mr. Antunes adds his own wretched experience as a medic in Angola during the Portuguese Colonial War (1961–74).

The belatedly translated “Knowledge of Hell” (Dalkey Archive Press, 312 pages, $13.95), from 1983, in many ways an autobiographical novel, draws heavily on Mr. Antunes’s memories of Angola — but the titular inferno lies elsewhere. “In 1973, I had come back from the war and knew about injuries, about the cries of pain on the trail, about explosions [. . .] knew about spilled blood and longing, but I had been spared the knowledge of Hell.”

Even a futile, unjust war cannot compare to what came next: life as a psychiatrist. Mr. Antunes’s narrator, himself called Antunes, is for much of the novel driving his car back to Lisbon after a weekend’s restless holiday in the Algarve, on Portugal’s southern coast. But his distaste for the Algarve’s “cardboard” sea and “sawdust sand” is child’s play compared to his hatred of what awaits him on Monday morning: “Hell, he thought, is psychiatric treatises, hell is the invention of insanity by doctors, hell is this stupidity of pills, this inability to love.” He sees psychiatrists as “rich clowns tyrannizing the poor clowns,” and recalls that at one point in his medical training he believed he was in Auschwitz, positing the doctors as jailers, and the patients as prisoners. He finally criticizes his fellow doctors as he might criticize his fellow novelists, calling them “the labelers of other people’s feelings: he’s obsessive, phobic, phallic, immature, psychopathic: they classify, stamp, pry, rummage, they don’t understand, they get nervous because they don’t understand.”

As a novelist, Mr. Antunes is often applauded for his psychological acuity, and his heavy use of stream of consciousness is indeed accomplished. But this only reminds us that many literary terms, while still descriptive, have lost some of their original purchase. Stream-of-consciousness writing, to the contemporary practitioner, is largely a kind of liberty — to switch subjects as abruptly as a distracted mind might. Few would argue that it sincerely attempts to embody consciousness itself. The fruit of Mr. Antunes’s obsessive engagement with psychopathology must be sought elsewhere.

Most scenes in “Knowledge of Hell” operate on at least three levels: the Algarve vacation, the war in Angola, and the dreaded hospital where Antunes works. These levels merge — not only psychologically, but visually — in a kind of ongoing hallucination. While Antunes is driving near the region of Messines, “The orderly stuck his head through the opening of the door in the glare of Messines, brushed aside a cloud that clung to his brow,” and began to speak. At first, this cartoonishly jumbled consciousness seems like a novelist’s fancy footwork, of a piece with Mr. Antunes’s mock-poetic taste in imagery: writing of, for example, “the turbid glare of the humid mist, in which the sun rose dampened by the juice of the fog like a crushed orange.”

But finally, in the long haul of Mr. Antunes’s demanding and effectively overwritten screed, we realize that his narrator is hallucinating, flopping from one memory to the other with such radical accompanying sensory disorientation for the sheer bitter irony of it. To go a little crazy: It’s his ultimate rebellion against psychiatry — or at least it’s his weekend release. Typically Portuguese, perhaps, the literary art of Mr. Antunes turns his point-blank negativity into a refined, self-consuming protest: the psychological novel that can’t believe in itself.

blytal@nysun.com