What She Left Behind by Ellen Marie Wiseman

Seventeen year old Elizabeth Stone, Izzy, knows that in less than a year, she will be aged out of the foster care system and on her own. In 1995 she finds herself on the grounds of the now shuttered Willard State Asylum. Peg, her new foster mother, with whom she has gotten along well, has asked her to come to the old asylum to help safeguard anything that might be worth keeping before the old buildings are condemned.  Izzy’s own mother, Joyce, is locked up in a psychiatric center for having killed Izzy’s father, shot him in the head while sleeping, and this visit to Willard brings back memories of visiting her own mother before finally begging her grandmother not to take her back there again. Izzy lives in constant fear that she will somehow inherit her mother’s psychosis.

Izzy’s story is one half of this 2014 novel by Ellen Marie Wiseman, What She Left Behind. The other half is that of Clara Elizabeth Cartwright who in 1925 is eighteen years old when she is sent to an expensive and exclusive home for nervous invalids, because she refuses to marry the man her father has chosen for her, and threatens instead to run off with her Italian immigrant boyfriend.  Later, when her father’s fortunes turn for the worse in the depression, and he will no longer pay her fees for the expensive institution, she is sent instead to the state asylum. The story-line of the novel switches back and forth between Izzy and Clara, although the primary emphasis is on Clara and her attempts to escape her imprisonment in the asylum.

Although Wiseman makes it very clear that this is a novel, it relies heavily on the research Wiseman did including Women of the Asylum: Voices From Behind the Walls 1840—1945, and The Lives They Left Behind: Suitcases from a State Hospital, by Darby Penny and Peter Stastny.

This is a chilling tale to say the least. While Izzy struggles with yet another new beginning in foster care, her work at the asylum with her foster mother draws her more and more into the past and the treatment of patients, especially women, who lived and died in mental institutions. And it also causes her to rethink her own mother’s institutionalization and the events that led up to it.

Izzy wondered what horrors the hulking building had witnessed. What dreadful memories had attached themselves to the bricks and mortar and clouded glass forever part of the structure, mortared and sealed with blood and tears? Just as pain and anguish would always be part of who she was, the memories of thousands of tortured souls would live on in Chapin hall and the surrounding buildings of Willard State. How could this place ever be anything but a reminder of lives and loved ones lost?

Izzy comes to discover that nearly half of the fifty thousand patients at Willard died there. There are many times in the novel when I became angry with the author as she time and again holds out a hope to the reader that Clara will finally be able to convince one of the doctors that she is not sick, does not belong at Willard, only to dash that hope, and then raises the hope that perhaps her loving and dedicated boyfriend will find her and help her escape back into the world.

Clara discovers one woman at Willard who had been committed by her husband when he caught her kissing another man.

Clara remains rebellious, continues to insist to the doctors that she is not crazy, does not see visions or hear voices, and that they must release her. Instead her denials get her labeled as delusional and resistant to treatment, finally leading her to solitary confinement in the Rookie Pest House. That confinement serves to convince Clara of just how dangerous it is to resist or struggle. When she is released back into the general population, grateful not to be chained to a bed twenty-four hours a day, she becomes much more circumspect in her attempts to escape.

Izzy, who is relatively happy in her new foster relationship with Peg, stops cutting herself, and finds new ways  to deal with the bullying that occurs at her school. The asides on bullying by ‘mean girls’ is an intriguing story on its own, as is the slow unraveling of the story of just how her mother came to shoot her own husband as he slept. Izzy has always accepted the claim that her mother is simply insane, and she worries that her own cutting and acting out are early signs that she, too, will slip into insanity. I will leave this little side mystery to the reader to discover, since clearly it is Clara’s story that Wiseman most wants to tell.

In an afterward, when the author is asked what inspired her novel and how researching asylums made her feel, she replies:

It was difficult reading about people in the past being institutionalized, in many cases for the rest of their lives, because of emotional or economic distress. While some patients were truly ill, many were sent to asylums under circumstances we view differently today; poverty, homelessness, depression, homosexuality, alcoholism, and emotional distress due to divorce, family disputes, abusive relationships, and the loss of children. A person could be committed for something as simple as being unable to find work. 

Women were especially vulnerable to being institutionalized for the long term. Husbands could commit their “troublesome” wives, while male doctors were more than willing to oblige. Many women also worked as domestics and were in close contact with their employers; any bad behavior or dispute could be contrived as mental illness. By the end of its first year of operation, Willard housed four times as many women as men. In one case, a woman sent to Willard because of depression spent the remaining seventy-five years of her life there, until she died at the age of one hundred and one. Immigrants with few community connections were sometimes sent to asylums while their families in the old country had no idea where they were. Many “mad” patients were sent to public asylums from other state hospitals, arriving in groups of a hundred or more, crammed into trains and buses, unaware of where they were being taken. Nearly half of the 54,000 individuals who entered Willard died there.

Like many of the real life patients of Willard, Clara was submitted to forced sterilization, “a common practice in state mental hospitals from about 1910 to the end of WWII, when it was largely stopped because of embarrassing comparisons to Nazi policies.”

Quite apart from the social significance of this novel, the stories of Izzy and Clara are interesting and well told in themselves, although for this reader it will be the social commentary that sticks with me.