Guests on Earth by Lee Smith

“The insane are always mere guests on earth, eternal strangers carrying around broken decalogues that they cannot read.”

-F. Scott Fitzgerald, in a letter to his daughter Scottie, c. December 15, 1940, epigraph in the book Guests on Earth

Evalina Toussaint's life started in New Orleans as the daughter of an exotic dancer. For a time, one of her mother's paramours takes the two into his home, much to the chagrin of his family. When she is thirteen, her mother commits suicide, and Evalina refuses to eat and so she is shipped off to Highland Mental Hospital in Ashville, North Carolina. She becomes the ward of Dr. Carroll, the famous director and chief psychiatrist of Highland, and is supported by money from her mother's lover's estate.

Highland Hospital Brochure, 1940

Smith uses Evalina's off-and-on stay at Highland during the years 1936-1948 as a way to tell the story of the hospital, the state of psychiatric care of the time, and the people and places of Appalachian North Carolina. Highland was founded in 1904 by Dr. Robert S. Carroll, who left the hospital when he sold it to Duke University in 1939. Per the brochure from 1940, treatments included occupational and recreational therapy, reeducation, as well as insulin and electric shock therapies. Introspection was discouraged, while participation in sports and the arts were mandatory.

Evalina lives at Highland from the ages of 13 to 25 except for the time she is in college and just after. By having her begin as a child in school and then returning as a young adult, Smith is able to describe the staff and clientele, the variety of treatments, and how the hospital changed after the departure of Dr. Carroll. Evalina becomes close friends with several staff and patients, and their stories are intermingled with hers.

One of those patients is Zelda Fitzgerald, and some book descriptions make it sound as if Zelda plays a larger role in the book than she does. Evalina is much closer to other patients, such as Dixie, a belle who has been sent to Highland for reeducation so that she can be a better mother and wife, or Jinx, an abuse victim deemed a "moral imbecile" who is sterilized. Later when Evalina is part staff, part patient, she also develops romantic relationships with some members of the staff.

In 1948, a real-life dormitory fire at Highland took the lives of 9 women, including Zelda Fitzgerald. Smith says that she used the book to provide a story to explain the unsolved mystery of how the fire began. The book turns out to be a series of stories of the city of Ashville and the hospital, using actual and fictional characters to describe a time in the history of psychiatry.

Evalina plays a central role in the first part of the book, and we are sympathetic to the chaos of her early life and the disruption caused by being committed to a psychiatric hospital far from her beloved New Orleans, but she becomes less lovable as an adult. Only postcards and letters tell the story of her life during college when she is away from Highland, making it clear that her narrative is just a thread to connect a series of vignettes about the hospital, the true main character. The epilog describing her life after leaving Highland is less than satisfactory, another example of how authors struggle with how to end books.

The 368-page book was a bit of a slog, but this may be due to my prior knowledge of the history of psychiatry and my familiarity with the hills of North Carolina. Someone would like this book if they were interested in a fictional coming-of-age story that is different than most. The references to Zelda Fitzgerald are interesting and based in fact, but the part she plays in the story is small, so this book wouldn't be for someone wanting a historical novel about Mrs. Fitzgerald.