Guests on Earth by Lee Smith

4.0 out of 5 stars --  Fascinating and poignantly drawn picture of life and times at Highland Hospital in Asheville, North Carolina during the 1930s.,

Evalina Toussaint is thirteen when she is admitted to this hospital, known for its cutting edge treatment of the more wealthy mentally ill, after her mother -- the mistress of a rich lover -- dies in New Orleans.

Evalina experiences her coming of age in this lovely place under the tutelage of the well-known Dr. and Mrs. Carroll where she also meets the infamous and mercurial Zelda Fitzgerald who undergoes multiple treatments in the ensuing years. Evalina becomes a piano protege of Mrs. Carroll and it is her music that gives her strength, comforts and sustains her during many difficult times. Highland Hospital becomes her true home and its staff and patients her family as the years go by.

The novel is about one young woman's search for her own sanity, identity and independence as much as it is about life and mental illness during this time in history. Well researched historical details blend fact with fiction creating a story and memorable characters that I can't stop thinking about.

The focus of this well-written story is not on either Zelda Fitzgerald or the fire of 1948 that kills nine of the patients at Highland Hospital, but about the nature and cycle of mental health and the continuum of wellness. Some aspects of the treatment of those judged mentally ill may seem both bizarre and/or inhumane, and the accepted practices then no longer used (lobotomy, insulin shock, etc.) as more becomes known about what works or not. But, truly, as one character so aptly states about clinical depression, "Nobody understands it..."

I really liked this book and would highly recommend it to anyone interested in what life at an upscale mental institution in the 1930s might have been like. Keep in mind that if you are looking for biographical detail about Zelda Fitzgerald, this is not the book for you. She is an incidental and side character in this work as Evalina Toussaint is the fictional woman whose story is told within.

Thank you to NetGalley and Algonquin Books for the ebook ARC to review.