This well researched historical novel examines asylum care in the 19th century. The central character, Hannah, is admitted with nymphomania, and Dudman’s first-person narration allows access to Hannah’s confused and frightened inner landscape.  A range of other characters demonstrate illnesses that now have very different clinical formulations – or indeed are not seen as pathological at all – such as General Paralysis of the Insane, Mutism and gender identity disorders.  Dudman also documents a range of early treatments with detailed historical accuracy, including wet packs and early ECT.

5 - "My name.  Cried out. Far away.  Somewhere I can’t reach.  Behind invisible veils that are clinging so tightly to me it is as if they have grown there”

11 – “She has signs of green sickness, that is all, perhaps a little melancholia.  Sometimes the doctor who is recommending the admission exaggerates his case just to ensure its proper consideration by the council.  Maybe Hannah’s physician felt compelled to shout this case more loudly than usual because the town asylum rarely admitted Israelites”

50 – “The number of mad is growing, they say, and tease each other to provide reasons.  Urbanisation causes anxiety, say the town doctors, looking up from their council statistics; people are forced to live in unhealthy, polluted air.  They become tense and withdrawn, their nerves crackle and then disintegrate.  But the conditions in the countryside are no better, retort their rural companions.  There is as much poverty here as there is in the town and it is getting worse.  The strain doesn’t take long to show.  Madness is everywhere, and always has been.  It used to be hidden away in the backs of houses.  It used to be chained down in stables and sheds.  It used to be caged in baskets hired out from the town council and placed in living spaces of their slightly saner relatives.  It used to be confused with poverty and criminality and dwelt in filth and terror in prisons and poorhouses.  On rare occasions it has been revered as holiness, its victims deified or vilified as possessed.  The mad were either visionaries or the familiars of Satan, supremely blessed or adamantly damned.”