What She Left Behind: A Haunting and Heartbreaking Story of 1920s Historical Fiction

In What She Left Behind, Wiseman focuses on an institution called Willard Asylum for the Chronic Insane and, later, Willard Psychiatric State Hospital. This was a real place, named for New York’s Surgeon General Dr. Sylvester D. Willard, on New York’s Seneca Lake. Established in 1865 and opened in 1869, Willard came into being a few years after New York’s very first asylum, Utica, was established in 1850. State-run asylums were largely the result of social reformer Dorothea Dix’s advocacy. At the time, those with mental illnesses were often subject to abuse by prisons or private contractors. Dix documented this mistreatment and worked with state legislatures in the hopes of creating better facilities.

For a number of years, Willard was the largest facility of its kind in the state, with almost 3,000 patients on 929 acres. As Wiseman notes in her novel, Willard’s first patient, Mary Rote, arrived by boat. Other narrative details are similarly true to life, including the cemetery with unmarked graves and the practice of having patients work on the grounds to grow and cook food, as well as sew and launder clothes. Wiseman’s portrayal of the modern-day investigation into Willard is also broadly accurate. In the 1990s, when Willard closed, patients’ suitcases were discovered on the property and photographed by Jon Crispin, fictionalized in Wiseman’s novel as Peter. Wiseman notes in her acknowledgements that she relied heavily on the nonfiction book The Lives They Left Behind and spoke with its author, Darby Penney.

Although asylums were conceived of as humanitarian projects, in practice, they often replicated the abuse they were meant to remedy while reinforcing societal prejudices around class, gender, disability, etc. Wiseman’s novel highlights how the abusive psychiatric practices of the 19th century bled over into the 20th century, disproportionately affecting women. In the Victorian Era, women’s behavior and physiology were often pathologized. “Hysteria” was a particularly common diagnosis. Described in antiquity as a condition where the womb supposedly wandered through the body, hysteria retained its association with female sexuality even after the development of more “scientific” theories. Changes or disorders related to menstruation could indicate or cause mental illness, according to such theories, as could both lack of sex and too much sex. More broadly, deviation from gender norms that dictated that women should be submissive, delicate, and maternal could be grounds for commitment; one woman in a 19th-century hospital recorded that a fellow patient had been committed simply for reading novels (Moore, Kate. “Declared Insane for Speaking Up: The Dark American History of Silencing Women Through Psychiatry.” Time Magazine, 22 Jun. 2021).

The treatments that Wiseman includes in her novel are based on real-life, outdated psychiatric practices, though not all of them were practiced within the 1929-1946 time frame of Clara’s narrative. These include forced sterilization, which occurred regularly in mental institutions between 1910 and WWII, insulin coma therapy, ice water baths, and electroshock therapy (which is still used in certain cases, but with guardrails that were not present in the early 20th century). Poor and working-class patients were particularly vulnerable to this kind of medical abuse, which primarily occurred in state-run facilities. Private institutions like the Long Island Home for Nervous Invalids, where Clara is first housed, were historically much kinder to their patients and sought to create a calm, homey environment. Socioeconomic class thus often determined how well a person hospitalized (rightly or wrongly) for mental illness was treated.