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

What She Left Behind is a work of historical fiction by Ellen Marie Wiseman, originally published in 2014. The Huffington Post named it one of the Ten Best Books of Summer 2015, it was a Kindle Top 200 Bestseller for two years, and it sold over .5 million copies in North America. Wiseman’s debut novel was The Plum Tree, which came out in 2012, and she has written five other successful novels in the historical fiction genre.

What She Left Behind draws upon Wiseman’s experiences growing up in New York, where the novel is set, as well as the real-life discovery of suitcases at Willard State Psychiatric Hospital following the institution’s closure. In exploring the mystery of a 1920s Willard patient named Clara through the lens of a 1990s teenager, Izzy, Wiseman explores themes of Institutional Control of Women’s Bodies, Defining Female Autonomy as Mental Illness, and Intergenerational Trauma and Resilience.

This guide cites the 2014 Kensington Books paperback edition.

Content Warning: The source material and guide feature depictions of mental illness, gender discrimination, physical abuse, sexual violence, sexual harassment, child abuse, child sexual abuse, suicidal ideation, self-harm, bullying, ableism, graphic violence, substance use, emotional abuse, addiction, illness, antigay bias, and death.

Language Note: The novel includes some outdated terms related to mental illness, which this guide reproduces only in quoted material and names of institutions.

Plot Summary

The novel alternates between two narratives: Clara’s experiences from 1929 to 1946, and Izzy’s experiences in 1995. Izzy is a high school senior who went into foster care after her mother, Joyce, shot her father. Izzy’s current foster mother, a museum curator named Peg, asks Izzy to assist her with a project recovering suitcases of former patients at Willard Asylum, which is now closed. While doing so, Izzy discovers Clara’s suitcase, which contains a journal, photographs, and letters.

When Izzy isn’t helping Peg, she is bullied at school by a student named Shannon, who resents that Ethan, Shannon’s boyfriend, is kind to Izzy when she drops some papers. Ethan’s father, Peter, works with Peg on the Willard suitcase project and brings Ethan along. As a result, Izzy starts to develop an attraction to Ethan. Upset that Ethan and Izzy are working together, Shannon escalates her bullying, telling their classmates about Izzy’s mother, gluing menstrual products to Izzy’s locker, and cornering Izzy in a bathroom to threaten her.

When one student, Alex, stands up for Izzy, Shannon pretends to be sorry and invites Alex and Izzy to a beach party. There, a group of Shannon’s friends convinces Alex and Izzy to walk down the beach to Willard and break in late at night. Once inside, Josh and Dave, per Shannon’s plan, lock Izzy in Willard’s morgue vault. Alex doesn’t realize Izzy is missing until leaving the building, at which point Ethan and Alex return and release Izzy. Then, Ethan breaks up with Shannon in front of everyone at the party.

Izzy reads Clara’s journal and learns that she did not have a mental illness. Rather, Clara was a teenage flapper who upset her rich father, Henry, by falling in love with a lower-class Italian immigrant named Bruno. After Clara brought Bruno home for dinner, Henry imprisoned Clara in his mansion for several weeks, insisting that she marry the son of his business partner. When Clara, who was pregnant with Bruno’s child, refused, Henry called the police and claimed that Clara had a mental illness. They took her to the Long Island Home for Nervous Invalids, which was private and fancy. However, when Henry lost money in the depression, he moved Clara to a state institution: Willard. During the transfer, Clara learned that her letters to Bruno hadn’t been sent. A nurse named Yott put the old letters in Clara’s suitcase and sent one new letter to Bruno.

Soon, Henry convinced the staff at Willard that Clara imagined Bruno. Clara endured ice water baths and isolation, as well as physical, sexual, and medical abuse. After she gave birth, she was put in the infirmary for about four months. There, she received adequate meals so that she could feed her daughter, Beatrice, healthy breast milk. Eventually, however, a doctor named Roach took Clara’s daughter and raised her himself because his wife couldn’t conceive. Roach also renamed Beatrice “Susan.”

After Clara resisted losing her daughter, she was placed in a section of the institution called the Rookie Pest House. There, she was chained to her bed and forced to take laudanum. When Clara returned to the main ward, she learned that Bruno had obtained a carpentry job at Willard and was looking for her. However, when Roach realized their connection, he admitted Bruno as a patient against his will. Meanwhile, Clara was given insulin therapy, injected with insulin until she entered a coma for two months.

When Clara and Bruno saw each other again at a Valentine’s Day party, Bruno shared a plan for escape. Lawrence, the hospital gravedigger, would smuggle Clara out in a coffin. Bruno and Clara would then take a rowboat onto Seneca Lake. However, the plan ultimately failed disastrously; orderlies intercepted them, and both Bruno and Lawrence died in the lake. After Clara was caught, she was put in isolation for 10 months. She remained in Willard until 1946, when she was about to receive electroshock therapy. Right before this could happen, Willard flooded. With the help of a nurse named Trench, Clara narrowly escaped.

After reading Clara’s journal, Izzy learns that her imprisoned mother had a stroke and is in a coma. Izzy visits Joyce in Bedford State Prison’s infirmary, where she tells Joyce that she loves and forgives her before Joyce dies. Afterward, Izzy finally reads all the letters Joyce sent her from prison, which she previously feared opening. The letters reveal a truth that Izzy has been repressing: Her father molested her when she was only seven years old. This is why Joyce killed him.

Izzy and Peg track down Nurse Trench, who helps them locate Clara’s daughter, Susan. Susan meets with Izzy and Peg in a diner, and Izzy gives Susan Clara’s journal and photographs. Then, Izzy, Peg, and Susan all visit Clara in her nursing home. Susan invites Clara to live with her, and Clara happily accepts. On Izzy’s 18th birthday, Peg and her husband, Harry, offer to adopt Izzy, and Izzy joyfully agrees. The novel ends with Peg, Harry, Clara, Susan, Ethan, and Alex celebrating Izzy’s birthday.