In W-3, the psychiatric ward of a sprawling university hospital in an American city that is quite possibly Chicago, everyone looks the same, which is to say: peculiar. So many varieties of strangeness! Frankie, famed for having ripped out a lavatory bowl with her bare hands, wears a shiny black wig that sits “crooked like a roosting wing” over her eyes. Zelma, who arrived with seven pieces of matching luggage, two wigs plus stands (hair, as you will have gathered, is something of an obsession on the ward) and a collection of hardback pharmacopeias, appears at dinner in full evening dress, complete with silk opera gloves. Trudy, meanwhile, is meant to be in isolation but keeps reappearing “like a cuckoo”, perambulating the corridors “lashed to her intravenous stand – bandages, pyjama strings loosened and streaming – looking like a sort of injured parade float”.
As characters go, these three should be indelible, their sartorial and other eccentricities pinning themselves to the mind like Polaroids on a wall. Something about them, though, fails to stick. They are, in a way that’s difficult to describe precisely, interchangeable: a collection of roaming afflictions whose roots may be less particular than those charged with healing them realise. “Histories like mine, of long, debilitating illness, vague recurrent symptoms, hospitalisations, were common enough on W-3,” notes the narrator of the book in which they appear. “These things go together.”
Talking cures are encouraged on the ward, but for her, the limited power of such therapy lies not with discovery – with cause and effect – but with a kind of extinguishing tedium. “It is not strictly accurate to say that these interviews were of no use to us,” she writes of the conversations patients are invited to have with terrified medical students under the supervision of the ward’s psychiatrists. “Because you would have to tell your story yet once more, all over again. And each retelling, each repetition, hastened the time when you would get tired of it, bored with it, done with it – let go of it, drop it forever – could float away and be free.”
In the early 70s, it was not beholden on a writer to tip-toe around the subject of mental illness
W-3, Bette Howland’s memoir of her stay in a psychiatric hospital following an overdose, was first published in 1974, and comes to us now following the reissue, last year, of her 1978 collection of stories, Blue in Chicago. Both, as you may already know, are back in print thanks to the determination of Brigid Hughes, the editor of the literary magazine A Public Space. In 2015, Hughes found a copy of W-3 in a secondhand bookshop in New York and, having recognised Howland, by now living in a home and suffering from Alzheimer’s disease, as a forgotten talent, resolved to give her a second life (Howland died just two years later). Blue in Chicago, in which the city, cruel and slum-scarred, is effectively put on trial in a series of autobiographical sketches, was widely praised both here and in the US, and rightly so, though I think it’s also fair to say that its author’s backstory may have played some part in people’s intense admiration for her lapidary prose and feeling for human battlegrounds. A working-class, Jewish, single parent, Howland was a lover and protege of Saul Bellow, who confessed himself moved by the “tough-minded” W-3. But having published it, Blue in Chicago and one further book of short fiction, and having received a MacArthur “genius” fellowship for her trouble, she disappeared into obscurity, seemingly unable to write. People tend, for obvious reasons, to overpraise “lost” writers. Dusting down the old involves a form of passionate justification that unveiling the new does not.
W-3 is a debut and, as debuts go, it’s very fine, at moments dazzlingly and daringly written. In the early 70s, it was not beholden on a writer to tip-toe around the subject of mental illness, to worry about terminology or stereotyping; it is a ruthlessly straightforward, almost impudent book and all the better and wiser for it. Its author captures quite brilliantly the comical competitiveness of her fellow patients – who’s the maddest here? they ask, each one hoping to claim victory, their insistent ambition reaching its zenith when the prospect of sanity starts to feel, for some of them, like a kind of failure – and she is excellent, too, at delineating what we might call the secret life of the institution. The patients exist for the hospital’s sake, rather than the other way around. It is “as mysterious as a submarine”, unseen forces always at work, irrespective of what the doctors do or fail to do.
But Howland’s technique in this memoir is to stare at others, not herself; her breakdown and its causes (men, money, something horrible that happened when she was a child) are touched on only intermittently and always at an angle. In the main, she is painfully absent from the text, an omnipotent narrator who also seems to be standing with one leg on either side of a gaping void. W-3 is more or less shapeless, its tone unvarying, the camera permanently fixed at the same distance from the action, its end oddly peremptory. While this may be an important part of the book’s design – its relentlessness mirrors both her illness and the unpunctuated days of hospital life – it’s also utterly exhausting. W-3 is not a locked ward, but the reader, held prisoner too long, leaves it with an overwhelming sense of relief.
• W-3: A Memoir by Bette Howland is published by Picador (£14.99). To support the Guardian order your copy at guardianbookshop.com. Delivery charges may apply