A fictionalised chronicle of life in a real institution, Lee Smith’s Guests on Earth takes place during the 1930s and 1940s at Highland Mental Hospital in Asheville, North Carolina. In 1936, F. Scott Fitzgerald left his wife, Zelda there to be treated for schizophrenia (she is now thought to have been bipolar).

Orphaned at thirteen and inconvenient to her guardian, narrator Evalina Toussaint is committed to Highland Mental Hospital in the same year as Zelda. Like Nick Carraway in The Great Gatsby, Evalina is a resident and observer of a highly stylized world. She records daily life at Highland, including her interactions with Zelda as well as a parade of other inmates, “guests” who have been sent by families/guardians to the hospital to be restored to “normalcy”. Zelda seems to respond well enough to the progressive brand of “cultural” therapy on the menu at Highland. For those whose mania proved resistant to the horticulture, theatre, arts and crafts cure, electroshock, insulin shock and lobotomies were prescribed. Why these “guests” actually need therapy or what happens to them afterwards, Evalina doesn’t always know.

Guests on Earth reveals a little known world of post-Freud, pre-pill psychiatry, describing real attitudes towards mental illness and actual procedures considered ground-breaking during the 30s and 40s. In a letter to their daughter, Scottie, dated 1940, F. Scott Fitzgerald wrote:

The insane are always mere guests on earth, eternal strangers carrying around broken decalogues that they cannot read.

Author Lee Smith, whose own father and son were at different times inmates of Highland Hospital, asks the question: Aren’t we all guests on earth?

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