Those searching for an easy read might best avoid Sara Stridsberg’s Beckomberga, a fictionalized quasi-history of the eponymous Swedish mental hospital once hailed as the future of psychiatric care. It is a confusing, disjointed, sad, frustrating story told from multiple points of view. However, it’s also a haunting study of how everybody involved in mental-health care — from medical providers to patients to the institutions themselves — continually fails (or is failed by) one another.

The real-life Beckomberga Hospital (which operated from 1935-1995) was one of the largest psychiatric facilities in Europe, housing 1,600 patients and approximately 800 staff. The most straightforward portions of the novel are those describing the goals of this grand institution of healing and how the physical structure itself mirrors those goals. The author’s emphasis on the buildings’ symmetry, its classical architecture, and its perfectly manicured gardens lulls the reader into forgetting it was all enclosed by a high fence and security checkpoints. The insane were to be well cared for — just far away from polite society. No matter how lovely their surroundings, residents could never forget they were locked in.

The story begins with the suicide of Olof, Beckomberga’s last patient:

“He keeps his eyes fixed on his hands to stop the dizziness, and all around him the night is clear: the stars, pinprick holes letting in light from another world…a promise of something else, a shimmering brightness that will sparkle and sustain him in place of the ever-seeping damp…He throws himself out into the night with but one wish: that something will sustain him…but he is only a bundle turned once or twice in the air.”

Stridsberg clearly intends for the reader to experience the residents’ sense of mental imbalance and alienation, and she succeeds. Her characters never express themselves at length or in emotional language, so their actions and choices remain opaque. The book’s primary narrator is Jackie, the daughter of one of Beckomberga’s recurring residents, Jim. On the surface, she seems steadfast in her loyalty to her father, but after several shifts in perspective, we glean that she is a deeply unreliable narrator.

Numerous other characters come and go, further fragmenting the narrative. Stridsberg appears determined to keep readers at a chilly remove from the patients and focused instead on the system. To wit, almost none of the patients are sympathetic, some are occasionally cruel, and all are hugely selfish. At one point, Jim says to his daughter during one of her then-daily visits:

“Remember, Jackie, I have no-one to live for, no-one to love. I never have.”

Many patients have resided in the facility for so long that they’ve lost all sense of time and place and merely note any aberrations in daily events, such as when they have visitors or sneak out to the city. Yet these events give shape to the story, allowing readers to cobble together the fractured timeline and grasp how Beckomberga changed from a place of hope into a crumbling tomb. By the end, when Olof is the sole remaining patient, he is like a ghost floating in a vast mausoleum.

“I have never saved anyone, never been close to saving anyone,” laments one character near the end of the novel, but the sentiment could’ve come from any of them. Stridsberg’s sadly deterministic and claustrophobic study of the mental-healthcare system is a denunciation of all involved — patients and practitioners alike — for failing to provide the understanding and communication necessary for healing.

Patricia S. Gormley lives in Northern Virginia with her librarian husband and four small, mysterious beings who profess to be cats but who behave like permanently disgruntled toddlers with no verbal skills.