Novelists seem to be taking on ever more challenging and imaginative topics on which to base their narratives. Such is the case with Clare Dudman’s second book, 98 Reasons for Being. The book is categorized as a biographical novel because it is based, in large part, on a real doctor: Heinrich Hoffmann (not the other man of the same name, a friend of Aldolf Hitler) and his mental institution in 19th-century Frankfurt, Germany.

Doctor Hoffmann was also a well-known children’s writer and illustrator, and that is where his final reputation landed. His collectible book, Der Struwwelpeter (or Shockhead Peter or Slovenly Peter) (1845), is still available. Several of its poems and illustrations are interspersed throughout 98 Reasons for Being.

Dudman’s novel centers on Hannah Meyer, a young Jewish woman who has recently entered Hoffman’s institution (the year is 1852) and is labeled a nymphomaniac. She is no such thing, but such was but one of the labels given to unhappy, unmarried women of the time. The patient suffers from separation from her boyfriend, and at the beginning of the novel refuses to speak or even look at others in the insane asylum. She barely eats and does her tasks like an automaton. As the novel progresses, however, her relationship with the female patients and with Dr. Hoffmann, who tries with varying success to bring his patients out of their states into happier, more functioning states, improves and deepens. By the end, Hannah is indeed greatly improved. Would we have institutionalized this woman today?

Definitions and terminology change about mental illness, and with today’s increase in depressive disorders among the American population (and probably among other populations in first-world countries), those definitions will, undoubtedly, continue to change.

As will treatments, thank goodness. If you consider electroshock therapy (EST) somewhat barbaric, consider, as an example, some of the treatments used for epilepsy (for which patients were institutionalized in an insane asylum) in this 19th-century institution: “We have not found the following to be of any palliative value at all: earthworms, the dried afterbirth of a first-born, ground-up human skull, or dried brain thereof, backbone of a lizard stripped of its flesh by ants, the heart and liver of a mole or a frog.”

The sympathetic character development, especially of the female inmates, and the discussion of ancient, often appalling, treatments make the novel a fascinating and unusual read, one sure to hold most readers’ interest. It is, overall, emotionally riveting.

As a reader, I always appreciate a glance inside a mental institution, historic or contemporary. Things have come a long way in our understanding and treatment of those with mental illness, but public perception still has a distance to catch up. The mentally ill in American society remain one of the least understood – and most feared – of all populations. For this reader (and college professor), it is always fascinating to consider the sometimes fine line between sane and insane, between doctor and patient. This, in itself, is another reason to read a novel such as 98 Reasons for Being.