When the reader first meets Evalina Toussaint, protagonist of Guests on Earth, it is on a note of self-deprecation: this is not her story, she tells the reader, but an account of her impressions of the famous Zelda Fitzgerald. Evalina and Zelda were both patients in Highland Hospital, site of the catastrophic 1948 fire that claimed the lives of Zelda and eight other women in the psychiatric facility. But as Evalina recounts the details of her life--from lush New Orleans to Highland Hospital in North Carolina and beyond--what becomes apparent is that while Zelda plays a central role in the novel, Guests on Earth is nonetheless Evalina's story. As Evalina struggles with conflicting desires--art on the one hand, and domestic security on the other--it becomes apparent that for her, Zelda Fitzgerald serves as a dark mirror, revealing the fate that awaits a talented, sensitive woman in a milieu where such desires may be perceived as madness.

Evalina is 13 when tragedy upends her life. Her mother, a beautiful exotic dancer in New Orleans, seems to find happiness with a much older, wealthy married man, and Evalina lives a comfortable life. But soon calamity strikes, with the death of her mother. Paralyzed with grief, Evalina finds herself at the mercy of an elegant society that considers her outcast, and she's soon shipped off to Highland Hospital for treatment. It is there that she first encounters the charismatic Dr. Carroll and his wife, and meets Zelda Fitzgerald, who is destined to be a lifelong, if intermittent patient. The doctor, nicknamed "Dr. C" by his patients, prescribes shock treatments for many patients, but also has a philosophy that involves an active, creative life for the mentally ill as a form of rehabilitation. However, for women, creative aspirations are purposely limited. Dr. C believes the women in his care should not entertain "unrealistic ambitions," and must be "re-educated toward femininity, good mothering, and the revaluing of marriage and domesticity."

These ideas meet fierce if metaphorical opposition from Zelda, who one day shocks Evalina by viciously destroying a paper doll after Evalina proclaims it a princess in a tower. Zelda tells the distressed girl, "It is far better to be dead than to be a princess in a tower, for you can never get out once they put you up there, you'll see." Her words could be seen as literally prophetic--for Zelda herself will die confined to the upper floors of Highland Hospital--but are also meant as a warning to Evalina against less tangible dangers. Tragically, as the story unfolds, it becomes clear that Evalina is not equipped to recognize these dangers in her life, much less meet them effectively. For if even the passionate and strong-willed Zelda must continually capitulate, what chance can there be for Evalina?

Yet even at the heart of Dr. C's treatments, there is a paradox: his wife is teaching Evalina to play piano, and hopes to see Evalina take the stage as a professional pianist. As in real life, Guests on Earth declines to make villains or heroes of any character, instead presenting a nuanced picture of the challenges women faced in the 1940s South. Likewise, while the idea of F. Scott Fitzgerald as an oppressor of his wife's creativity does loom, he is depicted as much a prisoner of his time, in some ways, as Zelda. Perhaps for that reason Fitzgerald is permitted to contribute the title of the book--"guests on earth" being his own sobriquet for the insane, in a letter to his daughter, Scottie.

Evalina grapples with this complexity throughout the novel, with heroic if doomed determination. She desires all the things that her culture declares a woman should want--marriage, a home, motherhood. At the same time, there is a compulsion in Evalina for the shadow half: untamed sexuality, travel and art. She is not the only one, and nor is Zelda: Highland Hospital is populated with an array of compelling women who in one way or another are ravaged by this gender-specific dichotomy.

In particular, Evalina's friend Dixie is attracted to the glamour of embodying the quintessential Southern belle, but crumples from the societal pressure. Through the story of Dixie, Smith explores the extraordinary challenges that were unique to Southern women even as late as the mid-20th century, beyond what the received wisdom of 18-inch waists and womanly decorum would allow.

Above all, Smith lures the reader with lush prose, evocative settings and a voice that is distinct from the beginning. Through Evalina's eyes and the richness of her experience, Smith explores the unnamed border country that lies between sanity and madness, joy and heartbreak. --Ilana Teitelbaum

Watch the trailer for Guests on Earth here.

Lee Smith (Oral History, The Last Girls) has published 12 novels and four collections of short stories. She is a recipient of the Academy Award in Literature from the American Academy of Arts and Letters, the North Carolina Award for Literature, and a Southern Book Critics Circle Award. Smith lives in Hillsborough, N.C.

Your depiction of Highland Hospital is so vivid and compelling. How much of this depiction came from research, and how much from imagination?

I spent years researching this book. For details of daily life at the hospital, I am especially grateful to the special collections and archives at the University of North Carolina. Though actual patient records are not available, letters, clippings, memorabilia and the many various Highland Hospital publications over the years proved invaluable to me in gaining a sense of hospital life during the years covered in my novel, 1936 to 1948. Here I found catalogs, brochures, programs of events such as concerts, dances and celebrations of all kinds, the Highland Highlights magazine and the wonderful Highland Fling newspaper published by the patients. Zelda Fitzgerald's own letters, both published and unpublished, are remarkable. I interviewed everybody I could get my hands on with any firsthand, pertinent knowledge, such as Mary Caldwell, medical ethicist and lifelong Asheville resident with early work experience at Highland Hospital; older psychiatrists, nurses and townspeople; and others such as Mrs. Scott Hill of Durham, N.C., who was a piano student of Mrs. Carroll's throughout her youth in Asheville. Once I had a real sense of life lived within this institution, I could let my imagination go, and release my own characters to walk the hospital halls, participate in the musical events and climb those lovely slopes up to the stately buildings on top of the mountain.

It is also true that I have my own personal knowledge of the landscape of this novel. Both my parents suffered from mental illness, and my father was a patient at Highland in the 1950s. Decades later, my beloved son Josh spent several helpful years there in the late 1980s, in both inpatient and outpatient situations, as he battled schizophrenia. During that time, I came to know the hospital like the back of my hand. And though I had always been interested in Zelda Fitzgerald, it was during those years that I became fascinated with her art and her life within that institution, and by the still-unsolved mystery of her awful death.

Do you think in the 1940s, creative and even extraordinary women were more likely to be diagnosed as "mad"?

Absolutely! Creativity--especially genius--is always "outside the box." It can make people uncomfortable, even scare them. It was often easier to diagnose a brilliant woman as "crazy" than to actually listen to what she had to say. In the past, many female patients were committed simply because they did not conform to what was expected of a woman in her time and place. The truth of the time is chilling... if you had enough money and your wife insisted upon being way out of line, you could always "send her away" for a course of helpful shock treatments and "re-education" as to her correct role as a dutiful wife and mother. For more serious cases, such as overly promiscuous young women, especially those who were black or from a lower class, the court might send them to a facility for sterilization or even a lobotomy.

Do you think F. Scott Fitzgerald was guilty of suppressing his wife's creativity?

The easy answer is "yes," but the truth, I believe, was infinitely more complicated. For starters, Zelda was first and foremost a product and victim of the deep South's "belle" system, which decreed that she spend her teen years primping, dancing, flirting with and fascinating as many boys as possible--often simultaneously. Frequently she had as many as six dates in an evening. Wild, zany Zelda fit the belle role to a T, amplifying it with her own daring and sexual boldness. She met the ambitious young writer F. Scott Fitzgerald at the Beauty Ball in Montgomery when she was only 17 years old; he was a soldier stationed nearby. They married two years later, after his novel This Side of Paradise came out, then threw themselves (literally) into a wild lifestyle for which the untravelled and uneducated Zelda was woefully unprepared. They lived uproariously in hotels and rented rooms in several countries, disregarding custom and manners, drinking all the time. The gilded life turned dark, then darker, as alcoholism, infidelity and mental illness set in. Throughout, Scott co-opted Zelda's personality and her life--and occasionally her actual writing--for his own fiction. At first she was flattered, even complicit, but finally declared "Mr. Fitzgerald--I believe that is how he spells his name--seems to believe that plagiarism begins at home." Later she would claim that he kept her from becoming a ballerina, too, though she had begun her study of dance too late, when she was already ill.

How ill was Zelda? Very--her chaotic mind was unable to organize her brilliant ideas and images, or control her behavior. Also, she probably suffered from lupus, undiagnosed and untreated, as well as the disabling psychotic episodes which would probably be identified as bipolar illness today, rather than schizophrenia. Finally, the hundreds of shock treatments took their own terrible toll.

If there was one idea you would want readers to come away with after reading Guests on Earth, what would it be?

First let me explain that the title Guests on Earth comes from a letter Scott Fitzgerald wrote to his daughter, Scottie, in 1940 about her mother, Zelda: "The insane are always mere guests on earth, eternal strangers carrying around broken decalogues that they cannot read." A decalogue is a stone tablet with instructions on it, like the Ten Commandments. So this is a very sad quotation, really--saying that people with serious mental illness are homeless in a symbolic sense, unable to find a secure place for themselves in a world they cannot understand. Anybody who has any real knowledge of major brain disorders knows the unfortunate truth of this. But we are all "guests on earth" in a way, aren't we? Here for only the brief span of our lives, and then forever gone... and most of us are a little bit crazy, one way or another. I hope we will all think about that, and examine that very thin line between sanity and insanity. In this novel I am especially interested in women and madness, and in the resonance between art and madness. I also want to show that very real lives are lived within these illnesses, and within these institutions. "Asylum" means a place of shelter, of refuge, after all.

This year marks the 45th anniversary of your award-winning career in fiction. Are there any particular themes that have inspired you throughout your career?

I have always sought to tell the truth as I saw it. Paradoxically, I have found that I can do this better in fiction than nonfiction, because fiction can reveal truth in all its complexity. A novel is not a "power points" presentation. A novel is like a prism, or a kaleidoscope... when you hold it up to the light and turn it, the colors glow and deepen, the patterns change, and change again... because, let's face it: human nature is complicated, and so is life, and honest art must be also. In much of my writing I have tried to give a voice to those who don't have one--to speak for children, for instance, who are so often powerless in their own lives; to illumine and honor women's lives, especially the older women I knew as a child, women who spent their lives "doing for others" or working in jobs that are often ignored or even looked down upon. I have often written about mental illness and also about the environment. I have tried to preserve pockets of history, folklore and ways of life. It has been such a privilege to do this work. --Ilana Teitelbaum