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When I start reading a book and the protagonist is a doctor recovering from a nervous breakdown, and he comes to a small town and settles down to practice small town medicine incognito and becomes interested in the daughter of the previous town doctor, I’m pretty sure I know exactly what I’m getting. In the case of Up the Hill and Over, by Isabel Ecclestone Mackay, I was very wrong.

It’s hart to talk about how I was wrong without giving away a couple of twists–twists that I did see coming, but not far enough ahead that I didn’t have to change my mind about what kind of book I though I was reading a couple of times. There are three specific things that complicate the narrative I expected. One of them was insanity, and I want to talk about that. The other two are a little spoilery, and I’ll mention them without giving details.

So, one of the characters, Aunt Amy, is introduced as being a little odd, and having strange fancies about things. You learn about her mental issues slowly, so at first it just seems like she’s perfectly sensible, if a little eccentric. Then you get more specific information: she believes that the sprigged tea set doesn’t like being touched by anyone but her, and that someone she refers to as “Them” is out to get her. The cause of her problems–her fiancé dying on the eve of their wedding–is typical of insane women in novels, but the details of her beliefs and their effects are so much more specific. I mean, when you’ve got a secret insane wife or something in, say, a Mary Jane Holmes novel, madness is a permanent change in state, a fundamental attribute of the character. There was a time when the woman was not mad, but now she is, and the only change possible going forward is her death.

It’s not like that with Aunt Amy. Actually, another character ends up fitting into that trope much more closely. Amy’s madness is a permanent state, but not…I guess the word I want here is homogeneous. I mean, it’s not just that she’s better at some times and worse at others. Her madness is multifaceted, and doesn’t make her any less of an agent. The development of Amy’s illness, or the depiction of it, is such that you move through being sorry for her to being scared for her to being scared for the people around her, and it’s just…really interesting. For early 20th century popular fiction, it’s very psychologically complex. There’s a fairly modern depiction of drug addiction, too, and while the, uh, legal complication that you’re probably going to suspect pretty early on is exactly what it looks like, there’s surprisingly little moralizing wrapped up in it.

I was never, at any moment, in love with this book or with any of the characters, so there were a few places where I didn’t get the emotional punch I needed to make certain plot developments work for me. At least, that’s how I’m explaining to myself the fact that bits that I didn’t think should have felt melodramatic did. I kept a little bit of an emotional distance from the book throughout, and not by choice. But I also stayed absorbed in it the entire time, and could barely put it down, and while there were bits that felt like too much, for the most part it just kept getting more and more interesting until the end. I expected a much more cheerful book when I started, but I wasn’t disappointed by any means.