I. The Institution and Its Vocabulary
McCall Hospital recurs across Mulhern’s fiction with the persistence of a real, remembered place rather than an invented setting revisited for convenience — described with near-identical language in “Arise and Go Now,” “Blindfolded,” and Give Them Unquiet Dreams, always approached by “winding up a slope of lawn to a sandstone Admissions building,” always flanked by “brick edifices with classical flourishes, such as gabled roofs, Roman columns, and ivy-covered walls,” always populated by “approximately twenty-five patients, all with a variety of illnesses: schizophrenia, mania, depression, obsessive-compulsive disorder, and borderline personality.” The specificity and consistency of this description across multiple texts is itself an argument: this is not an atmospheric backdrop invented once and forgotten, but a fixed coordinate in the author’s imaginative geography, returned to with the fidelity of trauma rather than the license of invention.
The institution’s own vocabulary is presented with careful, almost anthropological attention, and that vocabulary does real diagnostic work in the text, work the novel is quietly suspicious of. Aiden’s mother, Laura, has been committed on the strength of “her claim that she heard the voices of dead people and her frequent ‘visions of past and future events,’” a formulation that leads “to a diagnosis of schizophrenia.” The passive, official cadence of that sentence — “led to a diagnosis” — is worth pausing over, because it is a cadence the boy narrator has clearly absorbed from adults and bureaucratic paperwork rather than arrived at independently; a fourteen-year-old does not naturally think in the syntax of intake forms. The prose is showing us, without commentary, how institutional language colonizes even the child narrator’s private account of his own mother, so that “she saw ghosts” becomes, by the time it reaches the page, “her claim… led to a diagnosis of schizophrenia” — a translation from experience into pathology that has already happened by the time the reader arrives, and that the fiction as a whole will spend its length quietly, patiently undoing.
The nursing staff, meanwhile, are rendered with a specific comic-critical edge that separates institutional competence from institutional wisdom. Nurse Nancy — new, eager, “want[ing] to do things right,” repeatedly outmaneuvered by Catherine’s superior command of the ward’s social terrain (“We know how to get there, Nancy Nurse. . . . Your time would be better spent memorizing that board”) — represents institutional authority at its most procedurally correct and interpretively hollow: she knows the policy; she does not know Laura, and cannot see what Catherine, Aiden, and eventually the reader are asked to see. The novel’s satire of Nurse Nancy is gentle rather than savage, but it is satire nonetheless, and it is pointed at a specific target: the idea that credentialed institutional competence is the same thing as understanding.
II. Second Sight as Contested Diagnosis
The central epistemological move of Mulhern’s fiction is to present the exact same phenomenon — visions, communication with the dead, foreknowledge — under two entirely different descriptive regimes simultaneously, and to let the reader watch both regimes operate on the identical set of facts without granting either one uncontested authority. Laura’s condition is described, within the space of a single paragraph in “Blindfolded,” first in the clinical vocabulary of the institution and then in the folk vocabulary of the family, with no narratorial signal indicating which vocabulary the story trusts more: “My mother’s claim of hearing the voices of dead people and her ‘visions’ led to a diagnosis of schizophrenia. My grandmother and father had her declared mentally incompetent.” Then, four sentences later, in the same scene, Aiden’s dead grandfather offers the counter-diagnosis, delivered with total conviction and considerably more explanatory power: “Second sight is something that has been in your family for years. Your grandmother’s mother possessed it, and she, too, was demonized. . . . There are always people who are blind to the gifts in others.”
Neither vocabulary is granted the last word by the narrative structure itself, which is the point. The reader is given, in the space of a single page, a medical diagnosis backed by the full institutional weight of a psychiatric hospital, a court-ordered guardianship, and a “declared mentally incompetent” legal status — and a folk diagnosis backed by nothing but a grandfather’s ghost and an inherited family story about a great-grandmother who “dropped dead while lifting a bucket from a well” the night after hearing banshees. What tips the balance, again and again across the corpus, is not narrative authority declaring one reading correct, but accumulating circumstantial confirmation that keeps arriving on the side of the family’s folk reading: Aiden reports information about his dead grandfather’s private confession — a detail about choking on his own vomit, an apology for infidelity to Catherine that only Catherine could otherwise have known — that he has no naturalistic way of possessing. “He said you should stop blaming yourself for leaving him in the chair that night when you went to bed. It’s not your fault that he choked on his vomit.” Catherine’s reaction is not skepticism but visible shock — “Nanna’s face quivered and she put her cigarette in the ashtray. ‘Where in God’s name did you hear that expression?’” — the reaction of someone confronting evidence, not indulging a child’s fantasy. The novel repeatedly manufactures small proofs of this kind (the location of a lost pearl necklace, the exact circumstances of a grandfather’s death, a detail about a great-grandmother’s fall from a tree that matches, image for image, a photograph Aiden has never seen) that a purely psychiatric reading of Aiden’s “gift” cannot easily accommodate, without the text ever stepping outside the story to announce that the supernatural reading has won.
III. Whose Vision Counts: The Politics of Credibility
What makes this more than an exercise in ambiguous magical realism is the specificity with which Mulhern ties the believing and disbelieving of visionary claims to concrete axes of social power — gender, class, institutional authority, marital status — so that the question “is this person psychic or psychotic” becomes inseparable from the question “who has the social standing to be believed.” Laura, an institutionalized single mother with no independent income and a court-appointed guardian, has her visions pathologized into a diagnosis that strips her of legal competence over her own children. Aiden, a male child under the protection of a resourceful and socially capable grandmother, has structurally identical visions — communication with the dead, foreknowledge, a “gift” explicitly identified by his grandfather as passed down through the same maternal line as Laura’s — treated by the surrounding adults as endearing eccentricity rather than pathology requiring intervention. Nobody suggests committing Aiden. Nobody strips him of legal competence. His grandmother’s response to his claims is suspicion curdling into something closer to awe (“Where did you learn these things?”) rather than the institutional machinery deployed against his mother.
The novel is alert to this asymmetry and, this essay argues, deliberately constructs it as an implicit argument about the gendered and generational politics of psychiatric credibility. Laura’s father-in-law equivalent — Aiden’s father — voices the position of naturalistic disbelief with a bluntness the text places in explicit tension with everything else the reader has been shown: “There are no ghosts, Aiden. . . . We shouldn’t have released her from McCall’s. Schizophrenia is a serious mental illness.” The father’s skepticism is not portrayed as stupid, exactly — the novel grants him a consistent, coherent, rationalist worldview — but it is portrayed as convenient, arriving in the same conversation in which he reveals he is abandoning his family for Arizona and a new relationship, so that his disbelief in his wife’s visions and his abandonment of his wife’s care are structurally, if not causally, entangled. A man who does not believe his wife has second sight also does not believe he owes her, or their children, his continued presence. The fiction lets the reader draw that connection without insisting on it, but it places the two facts in immediate proximity for a reason.
Catherine occupies the more interesting middle position, and her arc across the two texts constitutes the clearest evidence that Mulhern regards belief in second sight not as a fixed epistemological stance but as a hard-won achievement, extracted slowly and against considerable resistance. Her first response to Aiden’s claims is flat denial dressed as concern for his sanity — “Aiden, lots of people have dreams about people they’ve lost” — a response that, notably, uses exactly the same normalizing, minimizing vocabulary that institutional psychiatry uses on Laura (“lots of people,” “dreams,” the implicit diagnosis-by-euphemism). But Catherine’s disbelief is porous in a way the father’s is not, because Catherine has skin in the game the father lacks: she loved her husband, she carries guilt over his death, and Aiden’s testimony offers her something she wants — absolution — badly enough that her skepticism cannot fully hold against the accumulating evidence. By the novel’s end, in scene after scene, Catherine has moved from “Stop with your malarkey. Ghosts don’t exist” to open, unguarded participation in the family’s shared vision at the hospital’s front lawn: “Before getting into the car, both my mother and I saw him. My grandfather was sitting on the grass beneath a tree.” That sentence’s syntax is doing careful work — “both my mother and I saw him” positions Aiden’s mother, the institutionalized, diagnosed, disbelieved woman, as a co-witness whose perception is, in this single unguarded family moment, restored to full evidentiary status, unmediated by any hedge, euphemism, or clinical vocabulary at all.
IV. The Cost of the Gift: Second Sight as Vulnerability, Not Only Power
It would be a mischaracterization of Mulhern’s project to describe it as a simple inversion — psychiatry bad, folk vision good — because the fiction is equally attentive to the genuine cost and danger the “gift” carries for those who possess it, a cost the text refuses to romanticize away. The story of Aiden’s great-grandmother, relayed by his grandfather’s ghost, is the corpus’s clearest statement of what happens to a visionary woman without a protector willing to believe her: “Once, she was joyful, envisioning life’s possibilities, but slowly she withdrew, hurt by the malice of others. . . . She dropped dead while lifting a bucket from a well. Tumbled right over the stonewall she did.” The grandfather’s own gloss on the story refuses easy comfort: “Yes, Aiden. But what good did it do the poor woman. Dead she was. . . . Aiden, most people are afraid to believe in things they cannot see. It frightens them and they become nasty.” This is not a fiction claiming that second sight is an unambiguous blessing misread by a benighted medical establishment; it is a fiction claiming that second sight, real or not, exacts a toll on those who carry it in a world unwilling to extend belief, and that the toll — isolation, “demoniz[ation],” in the worst cases death — falls disproportionately on women without the social capital to demand a hearing. Aiden survives his gift, in the novel’s own accounting, specifically because he has protectors — a grandmother, eventually a believing mother, a loyal brother (“If you say Grandpa fuckin’ visits you, then Grandpa fuckin’ visits you”) — that his great-grandmother, and for much of the narrative his mother, conspicuously lack.
This is what separates Mulhern’s treatment of the diagnostic boundary from a simpler romantic primitivism that would merely valorize folk belief over clinical modernity. The fiction insists, instead, that the content of a vision — true or false, medically explicable or not — matters less, in terms of a person’s actual wellbeing, than the social response the vision receives. A visionary child with a resourceful, devoted, if larcenous, grandmother thrives. A visionary woman without comparable social protection is institutionalized, medicated, and stripped of guardianship over her own sons. A visionary great-grandmother in an earlier generation, with even less social protection, dies alone at a well. The variable that determines each woman’s fate is not the accuracy of what she sees. It is who, if anyone, is willing to believe her.
V. Comparative Frame: The Novel Beside the Stories
Reading the Aiden stories in The Weight of Small Mercies alongside Give Them Unquiet Dreams clarifies how deliberately Mulhern has built out this argument across formats. The stories, working in the more compressed space of short fiction, tend to resolve their psychiatric-versus-visionary tension through single, concentrated images — the shared vision of the grandfather on the lawn, the moment Catherine’s disbelief cracks over the “bingo bus” confession, the recurring image of a mourning dove that appears at exactly the moments the family’s faith in the supernatural is being tested. The novel, with considerably more space to work in, is able to build the fuller institutional apparatus — the ward’s specific taxonomy of diagnoses, the procession of nurses, the legal machinery of guardianship and “declared mentally incompetent” status — against which the family’s folk epistemology has to argue its case scene by scene, across a much longer campaign. What both forms share, and what this essay identifies as the single most important formal choice underlying Mulhern’s treatment of mental illness across his corpus, is the refusal to grant the narrating consciousness — always sympathetic to the family, always predisposed to believe — final authority over the question. Aiden narrates his own visionary experiences with the same unadorned, declarative confidence he brings to reporting his grandmother’s crimes; the reader is never given interior access to a psychiatrist’s countervailing case, never shown Laura’s condition from a clinically sympathetic vantage that might complicate the family’s reading. This is a real limitation of perspective, and arguably the fiction’s clearest formal risk — a reader inclined to trust institutional psychiatry over inherited folk belief will find the deck more subtly stacked than a reader inclined the other way — but it is also, this essay would argue, an honest and consistent extension of the novel’s larger commitment to withheld judgment: just as Mulhern declines to adjudicate whether his grandmothers are thieves or saints, he declines to adjudicate, from any position outside the family’s own lived experience, whether second sight is real. He simply shows what it costs, and who pays it, when the surrounding world decides the answer on the family’s behalf.
VI. Conclusion: Diagnosis as a Social, Not Only a Medical, Act
What this survey ultimately suggests is that Mulhern’s fiction, for all its warmth toward its visionary characters, is engaged in a considerably more rigorous critique than “the doctors are wrong and the grandmothers are right.” It is a critique of diagnosis itself as a social act inseparable from the diagnosed person’s gender, class, marital status, and available protectors — an argument that what gets called schizophrenia in an institutionalized single mother gets called “the gift” in a favored grandson, not because the underlying phenomena differ, but because the surrounding social apparatus of belief and disbelief has already decided, on grounds that have nothing to do with clinical evidence, whose visions are worth taking seriously. McCall Hospital, returned to across three separate texts with the same brick edifices and the same twenty-five patients, functions in Mulhern’s fiction less as a site of medical treatment than as a monument to this asymmetry — a place where a family’s most vulnerable member is sent to be told, by people with considerably less insight into her actual life than her own son, that what she sees is not real, while that same son goes home to a grandmother who, on the strength of far less evidence than Laura possesses, has begun, however reluctantly, to believe.