By David Mehegan

Disrepair is the leitmotif. The atmosphere throughout is dark and gray, tinting a sadness that to the narrator seems to be inexpressible.

Beckomberga by Sara Stridsberg. Translated, from the Swedish, by Deborah Bragan-Turner. Farrar, Straus & Giroux. 282 pp. Paper. $19.

The intrinsic appeal and hazard of fiction about mentally ill people is that nothing need make sense — not their words, actions, or motivations. Fully to appreciate, absorb, and enter into their world (for readers as much as for characters who relate to them) requires acceptance of an atmosphere of strong feeling mixed with ambiguity and uncertainty. How that acceptance affects these others, or does not, is a fictional structure that must operate outside the realm of illness. No novel that is only about craziness is sustainable.

This is the problem that haunts Sara Stridsberg’s 2014 novel Beckomberga, published in English in the U.K. in 2016 and now in the United States. Told largely, though not entirely, in the voice of a young woman named Jackie, it centers on her father, Jim, a human wreck whose out-of-control addictions and other misbehaviors land him in Sweden’s Beckomberga, a secure psychiatric asylum.

Beckomberga was one of the largest institutions of its kind in Europe, built in 1932 and closed in 1995, housing at its peak as many as 6,000 patients. As a young girl, Jackie continues to visit Jim after her mother, Lone, a photographer, decides she no longer wishes to. Jackie spends so much time in the hospital that she comes to know many patients and staff members who populate the story. There is Olof, who has been in Beckomberga for sixty-three years; Sabina, in her thirties, who is loved both by Jim and by one of the doctors; and Paul, who becomes Jackie’s lover when he is allowed out of the institution for short periods. Jackie never stops hoping that her father might become well and return home again. But Jim and Lone know that will not happen.

Jim’s mother, Vita, had committed suicide when he was young, and he is obsessed with the idea: he “tries” unsuccessfully several times, which, along with epileptic seizures related to alcoholism, is what lands him in Beckomberga. He often talks to Jackie about his own death, how he will take a full bottle of pills and walk into the ocean. We assume that it will happen, or (at the end of the novel) that it has, but it is never announced, depicted, or narrated. He is the axis of the the story, and yet ghostlike—never quite coming into focus except as the object of Jackie’s longing and the locus of failure and disappointment.

If you had not read this précis or the back-cover copy on the book ahead of time, you might well find this a challenging book to read, possibly even to figure out. The story begins with a suicide — of whom only gradually comes clear. Who exactly Jackie and Jim and Lone are, and their relationship to one another, is also not clear until about page 34. To a large degree all the characters are diaphanous; none except the hospital doctors are given last names.

The novel has three unnamed parts, with Roman numerals, and many short, unnumbered chapters with ambiguous titles such as “Winterson’s Toys,” “The Second Conversation (The Atlantic),” “From Eternity’s Perspective (Vita),” “Dark Spring,” and “Lime Tree Avenue (Marion).” One title used repeatedly, “The Last Patient (Still in the Light),” reproduces a painful conversation, presented in episodic form, between Olof, who is terrified at the impending closure of the hospital, and psychiatrist Dr. Janowski. Chapters are broken up into small vignettes separated by typographical dingbats. It’s a tale told in bursts — stops and starts. Dialogue is mostly cryptic, vague, inconclusive, often puzzling in meaning even to the speakers. Everyone seems most of the time to be doubtful, confused, and at a loss. Impulse drives behavior.

There are two general time frames: Jackie as a girl visiting Jim and engaging with the hospital personae, and Jackie as an adult with a son, looking back and remembering, sometimes revisiting the grounds of the empty hospital. The story bounces abruptly back and forth between the two. While it seems to be, and mainly is, a first-person narration, there are scenes (such as the Olof–Janowski dialogues) of which Jackie cannot be the narrator because she is not present. Furthermore, there are many scenes that seem to be dreams or fantasies, such as Jim having conversations with his dead mother. In one, she expresses regret for her suicide and wishes she could come back. Symbols and images abound: trees, a star, the clock tower on the hospital grounds, the gold-lettered name over Beckomberga’s door.

Over and over Jackie sees, or imagines seeing, a white seabird flying along the hospital corridors, thence out of sight. This vision is the epigraph of the novel. Perhaps Jim — or Jackie’s longed-for closeness with her father — is the bird. Early in the book, a bluish pearl necklace is yanked from Sabina’s neck by an assailant on the hospital grounds. Jackie later finds and gathers the pearls and keeps them throughout the story. The unstrung row of pearls appears on the book jacket, under the title. We’re left to guess what they reveal about Sabina or Jackie.

When the institution closes, Jim is released, moves away from Stockholm, and has another chaotic, failed marriage with children. His fatal skid resumes. He never comes back into Jackie’s life except in a few fragmentary encounters. In retrospect she is clear-eyed about him, yet maintains an undemonstrable love for him.

“He has always … lived according to his own rules,” she tells us, “like an overgrown child, dangerous and unruly.… He has always done what he felt like doing, followed all his whims and instincts: dishonesty, deception, drink and desertion. I do not believe he has ever loved anyone.”

One supposes in such a novel that the sick people would be confused, delusional, and disoriented, while the sane must be clear-headed, living realistically in the real world. But no one in this story is firmly in the second category. Even the staff members are peculiar. Yes, Sabina is crazy; poor Olof is totally unequipped for the world outside; Jim is unable or unwilling to handle ordinary life or consider other people’s interests — he runs from life, even short of suicide.

But Jackie and Lone are also runaways in their fashion. Jackie leaves her husband (or boyfriend — more ambiguity) when she becomes pregnant — no reason is given — and her only close relationship seems to be with her son, Marion. “When I am older,” Jackie tells us, “it is Lone who keeps disappearing. She travels further and further away, wandering the other side of the world, where she photographs the devastation in disasters’ wake.… And while Lone is away everything falls into disrepair.”

Disrepair is the leitmotif. The atmosphere throughout is dark and gray, tinting a sadness that to the narrator seems to be inexpressible. We learn very little about the inhabitants of Beckomberga — what motivated them, what caused their decisions, what indeed were their diagnoses. Still, Jackie’s compassion never wavers — they are lost, vulnerable, needy, intelligent, hurting terribly.

If the massive old hospital is a kind of prison, it is also for its inhabitants a place of safety and refuge — far, far from the terrible world of Frederick Wiseman’s Titicut Follies. It does not cure these characters, but then neither does the world outside. Stridsberg knows well of what she writes. The book is dedicated “to all those who passed through the hospital park at Beckomberga over the years 1932 to 1995, among them my family.”

Perhaps she knows her story too well to help her readers understand it. I felt the need to read it over again, almost line by line, to try to take in all that the narrator does little more than imply throughout. Even then, the deepest truth about Beckomberga and its shattered lives would remain beyond my grasp, as it might have for the writer.

David Mehegan is the former Book Editor of the Boston Globe. He can be reached at djmehegan@comcast.net.