Tammy Gregg’s novel offers a journey through madness, love, and self-forgiveness in a modern-day gothic ghost story elevated by wit, rich characters, and proliferating mysteries.

Samantha, traumatized from criminal accusations of killing her parents, is now under the care of Patrick Denny, a best-selling novelist who has returned to psychiatry. Patrick weans her and other patients—notably Michael, who assures Patrick that he has “trapped the monster,” and Amelia, who has been virtually comatose for decades—off the drug regimens that he believes have reduced them to vegetables, to the consternation of Patrick’s nemesis, Dr. Dilby.

Patrick assigns Samantha to read a Victorian-era diary penned by the architect who designed the bleak New Hampshire institution they occupy, situated in classic Hawthorne territory alongside a cemetery and primeval forest. That diary, various dreams, Patrick’s backstory, sniping hospital doctors, wealthy town patrons with disturbing secrets, mushroom motifs, and Michael’s delusions (or are they?) interweave and morph in and out of insanity, dreams, and reality.

A master storyteller, Gregg implants exposition into the midst of powerful emotion, as when we learn both what happened to Samantha’s parents and the depth of her anguish when she cries “please don’t be dead.” And Gregg deftly holds mirrors up to real-life horrors, notably a Grimm-like rendition of the violence of childbirth and the vulnerability of the woman laboring.

Memorable characters embody tempers, humor, wickedness, pettiness; even the nurses, all-too-often relegated to window dressing, are ferocious, judgmental, loving. Gregg’s people act from complex backstories that explain most of their bad behaviors.

A climactic forest scene testifies to the author’s literary imagination: “The tree lurched and continued its expansion… as mushrooms sprouted from all the orifices of her body, …The hollow closed around her…”

The subsequent chapter provides much-needed comedic relief, and an epilogue ties up loose ends in this twisted, dark and deeply immersive tale.