(This review received second prize in a national-level book review competition conducted by Indian Psychiatric Society in 2021 and has been published in the Kerala Journal of Psychiatry)

One year of being a resident in psychiatry has taught me that mental illness is a lot more than a few neural circuits, neurotransmitters, and a handful of pills. In psychiatry wards, one meets two kinds of people: “those who suffer from mental illness and those who suffer from the mental illness of someone they love.” While the former are caught in an abyss of darkness forever, the latter have to walk the tightrope between love, guilt, and shame.However, an onlooker might find that world difficult to comprehend. Hence, for most authors and filmmakers, madness is either romantic or humorous. Em and the Big Hoom,a novel by Jerry Pinto, gives a raw and intense portrayal of mental illness.However, the novel is much more than the tale of a manic-depressive woman and her family. It is a story of introspection, love, helplessness, hope, fear, and sheer warmth; all blended into a narrative that is as much an autobiography as it is fiction.

The story unravels in a 50-square-foot flat in late twentieth-century Bombay. The unnamed narrator, his sister Susan, and their parents, Imelda and AugustineMendes (nicknamed Em “with an exclamation mark” and the Big Hoom), “live, love, and deceive one another within earshot” in this house. The cramped apartment also represents the reality of their lives, which once held great promise but has now shrunk into the penumbra of Em’s ever-changing moods. Em moves unpredictably from dark, fathomless depression to stratospheric mania in a span of moments. Her moods claw the family together yet inflict deep, bleeding wounds on each of them.

The story begins with Em in the psychiatry ward of J.J. Hospital and the narrator peering through one of her old letters. Em calls her husband ‘Angel Ears’. Peppered throughout the narrative are more such endearing nicknames that convey a sense of warmth, despite the author laying out a heart-wrenching story. A non-linear, yet seamless and flowing, narrative follows, which takes the reader across different timelines. We see a Bollywood-style love story blossoming between Imelda, the daughter of a Burmese immigrant family, and Augustine, who had run away from a Goan village. Both are silently coming to grips with new lives in new places. Imelda is a nervous office newbie who finds peace in the routineness of a stenographer and passively hands over every paisa of her earnings to her mother. Augustine is the well-dressed office heartthrob who manages to climb up the ladder despite having humble beginnings. The author’s prose moves back and forth between past and present as the children try to re-imagine their mother when she was “whole,” to find the roots of her disease. In that sense, the entire book is about the quest of the narrator and his sister to make sense of their surroundings—“the big, demanding place with no fixed syllabus.”

The narrator is an unnamed, emotionally sensitive teenager who gradually grows into early adulthood as we flip the book’s pages. He cuts together scraps of diary notes, unposted letters, and Em’s memories as if they were jigsaw puzzle pieces, to discover what went wrong and where. Throughout the story, Em and her moods dominate the family’s life. Her micro-weathers influence how they work, play, and sleep. The children often come home from school to see their mother caught in the dark, deep, dreamless tangles of depression. Then there are days when she is loud, obscene, and emotionally abusive. Susan, the narrator’s sister, snatches at Em whenever she is between these ups and downs and carefully plots her moods, only to find they are entirely unpredictable. There are rare, brief punctuations of normality in between when the children walk with their mother through “Van-Goghian fields of free association.” They scan every outpouring from Em and every titbit of information from her friends and relatives for signs of a “nervous breakdown”. With their candid observations of the complex surrounding world, the brother-sister duo is sometimes reminiscent of Estha and Rahel from ‘The God of Small Things’. The explanations they discover include crashed hopes, broken promises, erratic genes, and an unjust world, but most of their questions remain unanswered.

“Fight your genes,” the father tells the boy when he worries about the genetic tendency for mood disorders. But no one tells him how to do it. The boy fears that his father may die and his sister may move out, leaving him alone to deal with Em. For him, the world is split between the all-knowing, dependable Hoom and the capricious Em. The relationships that family members, especially children, have with a mentally ill person can be complicated.

On the one hand, there is the need for care and the stark reality of “madness.” On the other hand, there are mercurial temperaments, broken dishes, and suicide notes. Even as the narrator worries for his mother, he wishes for an easy escape. Empathy is phenomenally expensive, and he craves a normal life. We see him falling prey to numerous insecurities, confusions, and ambivalence.Pinto captures the narrator’s self-conscious guilt as his “defences” are broken up, and all he can do is hold on to“helpless, corroded love.” The chaotic mixture of emotions that churns inside the boy has been effortlessly woven into the story.

The Big Hoom is the stoic, solid figure against whom the entire family leans. He is a man who knows “how to do things and get things done.” Hoom is the narrator’s hero, his “paragon.” The narrator often finds it difficult to accept many aspects of his hero’s past.However, he cannot imagine that his father was once a humorous, charming young man. He is cautious to look away from the emotional sides of his hero even as he digs deep into Em’s bygone stories. Em’s disease had forced her husband to put on a solid façade. The bridge of silence that Hoom lays out between him and the children is a defence of many sorts.In this story, the façade breaks down in a few moments, revealing that inside, Hoom constantly bled.

Many social and cultural factors that seamlessly blend into the characters’ lives are interwoven in the story’s backdrop. Bombay, where the story takes place, is in the process of being built up, and people are flowing in to occupy every square inch available. The loud Bollywood music and street noise are audible in many word pictures. Em and Hoom are part of the “dosa-thin” middle class of the 1960s. There are references to them saving up every rupee possible and Em’s illness taking a massive toll on the family’s financial stability. Neighbours or friends don’t form a prominent part of the story, despite the family’s dire need for social support. The middle-class reality Pinto illustrates is that each family is an island unto itself amidst unemployment and limited resources. From Em’saunt, who thinks religion is best in small doses, and Augustine, who does not believe in a personal God, to the narrator, who is openly atheist right from his boyhood years, the generational shift in perception of caste, class, and religion is a part of the story. We also see other indicators of a changing socio-political landscape, like the story of a low-caste man buying land with funds from abroad, the tussle between Portuguese—“the language of rulers”—and Konkani—“the language of tillers,” and beautiful depictions of the Goan culture.At many points, the characters break traditional moulds of femininity and masculinity.The big Hoom prepares food, washes dishes, takes care of the household, and raises children. Susan grows up to be stoic and solid, while her brother seems to be the more emotionally vulnerable sibling. Rebellious in her ways, Em boldly writes a letter to her fiancé stating that she is not too keen on sex and even thinks about asking for his syphilis report. “We were suffering in expiation of Eve’s sin. Adam got away. Of course, men do,” she says at one point.

Em’s gliding speech during her mania is like “wandering in an unknown place with each path changing course midway.” When depressed, she “curls into a foetal ball, moans in pain, and breathes only because her body forces her to.” Mental illness is not dramatised or romanticised.The post-partum onset of her mood swings, the endless cups of tea and sleepless nights harbingering her manias, the black voices that ordered her to drive out her son, and the summers Lithium brought in are accurate imprints of bipolar disorder. The descriptions of Em’s symptoms are intense enough to reveal the vulnerable woman behind them yet meticulous enough for a psychiatrist to decode the phenomenology.The author has not pigeonholed mental illness into stereotyped descriptions;he has coloured itsdescriptions with warm, affectionate hues. The book also has a touch of gentle humour throughout. At some points, one may even break into laughter. The writer neither glorifies suffering nor tries to run a lecture on the morality of caregiving.

Pinto has made it no secret that Em’s character is based on his mother, Imelda Philomena Perpetua Pinto, whom he calls Meem in the dedication. He took 25 years to write, rewrite, and condense a deeply autobiographical storyinto 00 pages of “fiction.” Various facets of the “caregiver burden” that Pinto himself must have gone through are tangible in the book. “Suddenly, your mother steps into a patch of quicksand,” he writes. “She makes it worse by smiling bravely and telling you to go on.” The psychiatrist is a passive presence in the storyline. Em’s treatment has no bearing on her dark, deep worlds. It only mutes her paranoia and keeps the symptoms at bay. Em’s diagnosis changes from a nervous problem to a nervous breakdown, then to schizophrenia, and finally to manic-depressive illness. However, for her and the world around, she is simply “mad.”

“Madness”is a word that customarily fits into jokes, songs, phrases, and idioms. However, it loses its triviality when a loved one has the label. For overtwo decades, Hoom and his children crawl, drag, and pull their way through pills, hospitals, unheard voices, and suicide notes. The novel ends with Em passing away unexpectedly and the family facing a sudden, large void in their cramped apartment. The grief-stricken family’s world is broken and twisted for a moment. However, we see the family piecing it together and carrying on their journey forward—“conversations began, jokes were exchanged, food was eaten and commented upon, generally unfavourably.”

In the end, we see Hoom and his kids brewing tea just as Em had loved it. Perhaps, that is how their lives will be without Em—imprinted forever by love and madness. I put down the book, gazing at its violet and orange cover. I know I will often meet Em, Hoom, and their kids through my patients. Maybe, next time I should not limit myself to quelling one person.When the family stands outside the dark tower, looking for a “well-loved face that will peer out”, I know “love is never enough.” “Madness is enough—complete unto itself.” Yet, I want to assure them that despite the storms, there is indeed much sunshine and love involved. As Em herself would say, “What an investment life is!”