The Sanatorium

Fiction | Novel | Adult | Published in 2021

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Summary

Chapter Summaries & Analyses

Prologue-Chapter 14

Chapters 15-33

Chapters 34-53

Chapters 54-76

Chapters 77-90

Chapter 91-Epilogue

Character Analysis

Themes

Symbols & Motifs

Important Quotes

Essay Topics

Tools

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Discussion Questions

Themes

The Struggle and Stigma of Mental Illness

We first meet Elin as she is having an anxious episode inside of the funicular that she and Will are taking up the mountain, travelling to Le Sommet. Right away, mental illness becomes a prominent theme in the book. At the same time, the mental health struggles that characters in this book face are presented as reasons not to find them to be trustworthy, innocent, or even competent. Even as Elin struggles with PTSD following the death of her brother Sam and her own near-death experience at the hands of Mark Hayler, the insinuation that Laure might be suffering from depression causes Elin to suspect her of being involved in Adele’s death.

Elin fails to recognize that her own mental health struggle might also affect other people’s image of her. Will, her boyfriend, often doesn’t trust her judgement or finds her behavior to be unwarranted. He also becomes increasingly frustrated with her need to prove that she is capable of solving this case. She is also asked to stop investigating once the Valais police figure out that she’s on leave from her job as a detective back in England. Taking that extended leave of absence, even though it was for a valid reason, makes her seem unstable and incapable of investigating without problems or biases.

Mental illness appears throughout the book in the experiences of different characters. Laure has been prescribed medication for depression, which Isaac hides from Elin because he doesn’t want the stigma surrounding mental illness to cloud Elin’s opinion of her. Margot is diagnosed with psychotic depression, which is a form of severe depression in which an individual might experience hallucinations or delusions. Margot’s great-grandmother was one of the German mental patients transferred to Sanatorium du Plumachit to be experimented on and ultimately tortured to death. The German patients are an early example of how mental illness has historically been stigmatized. The women brought from the asylum to be experimented on at the sanatorium were stripped of their humanity, their designations as insane deeming them useless and disposable. While their treatment is seen as inhumane by the characters in the present day, the stigma that those women faced has only barely subsided.

Cecile’s unresolved trauma builds until it manifests itself in the serial murders she commits at the hotel. Her mental illness develops as a response to trauma, but because of the toll the trauma has taken, she is able to justify her actions, even gruesomely taking human lives. Elin and Cecile’s histories are paralleled, though their different responses to the traumas they’ve faced are opposite representations of mental illness. Cecile’s extreme reaction, murdering those who she feels have wronged her, is what the stigma looks like: The image of the person with mental illness being a danger to those around her. In reality, the mentally ill are much more likely to be victims of violence, like the women from the German asylum. Elin’s response, to pull herself away from her loved ones and throw herself into work is also far more common than Cecile’s.

The Systemic Abuse and Dismissal of Women

Women are the primary characters in this novel, and by that account, issues that women face are themes throughout the book. The women who were brought to the Sanatorium from the asylum were experimented on and tortured, but before any of that happened, they were first committed presumably by their family members who simply didn’t know how to deal with them. Cecile sees herself in their struggle, remembering how her family dismissed her when she revealed that Daniel Lemaitre sexually assaulted her. The response that she got, instead of being protected or believed, was to get her an abortion and never speak of it again. Cecile felt disregarded, just as the doctors at the sanatorium disregarded the women who they abused and tortured in the name of science.

What happened to the five German women from the picture that Margot carried around in the envelope is an example of systemic abuse. Those women had been entrusted to the care of an institution and were treated as if they were disposable. They were powerless to control their own situation, and they were buried in unmarked graves when they were killed, their humanity stripped away.

For Margot, the knowledge of what happened to her great-grandmother created generational trauma, consuming the lives of her grandmother and mother before it began to consume her, too. Similarly, when Margot asked Lucas, a man in a position of power, for help and closure regarding her great-grandmother, he instead used his power and influence to cover up what happened, valuing his bottom line more than he valued the lives of these women. Cecile sums up the abuse of vulnerable women when she confesses to Elin: “‘It was abuse.’ Cecile’s voice is barely audible. ‘The age-old abuse of power; it was an exploitation of vulnerable women’” (367).

The Use of Red Herrings in Building Suspense

A red herring is a literary device in which the reader is given false clues that seem like genuine leads to resolve the plot. Pearse uses red herrings often, even from the beginning of the book, to create a more tense and suspenseful atmosphere. The characters are trapped in the hotel, unable to be reached by police, and unable to leave without possibly freezing to death. Elin begins to see everyone as a suspect. When Laure first goes missing, Elin assumes her brother Isaac has something to do with it. Little things, such as Isaac pocketing a bottle of pills before Elin can see it, or a few drops of blood on the carpet, make Isaac seem guilty: “Blood. Barely visible unless you knew what you were looking at, had seen it before. A hazy splatter patter, blooming out in tiny, ragged circles” (86). The discovery that Laure was still alive and was hiding somewhere in the hotel immediately shifted Elin’s focus onto her.

Elin finds clues that are compelling evidence, but she is unable to put them together until the last moment, when she discovers who the killer actually is. She suspects, and Pearse leads the reader to suspect, Laure, Margot, and Lucas at different points in the book, never revealing that the murderer is Cecile until the final climax.. Pearse doesn’t provide the reader with sufficient clues to solve the case, saving the reveal for Elin’s big confrontation with Cecile in the end. However, little moments throughout the book serve as little nuggets, suggesting Cecile might not have been as innocent as previously believed.

The biggest red herring is Margot. When Margot attacks Will, it seems clear that she is the killer and that Elin only needs to find her before she can strike again. Pearse upends this assumption when Elin finds Margot dead. While Margot does play a prominent role in the murders, the reader learns that she is not the mastermind.

The Sanatorium borrows the concept of the red herring from classic mystery novels. And Then there Were None by Agatha Christie, one of the bestselling crime novels of all time, has no fewer than 6 red herrings. Notably, Christie’s novel features 10 guests on an island who are trapped there and slowly picked off by a murderer. The film version of the novel, Ten Little Indians (1965), changes the setting to a home on a snowy mountaintop, much like the setting of The Sanatorium.