Two mysteries are enfolded in Emma Healey’s Elizabeth Is Missing, a quietly moving debut novel about memory, loss, and family bonds. Maud, an elderly woman succumbing to dementia, is convinced that her friend Elizabeth has gone missing, thus echoing the disappearance of Maud’s vibrant sister, Sukey, when Maud was a teenager in post–World War II London. Understanding Maud’s past loss is crucial to understanding her current anxiety, but which story serves as the baseline: an old woman’s dementia, which makes family and caretakers brush off her concerns, or a long-ago absence that could evolve into a case of murder?
“It’s first a story about dementia,” explained Healey in a phone call from England. “There’s a mystery element here, but it’s not a crime novel.” In fact, Healey’s work was inspired by events surrounding both her grandmothers. Her father’s mother was just starting to experience memory slippage when she expressed concern about a friend who had vanished—as it happened, simply to go stay with family in another town, as friends soon revealed.
“But I wondered what would have happened if she had been further along,” says Healey, “or if they hadn’t had so many mutual friends?” Here was a small mystery that could shape a larger work, Healey realized, and her grandmother’s condition could be effectively investigated within a fictional framework.
Then Healey learned that her mother’s mother had only days to live and rushed to her side at the hospital, where she wrote down stories her grandmother had shared over the years as they reminisced. (“She even corrected things I got wrong,” confesses Healey.) Healey recognized that the novel just sparking in her mind needed a backstory, and these reminiscences “got into the gaps,” as she explains. For instance, a woman who had chased her grandmother as a child became the “mad woman” living on the streets near Maud’s family. Her condition effectively paralleled Maud’s, and she further proved to play an important part in the family’s story.
Healey underpinned her novel with rigorous research, coming to understand that dementia is defined by 24 symptoms emerging over time. At the beginning, Maud exhibits only a few symptoms, but a very specific Healey charted Maud’s deterioration by allowing altogether 18 symptoms to emerge. Among the symptoms is obsessiveness, particularly regarding past behavior; a dedicated gardener might become a fanatic with a trowel. As a result, says Healey, “If Maud is obsessed with someone missing in the present, there had to be someone missing in her past. It instantly made sense to me that it would be a sister; it was the right kind of parallel.”
In the end, Healey’s work opens up to investigate the ever-shifting nature of memory itself. “We can never trust memory,” asserts Healey, pointing to siblings with totally different recall of family events or how memories can emerge or change during therapy. She’s also quick to argue that while the burgeoning memory gaps experienced by someone like Maud can be unsettling for those around her, we make a big mistake in assuming someone suffering from dementia is simply a blank slate.
“There’s a person there, with all sorts of things going on in his or her head,” insists Healey, moreover arguing that we really can’t know what’s going on in anyone’s mind. We simply need to look for the logic, acknowledging that the individual has feelings and remembrances and moments of lucidity where it all connects. Not that she means to give readers a lesson, but Healey does want to encourage patience. “It sounds very grand, but I wanted to give a voice to those who don’t have one,” she concludes. Investigating memory loss, she has succeeded in creating a character and a narrative that are truly memorable.