This fast read leaves you with lots of food for thought. It has several mysteries running simultaneously. During parts of the book, the author uses a very interesting writing style in which she injects fragments of thought and/or action from the perspectives of different characters which also cover different periods in time. Don't let this put you off! Just keep reading and it will all come together!
Esme is the main character who is institutionalized for over sixty years. (She has been disrespected in a series of ways. First and foremost is that the administration in the asylum will not call her by the name that she goes by, Esme.) The psychiatric unit is closing down and a great niece named Iris finds out about Esme. She never knew about her great aunt before! Iris goes to meet Esme and feels responsible for her future. Iris feels connected to Esme on some level that she doesn't understand. She knows they are related but it goes deeper than that.
Esme and Iris have had a series of dysfunctional experiences and they intersect at the end over a horrifying realization.
I was especially put off by how men treated women in this book. Also, how the women were not familiar with their own sexuality. When you are done reading you are left wondering, was Esme sane or insane?
(For some reason reminded me of THE DINNER, by Herman Koch.)