Mothercare: On Ambivalence and Obligation 
by Lynne Tillman.
Peninsula, 149 pp., £10.99, March, 978 1 913512 27 9
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Lynne Tillman​ doesn’t believe in redemption. ‘Contemporary novels,’ she complained in 2001, ‘have become a repository for salvation; characters – and consequentially readers – are supposed to be saved at the end.’ Tillman has always avoided sentimentality. ‘Detachment would keep her fresh, it was a kind of freedom,’ the narrator says in Haunted Houses (1987), her first novel. But if you don’t believe in salvation, how do you feel about death? That’s the question Tillman asks in her most recent and most autobiographical book.

Mothercare is, at least on the surface, a straightforward memoir – an account of her mother’s long illness and death – as well as a consideration of the dysfunctional American healthcare system. Tillman first notices a change in her mother when they meet for breakfast in their usual Polish café. She is distant, dishevelled, downcast: ‘Mother was not a depressive; for one, she expressed anger frequently. Her affect now was atypical, puzzling.’ A neurologist suggests Alzheimer’s, but the family get a second opinion; eventually there is a new diagnosis: normal pressure hydrocephalus (NPH), a rare condition caused by excess brain fluid. Symptoms include memory loss, urinary incontinence and gait abnormalities.

There is hope, however: the pressure on the brain can be alleviated with a shunt. The operation goes well, but what might be the triumphant end of someone else’s story is only the beginning of Tillman’s. Shortly after the operation her mother has a seizure and ends up back in the hospital. There’s no happy-ever-after. The book charts a period of eleven years in which Tillman, along with her two sisters and a series of carers, look after her increasingly incapacitated mother, negotiating Medicare, wheelchairs, therapies and further surgeries.

There’s nothing romantic about caring for the elderly; it’s unrelenting, punishing and boring, very boring. ‘To adult children who care for sick parents,’ Tillman writes, ‘this story will be familiar, with variations, since the problems are the same and also different. To adult children who have not yet needed to care for their parents, or may never, lucky dogs, this may be a cautionary tale.’ ‘Diagnosis is everything,’ she tells us at the outset. Her advice? Challenge doctors: ‘Doctors are not gods, though some act that way. Some hate being questioned. Some have no time to listen. Some are fine. Many do a good job. They can fire you, I guess, but we never had that experience. More likely, you will need to fire them.’

Memoir isn’t Tillman’s usual mode. ‘Realism disturbs me,’ she writes in the opening line of American Genius, her 2006 novel about a historian trapped in what might be a sanatorium or an artist’s retreat (haha, as one of her characters would say). She is best known for The Complete Madame Realism and Other Stories (2016), a genre-bending collection of essays-cum-stories written by the fictional art critic Madame Realism, an alter ego Tillman began using in 1984 and through whom she has explored topics such as Jeff Koons’s sculptures and the history of Ellis Island. Mothercare doesn’t do away with these devices altogether: Tillman lists medications and dosages in a stark two-page spread; the section about her mother’s first operation is accompanied by a diagram of a brain shunt; there are sample parametric maps showing the differences in the brains of patients suffering from Alzheimer’s and NPH.

Tillman is especially interested in her mother’s ‘helpers’, a number of whom are mentioned throughout the book. She’s concerned with the ethical question of who is doing the helping, since the majority of carers in the US are people of colour. She knows that she and her sisters have hired poorly paid and possibly undocumented women to help their mother. The choice, as she sees it, is her life or theirs. Tillman can’t bring herself to ‘forsake my privilege’. ‘I could have done that by living with Mother … [But] I would have thrown myself out of one of the many windows in her apartment high up on the 24th floor.’

It’s in the descriptions of these carers – women who are both inside and outside the family – that Mothercare begins to resemble a typical Tillman novel. She demonstrates the same talent for compression, the same affection for bizarre behaviour, that characterised earlier books such as Haunted Houses and Men and Apparitions, both of which have recently been reissued. Of one carer: ‘Patsy slept in Mother’s bed at night to comfort her which was kind and Mother liked it, but she proved to be a lunatic and we had to fire her.’ Another, nicknamed Hats, wears unusual headgear and accidentally doubles her mother’s seizure medication. To keep her happy, Tillman buys her a large cake.

One helper, Lois, moves to Florida and recommends her cousin, Sharon, as a replacement. Sharon turns out to be hopeless and is fired almost at once, something Lois considers unforgivable. When Tillman calls her to talk things through, Lois pretends to be somebody else. ‘When I said, “I know it’s you,” she told me I was confusing her with her cousin. I rarely confuse voices, and it was absurd.’ The greatest pathos is reserved for Frances, her mother’s longest-serving companion, who is devoted but light-fingered, stealing small things here and there as though out of impotent fury at her employees. The relationship ends badly. Tillman is much happier to report on these women – detached curiosity has always been the driving force behind her work – than on either of her sisters, about whom we learn almost nothing.

Towards the end of the book, Tillman is given the task of arranging the seating plan for her mother’s birthday party. Where does she put the rude knitting teacher? What about the ‘next-door neighbour, who suffered from the sin of gluttony’? It’s a ‘miserable job’, but it’s also a microcosm of the way the novel works. Tillman herself often retreats from view; instead, the narrative tracks the other personalities in her mother’s orbit and the roles they play in keeping her alive. Perhaps because Tillman isn’t a needy writer – she doesn’t perform self-satisfied tricks, she doesn’t concede, her bursts of humour are surreal and self-contained, close to private jokes – Mothercare is a peculiarly un-American book, free of self-actualisation or therapy speak. It’s an egoless memoir, a messy house. ‘Redemption,’ Tillman tells us, ‘is an American disease.’

But eventually we have to ask the dreaded question: what about your relationship with your mother? ‘About Mother,’ Tillman writes, ‘I never felt guilty. Anything I gave her was more than she deserved. That sounds awful. I wanted to behave as I wished she had towards me.’ She sometimes refers to her mother by her full name, Sophie Merrill, and recounts with dispassion details of Sophie’s upbringing as the child of first-generation immigrants, her relationship with Tillman’s father, her tactlessness, her competitive nature, her resourcefulness.

Tillman doesn’t pull her punches: ‘From the age of six, I had disliked my mother but I didn’t wish her dead.’ If she has uncharitable thoughts towards her mother, the feeling’s mutual. A friend praises Tillman in front of Sophie and is met with a barrage of insults. Whenever the conversation turns to Tillman’s work, her mother brings up her own writing, which Tillman hasn’t helped her to get published (it consists of one short story about a cat called Griselda). This bad behaviour is barely remarked on, but Tillman does admit that she finds it hard not to envy her mother’s unflappable narcissism. At one point, Sophie sits up in bed and announces: ‘If I had wanted to then I would have been a better writer than you.’ After her death, Tillman learns that her mother said the same sort of thing to her singing teacher and her massage therapist. She enjoyed testing her daughter’s limits. As Emily’s mother says in Haunted Houses, ‘I didn’t realise I could hurt your feelings.’ But isn’t it fun to try?

What Tillman most resents is the loss of her freedom. Haunted Houses follows a trio of strange girls who never meet as they move from childhood into adult life (‘She prided herself on her ability to separate neatly body from mind, self that was hers from self that she gave away’). In Weird Fucks (1978), about a series of odd, intense sexual encounters in the 1960s and 1970s, Tillman writes at breakneck speed, as if racing to get her impressions down before being diverted again by a new partner, a new city: ‘I was a slum goddess and in college. He looked something like Richard Burton; I resembled Liz. It was, in feeling, as crummy and tortured as that.’ Weird Fucks is a youthful book – people drift in and out of one another’s lives and beds, they live in bars and cafés, they move countries easily, packing up their belongings and abandoning their lovers. It’s all one long seduction game. ‘I’d sit at the counter with hot coffee mug in hand, unable to speak, heart located in cunt, inarticulate.’ Worries don’t figure.

In Mothercare, life is stuck, weighted not only by obligations, but by instruments, procedures, nurses, doctors, medication. What happened to irresponsibility? Tillman doesn’t handle the transition gracefully: ‘My life felt narrower, and not my own. I gave up some of my life, that’s the kind of thought I had, common to us who don’t want to do what we feel obliged to do. A sacrifice. I rebelled against that loss of freedom.’ She is ageing too. ‘My possibilities and fantasies were being stolen by Mother, whom I didn’t love,’ she writes.

In Men and Apparitions (2018), a character called Ezekiel remembers that as a child his parents were always telling him ‘to act like a grown-up’. Why? Tillman seems to ask. What could be more awful? Mothercare was an uncomfortably grown-up book for her to write, and she acknowledges as much. On the moments after her mother’s death: ‘We saw it, that black rubber bag, for a few moments. Mother was just a thing now, anomalous, an object, nothing anymore … This was done to everybody, anybody, the impersonalness augmenting her new nothingness.’

Mothercare shows us the end. Reading it, you feel Tillman’s clammy grip on your wrist reminding you not to waste time. She offers a writer’s prescription: examine the world closely, and as only you can. Emily in Haunted Houses is one of the lucky ones. She grasps this early:

Her private life was her business. She owned it like a coat or a record. She imagined a sign on an office door that read Fantasy – My Business, and she’d be a kind of detective operating a lost-and-found … What she thought about when she stared out a window or rode on a bus or looked in a mirror over a bar, that was hers. Or that was hers, that momentary sensation. In a way, she thought, it was all anybody ever really had.

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