We are delighted to present NB’s Recommendation for the month of February: the chilling and atmospheric Sanatorium by Sarah Pearse. To kick off our month-long celebration of The Sanatorium (we’ll be posting every Friday, so keep your eyes peeled) Paul Burke spoke to Sarah Pearse about the inspiration behind her outstanding debut.

Questions by Paul Burke


Paul Burke: Congratulations on your debut novel. I have to ask what was the inspiration for The Sanatorium, set at a luxury hotel, a former tuberculosis clinic, in the Swiss Alps?

Sarah Pearse: Thank you. My inspiration for the novel came from living in Switzerland in my twenties. I was immediately drawn to the mountains – strikingly beautiful, but also really raw and wild, a combination that I find mesmerising. It’s a stunning place in both summer and winter, but for me, the winter is when it’s at its most dramatic. When the snow starts falling and totally transforms the landscape, you get a real sense of nature’s power and the inherent dangers, and I thought this backdrop would be perfect for fiction.

The idea of setting the novel in a converted sanatorium came about after reading an article in a local magazine about the legacy of tuberculosis sanatoriums in Crans Montana. Sanatoria were the main driver of people coming in numbers to the town but when antibiotics became available in the mid-twentieth century, some were converted into hotels, as part of the town’s winter tourism industry. This sparked my imagination and I started thinking about the darker side of this – how would it feel to stay somewhere that had once been a hospital, a place where many people lived and died?

As I researched, I began to think an old sanatorium would be the perfect creepy, gothic setting for a novel. I’m fascinated by repurposed buildings in general and I loved the idea of making the building itself a character within the novel, exploring the idea that the history, the energy and malevolent forces of the past might still be lingering despite its conversion.

I was also captured by the architecture of sanatoriums, in particular, how they were often designed according to the principles of ‘functionalism’ – the design and décor optimized to stop the spread of infection and help tuberculosis patients recover (the building itself utilised as a medical instrument.) The design of these buildings was so influential that early 20th Century Modernist architects picked up many key elements of the minimalist design of sanatoria – large windows, balconies to maximise sunlight exposure, clean, smooth surfaces without clutter, floors and walls clear so there were less places for germs to hide.

I started thinking about how this minimalist, clinical design might be used in the hotel itself and how a guest might experience this. I thought it would be a great way to heighten tension in the novel, especially if some reminders of the building’s clinical past were included within the design.

It was also inspiring that these sanatoriums were often based in remote, high altitude locations – not only for health reasons, but to stop the spread of infection. I really wanted to use this isolation to put my characters, especially Elin, my detective, under pressure.

Whilst researching, I also learnt about sanatoriums in Switzerland (and elsewhere) for people classed as ‘morally insane.’ In the nineteenth and early twentieth century, many women were placed in medical care for spurious reasons by a male guardian, often diagnosed with ‘Nervenkranke’ (those ill in their nerves). Sometimes this was a guise to take control of an inheritance, or to suppress independent thought and ideas. Some women spent decades being ‘treated.’ This gave me the idea of exploring this theme within the novel (including with my detective, Elin, and how she is treated because of her emotions) and the echoes with the present day where women are still being judged for their feelings and experiences.

PB: The Sanatorium is an atmospheric and claustrophobic thriller embracing classic elements of the horror genre. Did you always envisage such a dark and brooding story?

SP: Yes. I love reading dark and creepy novels, so it was a natural step for me to write something in this vein. I love the tension and intensity you get with a dark story – that unsettling feeling that makes your hairs stand up on the back of your neck. I think that feeling often comes when a story manages to tap into your worst fears and anxieties. From the minute I read about old sanatoria and started researching, watching videos filmed in abandoned clinics and examining archive photographs, my imagination took me to some sinister, eerie places, all rooted in my own fears, and I knew that I wanted the story I was about to write to take a dark turn.

PB: The weather plays such an important part of the novel, it’s more than a backdrop, tell us about that please.

SP: I wanted the weather, like the setting itself, to almost become a character within the novel. I think weather can be as powerful within fiction as it is in the real world – it can help influence not just the character’s emotions within the story, but the reader’s too. Extremes of weather can create conflict and tension in a narrative that reflects and magnifies a character’s inner landscape and the wider narrative too.

The stormy, snowy weather in The Sanatorium perfectly complements the brooding mountain setting. I think that in the Alps, the mountains themselves and the weather are naturally intimately intertwined – the weather has a huge effect on how safe or how dangerous they feel as a location and I wanted to use this to advantage in the novel. By setting The Sanatorium during a storm, you are immediately working with the dramatic, isolated Alpine setting to build a horrifying sense of unease for both reader and the characters in the novel.

When the threat from the weather intensifies in the novel, it not only brings dramatic tension to the narrative – isolating Elin and the guests from the Swiss police and any potential route to escape, but also perfectly complements and amplifies her inner turmoil and her feelings of being trapped and scared, something I hope the reader feels as well.

PB: The Sanatorium is a novel emotionally haunted by the past; character have their own secrets and the building itself is drenched in mystery. Did you enjoy creating that ghostly feel?

SP: Yes. I think the idea that your own memories and misperceptions can haunt you is something extremely powerful. I think one of the things we take for granted is that we know ourselves better than anyone – the idea that we might not and that we can’t trust our own recollections is something deeply unsettling.

I also wanted the building itself to be seeped in the past and with visible reminders of that past everywhere, despite the new design. I tried to do this through both my description and my character’s perceptions of the hotel. This is something I love doing while I’m writing – using detail and suggestion to toy with the readers. I think there’s a sweet spot in fiction where you can hint at something – be it something ghostly, or sinister, or an emotion in itself, and then let the reader’s imagination fill in the gaps. This is often far more powerful then spelling out something explicitly.

PB: Detective Sergeant Elin Warner is at a crossroads in her life when she arrives with partner Will for the engagement party of her estranged brother, Isaac, to his fiancée, Laure. She is deeply troubled but everyone will soon have to rely on her. Tell us about Elin.

SP: I loved creating Elin as a character as she is complex, challenging and can be controversial – as I believe every woman to be. Having a female detective was really important to the novel as I wanted Elin’s emotional state and how it is dealt with by the people around her, to mirror one of the themes of the novel – how women and their emotions and experiences often aren’t taken seriously or are weaponised against them.

I wanted to explore the fact that people sometimes struggle with women or indeed men, openly expressing their emotions and how it’s often dismissed as ‘irritating’ ‘a flaw,’  ‘a weakness’ or ‘paranoia,’ often disqualifying them for being taken seriously in the workplace or in their personal life. This has the knock-on effect of people feeling unable to speak up about their feelings or experiences in case it reflects poorly on them. I think there’s still an overriding sense of the need to ‘man up’ or ‘woman up,’ because someone being open about their experiences can make people feel uncomfortable. People often choose to ‘look the other way’ rather than listen, as explored in the novel, which can have devastating consequences.

I thought it was really important that Elin was a woman so she could see the world through this lens and understand why the women in the novel might be motivated to do what they do. Not only that, I wanted to show her as going through similar experiences, particularly in her role as a female detective. I’ve tried to make her a complex character with a rich emotional life who has experienced past trauma and has wrestled with the confidence in her ability to do her job.

I wanted to show in the novel working through complex emotions and anxiety, as someone may well be doing in real life and show how the characters around her react to this as she goes about her work. I was keen to show her visible struggle and gradual journey back to confidence while she’s working as a strength, not the weakness that it’s often perceived to be.

I’m sometimes frustrated reading other novels featuring female detectives when they’re given what are traditionally seen as more masculine traits and attributes in order to fit into what is ‘expected’ from a detective within the genre. Often this amounts to suppressed emotion portrayed through the tropes of alcoholism or addiction. I wanted to show Elin as able to openly express her feelings and still to be able to do her job despite the very real possibility of judgement by both the characters in the novel and readers alike.

This reader experience is really interesting to me. I wanted to explore whether readers judge female characters in fiction and hold them to a different standard to their male counterparts as in real life, again a parallel with the themes in the novel. By making Elin a female detective I’ve tried to provide readers with a character who may challenge their expectations of a detective and also how they perceive someone who is open with their emotions and experiences.

PB: When the hotel is cut off from the outside world by an avalanche Elin has to investigate a murder, a disappearance and try to protect the remaining guests and staff, the Swiss police can’t reach them. Given that Swiss law is very different and Elin has no jurisdiction how did you ensure this was authentic?

SP: While in Switzerland I visited the Valais Police, based in Sion. I was lucky enough to sit down spend time with a senior sergeant there and meet the regional commander to run through the story, its plot points and Swiss police procedure. We had some fascinating ‘what if’ discussions both in person and over email which helped greatly with the plotting.

PB: memory is a theme in the novel, the things people remember and the things they forget or block out, (false memory). The psychological drama is fascinating, how do grief and guilt and, even, shame shape the narrative?

SP: I wanted to explore in the novel was the idea of how precarious our own memories can be and how we are able to fool ourselves as self-preservation. I think this aspect of the human psyche is what I find most fascinating – how people can believe with absolute certainty that they know themselves, but in actual fact their own mind and perception of self might not always be reliable. I believe our subconscious mind is capable of extraordinary things, protecting and shielding us from experiences and memories that might be too much for our conscious mind to deal with. The plot of The Sanatorium and indeed Elin as a character, hinge on this idea and the way guilt in particular is something that we struggle to come to terms with. I think many people have issues accepting responsibility for their actions and choosing to look the other way or deceiving themselves is often the easiest way to deal with it.

PB: The Sanatorium is very contemporary but there’s a nod to the locked room mystery, the potential victims are trapped and isolated with a killer/s, these are tropes from the golden age of crime. Was that an influence on the novel?

SP: It was! I love locked room novels. I think the innate friction and conflict that comes with placing a group of characters in an isolated, claustrophobic setting has a certain magic. The simple fact that there’s no escape and no magic bullet of anyone else coming in to help, such as rescue teams or police, means your characters, in this case, a detective too, are pushed to their physical and emotional limits which is really fun as a writer to explore.

PB: Agatha Christie or Stephen King?

SP: I’m not sure I can make the choice between two great authors! However, partly as she lived in my town (!), I’ll edge towards Agatha Christie. I’ll never tire of her characters or the exotic settings she places them in, and I adore her ingenious plotting. I love the dichotomy within her books – the ‘comforting’ aspects of a cosy murder mystery juxtaposed with the deeply unsettling way she skewers class and familial / relationship dynamics, something that can often be as chilling as the murders themselves.

PB: Will we hear from DS Elin Warner again? (I don’t want to say much because of the ending)

SP:  Yes. I am – in my next book, Elin returns to her job as detective in the UK police force in another dark and dramatic setting with a complex case that pushes her to the edge in both her personal and professional life. Elin continues to struggle with her relationship to her past and her way of blocking out troubling memories, as another secret from her past comes to light in a terrifying way.

Thank you Sarah!

Publisher : Bantam Press (18 Feb. 2021)
ISBN-13 : 978-1787633315