What spurred Lynne Tillman to write Mothercare, her first work of memoir, is in many ways a mystery. In a long and prolific career of writing fiction, criticism, and essays, she has avoided personal writing and does not seem to feel liberated by it now. “I have strong reservations about doing it,” she writes, “and now I am doing it.” The book is Tillman’s account of her mother’s decline from normal pressure hydrocephalus, a form of dementia caused by excess cerebrospinal fluid accumulating in the brain. Mothercare chronicles the experience, recounting it through surgeries, doctors’ appointments, the hiring and firing of live-in caregivers. Obtaining a proper diagnosis and care proved difficult in the 1990s, because normal pressure hydrocephalus was not widely understood at the time and was frequently misdiagnosed as Alzheimer’s, which, unlike NPH, is not reversible. Once the illness was identified and a treatment found—a shunt to drain the fluid—the difficulties continued: The shunt backed up repeatedly, like rickety plumbing, causing seizures and other debilitating neurological problems. Tillman’s mother was incapacitated for the rest of her life: 11 years of illness and dependence.

Mothercare is billed as an odyssey through our “unnavigable medical world,” but though the book largely takes place in the medical world, it’s not about that. Instead it skates on the surface, directing blame at individual caregivers: the aide who was a “lunatic,” the hospital interns who were “lame,” the neurologist who was too “arrogant” to reconsider an initial diagnosis. Geriatric medicine, Tillman argues at one point, is not of the caliber it should be because doctors are scared of how “the elderly represent mortality.” She mentions money only once, to say:

Without Medicare, it would have been impossible to give Mother the care we did. Her savings, which could have lasted for her lifetime, would’ve been savaged, my sisters’ and my finances decimated. Medicare paid for her operations; and, with co-pays, also her doctor visits. All of Mother’s doctors took Medicare assignments. Still, be prepared: Medicare statements and bills are confusing. What has been paid, what hasn’t, is hard to figure out. Luckily, we were helped by a family friend who did that work professionally.

That “Still, be prepared” gestures toward a desire to be helpful to others that runs through this book, but it never goes further than this. Even when Tillman addresses the political currents of a situation, she does not fully confront the implications. On hiring aides—often women of color—Tillman writes:

My privilege lived through the after-effects of colonialism and imperialism. The terms and effects were not abstract, they were personal, embodied in the women we were able to hire to care for Mother. I was conscious of it, but didn’t forsake my privilege.

Later she admits, “Sometimes overwhelmed, I lost time and capacity to think clearly, if at all, about the ethical questions raised by her needs and our finances.”

Tillman approaches her mother, and her sisters, with a similar reluctance, to fascinating effect. To provide backstory, she turns not to memories or stories of her mother but to old photographs: “Sophie Merrill is always fashionably dressed, often wears a cloche hat, or lets her long dark hair flow freely down her back.” When she writes about her mother’s aging body, she does so with clinical remoteness: “She lost her bowels on the living room floor” is how a seizure is described. This lack of tenderness is deliberate. Early on in the book, Tillman writes, “My possibilities and fantasies were being stolen by Mother, whom I didn’t love.” It’s exhilarating to hear this said point-blank: a delicious taboo that is as seldom admitted as it is frequently thought. With it, Tillman pushes back on the sentimental idea that in moments of crisis, our emotions rise up to carry us through. “To care” is both an action and an emotion, and Tillman reminds us that they are distinct.

Rather than loving her mother, Tillman resents her for her “meanness and selfishness,” which became less pointed but also less disguised as she aged. Tillman does not relish the chance to tell vengeful stories, as some memoirists might. She simply wants the reader to understand how unbearably onerous the demands of caregiving become when they are driven by duty alone. “Sometimes I imagined I loved her, she loved me,” Tillman writes. “Illusions helped me cope.”

In an essay for The Nation about Tillman’s “obsessive and maddening prose,” Haley Mlotek wrote, “Tillman’s writing is truly her own.” In The New York Review of Books, Laura Kipnis wrote that Tillman’s literary project is an attempt to reject “all the forces standing between writers and our freedom, goddamnit, and finally make a break for it.”

In Mothercare, Tillman’s mother comes to embody the force that stands between Tillman and her freedom. “Walking away from Mother’s apartment, I breathed air that wasn’t hers. That felt free,” she writes. Even before the demands of illness, Tillman’s mother represented confinement in her mind. Of going to sleepaway camp when she was 8, Tillman confesses, “Being away from her and a family that was contentious and fighting, living in a new setting with new people, offered a sense of what the future might bring: Freedom…. I didn’t miss Mother.” Tillman says repeatedly that she could have put her mother in a home and regained her freedom completely. Much as she wanted to, she could never choose her own life over her mother’s.

The burden of caring for a parent is practical, but it is also psychic in nature. Tillman says that during her dependence, her mother was no longer able to hide her competitiveness with her daughter.

When she was ill, and before then, if someone mentioned my writing, she would interrupt, “Lynne, when are you going to publish my cat story, about Griselda?” She wanted attention for her writing when mine was mentioned…. I told her one day I’d get it published. Then she would be mollified.

Tillman’s mother’s story is about the family’s cat, which she took to a shelter after it killed Tillman’s pet parakeet. The short story remained unfinished, and her mother’s dreams unrealized, because she never wrote about the parakeet’s death and Griselda’s abandonment—the part of the story that would assign blame, either to Tillman or to herself. Then, in an astonishing moment, Tillman excerpts her mother’s story in her book. Is Tillman capitulating—posthumously mollifying her mother by fulfilling her wish? Or is she snapping back—showing once and for all that her mother will only ever be a source text in her book? This encounter is so psychologically overcrowded, it’s not clear. Either way, her mother has long since died, but in Mothercare Tillman continues to wrestle with her, to live on her terms. (The book’s cover features a cat, slinking between letters of the title, its shadow cast over the word “Mother.”)

It makes sense, then, that the difference in form and tone between this book and Tillman’s other work is so stark. That contrast is on full display in her most well-known novel, American Genius: A Comedy, which is about a historian named Helen who is staying at what is either an asylum or an artists’ colony (their indistinguishability is the root of the comedy). American Genius is made up of a circular stream of consciousness—riffs that double back on themselves, connected by a thrillingly tenuous associative logic. In one sequence, the narrator contemplates sleeping, the Manson family member Leslie Van Houten, sly glances from men, the ocean, salad dressing, the legal conception of ownership, and Leslie Van Houten again. It’s as wonderfully, exuberantly erratic as it sounds. Men and Apparitions, Tillman’s most recent novel, employs a similar device: The narrator, Zeke Stark, is also an academic, allowing for wild digressions on his research into family photographs and the theory that undergirds it. One of Tillman’s most ingenious creations is Madame Realism (a feminine play on Sir Realism), a narrative persona that allows Tillman to straddle fiction and criticism, to deliver ideas from in-scene. Madame Realism is an invented art critic, who offers her observations from within short stories in which she visits museums, watches television, and reads, but also sleeps, smokes, and gets nose bleeds. The stories are, for the most part, told in a close third person, skirting the assumption that Madame Realism is Tillman in disguise. Through her use of Madame Realism, Tillman dodges the expectation of authorial authority that comes with presenting oneself as an art critic who speaks the definitive truth. Instead, she can trace the bodily sensations that give rise to a subjective experience, capturing the kinetic quality of thought as much as its contents.

But in Mothercare, that thought has slowed to a crawl. Nothing reminds Tillman of anything; nothing catalyzes her imagination. She seems entrapped by the moment and the duty to describe it—unable to breathe air that is not her mother’s. When speculating about the meaning of the word “to fire” (as in an employee), she writes, “Maybe Foucault mentioned these etymologies in Discipline and Punish. I’ll check.” But she never does. It’s like she doesn’t have it in her.

Tillman gestures to a desire to make art out of this experience, but she does not draw upon it here. “If I were to write a novel whose protagonist was a companion, she would be mysterious, intelligent, charming, enigmatic, a good worker with ambition and ambivalence,” she writes. But she makes no attempt to characterize the aides she knew. She seems to find memoir less like writing and more like an ungratifying attempt at unburdening. “No consolation came from discussing Mothercare problems, and sympathy didn’t help me, it actually made me feel sorrier for myself,” she writes.

This conflictedness never abates. Near the end of the book, Tillman writes: “Exposing myself, Mother, a family’s inner workings, in this account, is strange to me, very uncomfortable, even disturbing.” How funny, I thought, to call these “a family’s inner workings” when everyone feels so deliberately cloaked in anonymity. So few of the particulars that make up character or interpersonal dynamics are revealed here. “There were differences among us sisters as time went on,” reads one exemplary sentence.

Stymied by this withholding, the book moves forward without an engine. Tillman does not conjure her mother because she misses her but because she is haunted by her. She does not want a deeper understanding of this time; she needs, it seems, to get it out of her system, even though the act of doing so makes her uncomfortable all the way through. This is not a criticism. The reluctant trudge forward mirrors the way that Tillman describes caring for her mother until the end. “The weight of responsibility never lessened,” she writes at one point. Or, “I never entirely became used to it. I just coped better.” After her mother’s death, she tells a friend that she regrets having spent those 11 years on her. “But don’t you feel good about yourself, because you did it?” the friend asks. Tillman responds, “I didn’t. I felt my sacrifice, if it was, was wasted on her. Now I have to let go of that.” There was no transformation experienced, no meaning made, no insight gleaned—all the things we hope might justify suffering, or be found through writing.

Yet, again, Tillman makes it clear that writing Mothercare did not have much in common with her usual creative work—neither in its pleasures nor its process. “If I use something that happened to me in a story or novel, the experience comes into it, not my feelings about it,” she writes. In this memoir, it is only her feelings that she writes about with certainty. Tillman writes less to illuminate the process of grieving or care than to make the reader share in the state of stultification, guilt, and self-doubt that she experienced in that time. This is the aspect of her story that Tillman renders most vividly and evocatively; it is the book’s true subject and its greatest triumph.

Otherwise, her mistrust in her ability to convey the truth of the situation is palpable. It is the inverse of the Madame Realism stories, which allowed Tillman to make use of her imperfect perceptions unselfconsciously. Without that fictional freedom, she feels too exposed. On the second page of the book, she writes, “My sisters would tell different versions of the same events and relate other events…. This is a partial picture, told from my vantage point, and possibly to my advantage, though I hope to write against that tendency.” It is that intention to “write against” herself that dictates the mode of the book. Instead of writing anything truly personal, which would involve embracing her vantage point in order to portray a world and tell a story, she lays everything out plainly, beat by beat, and asks the reader to determine the truth. Seduced by her mother’s competitiveness, she presents their respective writings and asks us to decide whose is better. Challenged by her sisters’ versions of things, she recounts what she did for her mother and lets us determine whether it was enough. As much as she may have wanted to, she could never choose her own perceptions over her family’s. But to write a memoir is to make the attempt, and this is reason enough to do it.