Plot: Visit from the health visitor

Set roughly midway through the novel The Trick is to Keep Breathing, this scene initiates a turning point in protagonist Joy’s mental health decline.
The Health Visitor comes to Joy’s home after being alerted by neighbours, indicating a concern from the external community about Joy’s state of well-being.
Joy’s interaction with the Health Visitor represents her struggle to maintain an appearance of normality and control despite the chaotic and deteriorating circumstances of her life.

Joy’s attempts to carry on a normal conversation with the visitor despite her erratic thoughts show her fight against her declining mental health.
The Health Visitor’s polite but insistent questioning uncovers the worsening state of Joy’s physical and emotional health.
The interaction ends abruptly when the visitor leaves after advising Joy to get some help, emphasising the frustrating disconnect between institutions of care and the individuals they’re meant to help.

This visit from the Health Visitor acts as a physical manifestation of Joy’s struggles, shifting the narrative from her internal thoughts to an external interaction.
The scene accentuates the societal stigma around mental health and how it can contribute to the sufferer’s feelings of inadequacy and isolation.
The disconnect between Joy and the Health Visitor is indicative of Galloway’s wider commentary on the shortcomings of institutionalised mental health support.

Mental Illness: The scene vividly portrays the effect of Joy’s deteriorating mental health, both on herself and the way she interacts with others.
Isolation: Despite the presence of another person, Joy’s inability to genuinely connect with the visitor intensifies her feelings of isolation.
Societal Expectations: The visit from the Health Visitor forces Joy to grapple with societal pressures to appear ‘normal’, despite her worsening mental health.

“Her face was friendly, but her eyes were not.” - Visual representation of the disconnect between the professional smile of the Health Visitor and her internal displeasure or concern.
“I’m surviving, I told her again.” - Joy’s desperate insistence on her coping mechanisms highlight her struggle to maintain a façade of normalcy in front of the visitor.