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The Madeline of Jane Hamilton’s rich new novel, “When Madeline Was Young,” is a child in a woman’s body. Having grown up, gone to college and married, young Madeline Maciver has a bicycling accident resulting in severe brain damage that leaves her, after a long convalescence, with a mental age of 6. Her husband falls in love with her nurse, whom he marries after divorcing Madeline in a way never explained here, and the two of them take care of Madeline as one of their children. She has no recollection of her marriage and much prefers her “mother” – that is, her ex-husband’s new wife – to the man she had once married.

Hamilton acknowledges a debt to Elizabeth Spencer’s 1960 novella “The Light in the Piazza” (also a film, with George Hamilton, Yvette Mimieux and Olivia de Havilland), in which a young woman with less severe brain damage is courted by an Italian, raising the question of marriage.

In “When Madeline Was Young,” a similar incident has occurred while Madeline was single and unimpaired: A young Italian met her in a Florentine piazza and stole her heart.

The novel works out the implications of the unusual family situation produced by Madeline’s injury and her husband’s remarriage in sensitive and inventive ways. Though Madeline is girlish and even in middle age most enjoys playing with the little girls of the neighborhood, she has the needs of a woman and becomes “engaged” to a man of her own age, also brain-damaged.

Madeline’s affecting story, including a possible remembered glimpse, late in life, of her youthful encounter in the piazza, is only part of a complex family story of the Macivers, including friction between cousins and in-laws, political quarrels, disruption and death.

The narrator, Timothy, nicknamed Brains, is a middle-aged surgeon whose memories of growing up with Madeline (who never grows up), his strong-minded musical sister and a large extended family focus most strongly on his first cousin Buddy. Buddy is older, more confident, sexually experienced and a leader to the Maciver boys, someone who effortlessly makes Timothy feel inadequate. He is also coarse and intolerant.

Buddy joins the Army and serves two tours in Vietnam, and in the “present day” of the novel, is burying his son, who was killed in Iraq. His mother, Figgy, is one of Timothy’s main informants – she knew Madeline before the accident but finds the odd family arrangement repellent. She is married to a Johnson administration official committed to the war, while Timothy’s mother is an outspoken pacifist, a conflict that leads to an angry argument and a decisive rupture.

There may be a bit too much plot in this novel: The oscillations between present and past sometimes come too frequently, Timothy’s wife never becomes clear to the reader, and the pathos of Madeline’s life gets pushed aside by Vietnam and the first and second wars in Iraq.

But it is a finely imagined history, subtly combining the universal (those features all families share) with the unique (the married couple raising the husband’s afflicted former wife). Particularly adimirable is the transgendered skill with which Hamilton impersonated a boy/man as her narrator and principal observer and made him believable, an accomplishment as impressive as her successful reimagining of “The Light in the Piazza.”

Merritt Moseley is a professor of literature at the University of North Carolina-Asheville.

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When Madeline Was Young

By Jane Hamilton

Doubleday, 288 pages, $22.95

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