Are we defined by our parents? That is: are our personality and temperament established the moment we emerge from the womb? Or can we escape the flaws of our predecessors and the legacy of the cruel acts they’ve perpetrated, and create new, bolder identities for ourselves?

The age-old nature vs. nurture debate is at the heart of Ellen Ullman’s novel By Blood (Farrar, Straus and Giroux), set in 197s San Francisco—a period when the Zodiac Killer and Patty Hearst loomed large. A university professor relocates to a downtown office after a scandal forces him to take leave. Through the thin walls, he eavesdrops on the psychiatric sessions of a conflicted woman, unhappy with both her adoptive family and her critical girlfriend. Both the professor and the woman’s therapist, haunted by their respective family histories, seek to alleviate their distress through the patient. One of them hopes that the patient will embrace a tabula rasa perspective of her genetics; the other encourages her to find her birth mother.

The professor’s role as intrusive narrator—a voyeuristic substitute for the reader—injects a sense of pervasive unease as he worries about being caught, never again to hear “my dear patient.” Since he serves as our only guide, the narrative occasionally strains to provide him with opportunities to pick up key moments of the patient’s story.

Ullman, herself an adopted child, offers a sympathetic portrayal of the unnamed patient, who is insecure and at times prejudiced, but whose desire for love and acceptance, and whose harrowing journey, make her a heartbreaking heroine and the book a compelling and worthy read.