This recommendation comes from Sarah O. Follow her on Tumblr at tales-and-tea.tumblr.com and on twitter @tales_and_tea.
Sarah Canary (1991) by Karen Joy Flower
"When black-cloaked Sarah Canary wanders into a railway camp in the
Washington territories in 1873, Chin Ah Kin is ordered by his uncle to
escort "the ugliest woman he could imagine" away. Far away. But Chin
soon becomes the follower. In the first of many such instances, they are
separated, both resurfacing some days later at an insane asylum. Chin
has run afoul of the law and Sarah has been committed for observation.
Their escape from the asylum in the company of another inmate sets into
motion a series of adventures and misadventures that are at once
hilarious, deeply moving, and downright terrifying."