This was gutting. I think it was generally very well done, although—even though it went to lengths to avoid a comfortable, tidy conclusion—the ending was still a bit pat for my tastes. To get my complaints out of the way, especially annoying to me about the ending was:

the description of Martha's relationship with Patrick having been mutually destructive—"we ruined each other's lives." I think there's some analysis to do about Patrick as an enabler; maybe this is what Martha means, but I do think this lets Martha off the hook for what is pretty egregious behavior, when Patrick's behavior—if misguided and briefly cruel—was generally much less egregious, much less cruel, much less ruinous overall than Martha's. I'm putting this here because characterization of Martha's behavior as cruel is I think at the crux of the book, and I'm going to discuss it again.

Some overly personal background. Last year I was struggling quite severely with what I thought was depression; it was interfering with my life, putting pressure on my relationship, and this had been going on for years. I had recently been assigned a family doctor for the first time in eight years, so I did a mental health screening and—though I struggled with what my doctor described as mild symptoms of depression—my much bigger problem was anxiety. My anxiety was not news to me; I had first been diagnosed with an anxiety disorder at 18, and I have struggled with it and others like it ever since; I know where I got it and I know it has defined my life. But the news that, if I had depression, I was coping with its symptoms relatively well (the textual reason I had gone to the doctor was "constantly falling asleep in the middle of the day," which it transpired was tidily addressed by an iron supplement) allowed me to let go of my identity as a person who struggled with depression. This changed my life.

This book is ultimately about how mental illness defines us or fails to define us. Martha spends 23 years unsuccessfully trying to diagnose and treat her mental illness until, for some reason, one random or particularly empathetic psychologist gets it right. Her illness is never named; there is a note at the end that denies Martha's symptoms are about a real mental illness, which is rendered in the text as __. This is a very interesting choice, one I respect, and one that neatly circumvents what the book itself complains about, which is inaccurate, troubling, and moreover stigmatizing representation of mental illness in media.

The illness is coded as, or is an analogy for, Bipolar disorder, specifically Bipolar II. The book knows what it's doing; it's not throwing random symptoms in a blender. This is important to me as a reader, because I have wondered at various parts of my life if I had Bipolar II (I no longer believe I do), and I have wondered—continue to wonder—if my mother, an alcoholic who was frequently very cruel to me, had Bipolar II. Martha's nameless mental illness is quite explicitly, at length, noted to be hereditary; of course Bipolar is said to be one of the most heritable mental illnesses. These factors invested me with particular strength in this narrative.

Proper diagnosis and treatment allows Martha to change her life, but by no means does she manage this instantly. One of the things the book does really well is that it complicates the narrative that good treatment makes all the difference by continuing to make Martha's comparatively "well" behavior incredibly toxic. She continues to make choices that are cruel, particularly to her husband. The book opens on a scene of such cruelty to her husband, and one of the kickers is that—by the time we get to that scene in the chronological deconstruction of her life to date—we eventually learn that her illness is actually managed in that scene.

In other words, it is not solely the mental illness that has made Martha's life a fiasco, though, again, the book does a very good job at things like describing Martha's horror at watching her own violent behavior as though from without herself. She is a woman who, her final psychologist notes, has been in a great deal of pain for a very long time. Her capacity for cruelty does not come from a place of wanting to be cruel, not even once. But she drew a bad genetic hand. Her luck has been bad, she has suffered so profoundly, and she is so, so angry. As Patrick later deconstructs textually: though she swallowed a great deal of that anger and turned it inwards and has been unkind to herself most of all, there was so much anger that it leaked out toward whomever happened to be in most frequent proximity to her simply because they were there.

The book does an excellent job of painting mental illness as a great tragedy, as well as a fact. It shows what is in people's control and what is out of it. Sometimes what's not within your control bleeds uncontrollably onto what is, and the things that are within your control are variable. It does this using a great deal of comedy. It is a very funny, profoundly painful book. This is its greatest achievement—how well it balances tone. Martha's relationship with her sister is extremely funny; giving someone in this story a strong sense of humour was a powerful choice. The Jonathan interlude is unfortunate, but his description is fundamentally satirical and comedic. Without these things, the book could not have been as compelling as it was. I had one moment in the front third where I sensed a slowness, but otherwise I also found it paced very well—impressive for a character-focused book that spans 25 years.

My issues with the ending are fundamentally mild, because I think the book ended with care and grace, and a great deal better than others like it would. One of the powerful messages of the book comes in the form of Martha's realization that she never asked Patrick what he was going through, being married to her. The reader has a reasonably expansive idea that, as he eventually put it, "it fucking sucked"; the book does a good job of describing throughout how he is cleaning up after her, getting hit by things she has thrown, and so on, and he alludes to those factors in dialogue again.

But what the reader doesn't have a good idea of is why he continues to choose to love her. It is presented simply as a fact: he just does. He always has, and so he continues to, despite her cruelties and quirks. I struggle with this in books like these that are also love stories. This is, I think, a problematic view of mine, but it is honestly held: for a relationship to work between a person who habitually struggles with mental illness and another who habitually does not, there has to be something the relationship offers the normative party that makes the bullshit mental unhealth creates worthwhile. This is a problem I have faced in my own relationship, where I struggle and my partner generally doesn't. This is a problem I long identified in my parents' relationship, which has similarities with Martha's parents' relationship in the book. When Martha asks her kind and tolerant (though, in contrast to Patrick, professionally unsuccessful) father why he stays with her difficult, alcoholic, probably bipolar mother despite it all, he says again, simply, that he loves her.

What could this mean? Martha's mother later repeats a line that a marriage is its own ecosystem, fundamentally unknowable to parties outside of it. This message of unconditional or inexplicable or impenetrable love seems to be part of this idea that relationships are unknowable, that the source or justification of love is unknowable. This is a framework of the book that I don't agree with. Apart from having a moral obligation to be as good to each other as we can possibly be on this earth, a relationship generally needs functional reasons for its continuance, whether or not love factors in. Martha's father's reasons for continuance are a little clearer—he is not a successful man and it is more fun to be a fuckup in company—but Patrick's reasons for continuance are not whatsoever clear to me. The book tries to explain this to a degree by describing Patrick's psyche as fundamentally avoidant or repressive, and by giving him such a tragic backstory that he would become attached to people in a way he would be loath to separate from. But especially given his father's cruelty/indifference, it doesn't make a ton of sense to me that he would tolerate the same from his wife.

This is where my complaint of tidiness comes in: Patrick is a catalyst, a plot device, for a certain type of ending. The book needed a tolerant man, and Patrick is certainly that.

One of the journeys I went on with this book was the result of the personality changes I have undergone and engendered in the year since I stopped thinking of myself as a Depressed Person: I am game for activities, I am much more active, I am much more spontaneous, I laugh more, I cry ... for different reasons. I am happy more mainly because I understand my capacity for happiness differently. It has been a mindset change, a paradigm shift, more than anything else. This is my journey, of course; I mean to prescribe similar methods to no one, knowing full well how poorly they have historically worked for me; they merely worked this time, under these circumstances which I could not recreate on my own. I did need a medical professional to tell me what was really wrong with me before I could reasonably make those changes. But the capacity for change was—at that moment, under those circumstances—within me, and I probably could have pulled myself out of the rut I was in sooner with different self-understanding.

Again, one of the things the book does well is showing Martha as someone who needed a catalyst outside the confines of her mental illness to change her behavior—while also showing that such a catalyst would have been absolutely useless while her illness was untreated. I still have untreated anxiety; I am not able to magically stop experiencing anxiety or showing certain anxious behavior. Martha's behavior that seems to come from another person would persist for as long as the imbalance would—but, once treated and with some understanding, she regains a measure of control over other behavior.

Patrick learns that her cruelty persisted past treatment—again, for reasons we are sympathetic with; the profundity of Martha's pain, her anger, her shit genetic hand, none of which Patrick had any hand in, is well established. This cruelty persisted for months.

And he decides not only to try to forgive her for this, but to continue their marriage. This is beyond tolerance to me. I do not understand what this woman offers him in the context of a marriage. They are already separated, and he has decided that her capacity for cruelty is easier to bear than not being married to her. Being married to her must offer him something, and I don't think it's sufficiently established what she, specifically, offers him at this point in their lives. That is what about the ending I find too pat: Patrick may have done her (and himself) many disservices by being passive, too accepting, cleaning up after her myriad messes and never starting conflict about it. At the end of his tether, he is cruel to her once. She is habitually cruel to him.

Did they truly, as Martha claims, "ruin each other's lives"? What does it mean for Martha to say that Patrick, of all people, ruined her life?

This statement from her gives me zero confidence about her ability to be a good partner to him ever again. I wanted more information from Patrick about the best kind of life he envisioned for himself, and—from his perspective—what role Martha could play in it, before I could believe any degree of reconciliation, however partial, could be a healthy decision for him.

Because while I want a good life for Martha—a major success of this story is how much it tells us she could use it—she's not the only character in this tragedy. What's good about this book is its trying to show that mental illness can feel ruinous for everyone who loves the person struggling with it. It is complex, nuanced, heartbreaking—for everyone. Ah, you know. I do think this book is very good.

A final note about messaging. I cried at various times through the first 2/3 and not at all at the end, mainly because of the little gems of wisdom that are tossed out with incredibly casualness throughout the book. One example: Martha's mentor Peregrine—a relationship in this book that is untouched by the shadow of Martha's destructive behavior, another great thing I was glad to see—says something offhand while encouraging her to spend time in Paris: that [paraphrasing], "absent other reasons, beauty is a reason to live." This is so offhand, and yet the book fell involuntarily out of my hands, I sobbed, I lay with that thought awhile. This sentiment is one of the most fundamental things I believe and that has helped keep me wanting to stay alive through crisis points, and it was quite amazing to see it casually thrown out in a bit of dialogue without a sense that it was more remarkable than his other pontificating. So true king, what the fuck.

I think this is a great book for anyone who has struggled with turning up reasons to live for the mirror it holds up, but I am not sure I would recommend it to anyone currently struggling with reasons to live. It's a book that cuts very deep. It does this with supreme competence, compassion, nuance, and—commensurate to my experience—accuracy. It is excellent. It was a two-sitting read. I have twice wept just writing this review. I hope it holds on to stay one of my favourite books of the year.