:quality(75)/https%3A%2F%2Fdev.lareviewofbooks.org%2Fwp-content%2Fuploads%2F2023%2F07%2FCommitment.jpg)
Commitment by Mona Simpson
WHY DO PEOPLE lose their minds, and where do they go when they’re no longer themselves? Is mental illness curable? To the extent that a work of fiction can contend with the enormity of these questions, Commitment, the seventh novel by Mona Simpson, does a masterful job of it. The story sets a family in motion over 400 pages, painting a portrait of a mother, her children, and their friends, in an attempt to get at the heart of what it’s like to have someone in your inner circle completely lose themselves to a mental breakdown.
The novel starts off placidly enough when Walter Aziz leaves home for UC Berkeley with a high school friend, whose mother drives them up from Pacific Palisades. The first of three kids, with a father who hails from Afghanistan, Walter is a dutiful American son who thinks “of himself as a slender pin that kept the machinery of his family ticking.” It’s not long before we discover that the Aziz family is poor and that the father is out of the picture. Walter will need to apply for student aid, but—too proud to ask for help—he is determined to land jobs and pay his own way. A few chapters in, he discovers that his mother has stopped going to work, and that the phone company turned off their service until his sister cobbled together the funds to get it turned back on.
An understudied topic, poverty can be a precursor to mental illness, with the conditions and consequences of economic struggle often being passed down from one generation to the next. Meanwhile, as Rachel Aviv points out in her 2022 book Strangers to Ourselves: Unsettled Minds and the Stories That Make Us, mental health institutions, operating within “a field that has been dominated by middle-class white people […] were not designed to address the kinds of ailments that arise from being marginalized or oppressed for generations.”
In Commitment, the reader understands that the family is operating under duress, that this mother of three adolescents is not making ends meet yet is at great pains to ensure that her eldest gets off to college. It is, however, unclear just how much the family’s poverty may have exacerbated Diane’s declining state of mind. Where I have a quibble is that, while Simpson is savvy about describing the ways in which penury inflects the lives of the Aziz children, she does not reveal a crucial detail about their identity until very late in the story. This appears to be a conscious choice by the novelist, a belief that the reader’s imagination will fill in the blanks, but I’m not so sure.
In any event, Diane does not go off the rails because she has a history of clinical depression. She doesn’t lose herself after years of chronic illness, fatigue, or pain. We don’t know whether she suffers from PTSD. Her illness comes on suddenly yet also gradually, almost like sleeping sickness: day by day, beset by fatigue, she fails to show up for life. Her self, which we are never privileged to see from the inside, unravels quietly, in the darkness of her room, unseen and unfathomable by her children, whose interior lives we are privileged to visit. At first, there is her eldest, Walter, his mother’s pride; then the middle child, Lina, the daughter who is a good student in high school and works at the ice cream parlor in the Valley to supplement her nurse mother’s insufficient income; and finally, the youngest, Donnie, who is 13 when his brother leaves for Northern California and his mother begins to become someone else.
There is no father present, and no child support. On one occasion, Lina travels to Reno, Nevada, pleading with her deadbeat dad for help, and returns with only a $300 check. The absence of any sense of their father’s identity, of the rich culture and history of his native country, forms part of the backstory, as if this physical and cultural void carves out a hole in their American lives—an abyss most urgently felt by the children, who are like orphans now that their mother is in an asylum. We learn that Diane partially grew up in an orphanage, and we begin to think we understand her madness; at least it seems to have a root cause, a place where we can begin to contemplate how a mind goes missing after decades as a mother, a nurse, a taxpayer, perhaps a voter: a woman who still has a future in Los Angeles.
The mother’s loss of self only punctuates what was already a kind of listlessness, a lack of energy and determination, in her children. Life happens to them, it seems. Walter goes to college because that’s what he is expected to do. Lina dutifully works at the ice cream parlor and contributes to the household income, even as her mother writes bad checks against her daughter’s checking account, which the bank closes; predictably, Lina never confronts her mother about this small betrayal, even though that money should have been her savings for Barnard. Lina winds up working for the May Company instead, visiting her mentally unhinged mother every Sunday in the mental facility.
There is a quiet, almost forlorn quality to the narrative; the descriptions, rigorously unsentimental, bring to mind Joan Didion’s stark evocation of California madness in Play It as It Lays (1970), in which a single mother is admitted to a psychiatric hospital. Here, too, there is an inherent loneliness to the characters, as well as a sense that we will always have more questions about the Aziz family than answers. Simpson captures the languid expanse that is Southern California, the feeling that Los Angeles is too vast, and too vague; as a result, Californians seem to be unfinished Americans, like Norman Rockwell paintings missing the faces.
Diane is brought in on a 5150, an involuntary commitment—a 72-hour hold during which the psychiatric hospital ensures that you’re not a danger to yourself or others. She resists at first but then agrees to voluntary commitment to the facility in Norwalk, the Metropolitan State Hospital: “At first, Julie told him, his mother fought. Even after she’d agreed, she went back and forth. She wouldn’t sign the paper to be a voluntary admit. Finally, she did.”
Her mother’s best friend, Julie, is a fellow nurse and an adoptive mother to her kids. She tells Lina, “I haven’t heard a diagnosis. Everyone says she needs a rest.” But Lina thinks her mother already had a rest as she had been lying in bed at home for weeks, not returning to work. When they go out to Norwalk for a family visit, Julie explains, “Most of the people here have bigger problems than your mom […] But your mom knows, hospitals have the acute and the chronic, and at first, your eye goes to the worst.”
Diane is put on Elavil and maybe lithium or Thorazine. These drugs repress your feelings, cut you down, manage you—but you’re no closer to being cured. To what extent do you become mentally deficient, a virtual vegetable, when you’re on psychotropic drugs in an institution? The kids see One Flew Over the Cuckoo’s Nest (1975) when it comes out a year after their mother’s institutionalization, and they don’t buy it; the environment and the patients depicted don’t match up with their experience of their mother’s life in Norwalk. Lina says, “Those people weren’t real […] They were comically crazy.”
Walter writes to his mother regularly. Of course, he receives no return letters. When you’re the relative of someone who has been committed, all you want to do is help. You hope that you can, but really, there’s nothing you can do. When someone becomes mentally unstable, all you can do is become a member of their support system, but they will have to find their own way out of the dark forest. And it will take years. Some never make their way out. Aware of the long time his mother is taking to recover, Walter asks, “Do you think Mom’s getting better?” Julie replies, unsure: “It’s hard to tell […] I think so.”
A student in premed, Walter takes an interest in architecture and design. Anxious to be of some use to his mother, he looks into the nature of asylums and learns about a Quaker physician named Thomas Story Kirkbride (1809–83) who became obsessed with designing “hospitals for the insane” and “believed the hospital building itself helped the healing.” Eventually, Walter creates a life for himself working with buildings and community projects, and like his siblings Lina and Donnie, he becomes a regular at their mother’s Norwalk hospital complex, getting to know the nurses and doctors, and some of the other patients. He even hopes that Diane’s main psychiatrist, Dr. Moss, will fall in love with his mother, who is still an attractive woman in her forties. The doctor advises, “Your mother is settling in […] I gave her headphones to listen to music, but she doesn’t like them.” He adds, “We’re still adjusting the medication. She hears voices. They taunt her, put her down. It’s difficult to quiet those without making her what your sister calls ‘doped up.’ The drugs are big hammers we’re using on a needle.”
A fourth of the way into the story, we get a DSM diagnosis: “296.33, major depressive disorder.” “Eventually,” the novel advises, “these terms would become blankets to throw over obscure painful shapes.”
To what extent are we aware of our illness? When you interact with people suffering from mid-stage dementia, you realize that they are often unaware of their own memory lapses; they are unable to take in the breadth of their own illness. With mental patients, at times they know. As Diane says at one point, “I’m trying to hold on to my mind.” And Walter replies, “I know, Mom. You have to keep trying.” But it can be a futile attempt.
There are people who have suffered mental breakdowns and managed to hang on to their lives but became walking shadows of themselves. They strain to convince you that they are fine, that they are managing, that they are not bipolar or schizophrenic and don’t need therapy, nor do they need to take medicine that has been prescribed for them. It is an inversion of gaslighting.
In its own quiet way, Commitment is a page-turner and an emotional roller-coaster ride—all the more so if you’ve ever dealt with mentally unsound or addicted people in your immediate family. As in life, Simpson’s readers will find it unclear to what extent mental illness can actually be managed. The dutiful daughter goes to see her mother, visiting from her New York sojourn at Barnard, and wonders if any of her visits have ever made a difference. Were they important “if the self was no longer here, or if it swam inside somewhere loose, unattached, beyond reach?” In Lina’s view, “Julie rails about the stigma. She says, If your parent had cancer … but, you know, sometimes I think this really is different. Cancer takes over cells but this, it infects love. She turns away from love.”
For his part, Walter confides in Dr. Moss as if he were his own therapist: “She wanted a husband. Our dad didn’t work out, but she revered that kind of life. Marriage. Family.” He worries about the state his mother is in when he visits her:
For years, Lina worries that “her mother’s illness was inside her, biding its time.” She and her New York fiancé quarrel:
Lina thinks that “she need[s] to justify being luckier than her mother.” Like Walter, Lina wants to help, searching for answers that can address her mother’s disease:
Walter, meanwhile, comes to accept their lives as bereft children. “You got to stop waiting for her to come back the way she was,” he tells his sister. “We’ve got to move on.” He realizes that he is beginning to live life as though his mother were gone. He forgets her birthday and then plans to send something, but “it wouldn’t matter that he was late; he doubted she kept track anymore.”
And yet, the children live for years in the hope that their mother will recover, that she will move out of the hospital and back in with her friend Julie, or with one of them. At what point do you decide you’re going to accept what appears to be the inexorable reality? When do you understand that your life has changed forever—that you’ve lost this person? The next logical thought might be: Is an insane person akin to the living dead? If they are no longer themselves, are you harboring hope for the return of a person who has become a mere husk? These questions are enough to drive you around the bend.
And yet the reader of Commitment wants to read to the end in the hope that Diane will recover her senses; we want to believe that a miracle is possible. It makes me wonder where human beings acquire all this unreasonable hope. Maybe we have no choice but to hope for better days ahead, because the alternative offers only a bleak outcome. In the end, what we do is cope, and our commitment in life has to be how well we do that.
Commitment makes it clear that one’s entire family is unavoidably impacted when someone has a breakdown. First, there is all the management a family has to do for a mental patient, all the adjustments, including the need to articulate to outsiders that your parent or sibling or other loved one is down for the count. Then there is the fear that you may someday become unstable yourself.
To what extent do you become your diagnosis? What is the danger that your illness becomes your identity? According to Irish neurologist Suzanne O’Sullivan, author of It’s All in Your Head: True Stories of Imaginary Illness (2015), the danger that you will always identify with—and be identified as—your diagnosis is stark. In a 2021 interview, O’Sullivan explained:
In Strangers to Ourselves, Rachel Aviv observes that “[p]sychiatrists know remarkably little about why some people with mental illnesses recover and others with the same diagnosis go on to have an illness ‘career.’”
It becomes increasingly likely in Commitment that Diane’s diagnosis will define her for the rest of her life. And yet one reads on, hoping that she will recover her mind, that she will be released back into the world. As I closed the book, I asked myself if my feelings of hopefulness were what had spurred me forward, more than the narrative momentum. I have in my own family individuals who suffer from mental illness, one in denial and the other in treatment; one is blithely unaware of himself as suffering from disease while the other knows that, without addressing it, the danger is that she could one day lose everything. As a concerned family member, hope is my last resort.
Jordan Elgrably is a writer living in Montpellier. He is the editor of The Markaz Review.
The novel starts off placidly enough when Walter Aziz leaves home for UC Berkeley with a high school friend, whose mother drives them up from Pacific Palisades. The first of three kids, with a father who hails from Afghanistan, Walter is a dutiful American son who thinks “of himself as a slender pin that kept the machinery of his family ticking.” It’s not long before we discover that the Aziz family is poor and that the father is out of the picture. Walter will need to apply for student aid, but—too proud to ask for help—he is determined to land jobs and pay his own way. A few chapters in, he discovers that his mother has stopped going to work, and that the phone company turned off their service until his sister cobbled together the funds to get it turned back on.
An understudied topic, poverty can be a precursor to mental illness, with the conditions and consequences of economic struggle often being passed down from one generation to the next. Meanwhile, as Rachel Aviv points out in her 2022 book Strangers to Ourselves: Unsettled Minds and the Stories That Make Us, mental health institutions, operating within “a field that has been dominated by middle-class white people […] were not designed to address the kinds of ailments that arise from being marginalized or oppressed for generations.”
In Commitment, the reader understands that the family is operating under duress, that this mother of three adolescents is not making ends meet yet is at great pains to ensure that her eldest gets off to college. It is, however, unclear just how much the family’s poverty may have exacerbated Diane’s declining state of mind. Where I have a quibble is that, while Simpson is savvy about describing the ways in which penury inflects the lives of the Aziz children, she does not reveal a crucial detail about their identity until very late in the story. This appears to be a conscious choice by the novelist, a belief that the reader’s imagination will fill in the blanks, but I’m not so sure.
In any event, Diane does not go off the rails because she has a history of clinical depression. She doesn’t lose herself after years of chronic illness, fatigue, or pain. We don’t know whether she suffers from PTSD. Her illness comes on suddenly yet also gradually, almost like sleeping sickness: day by day, beset by fatigue, she fails to show up for life. Her self, which we are never privileged to see from the inside, unravels quietly, in the darkness of her room, unseen and unfathomable by her children, whose interior lives we are privileged to visit. At first, there is her eldest, Walter, his mother’s pride; then the middle child, Lina, the daughter who is a good student in high school and works at the ice cream parlor in the Valley to supplement her nurse mother’s insufficient income; and finally, the youngest, Donnie, who is 13 when his brother leaves for Northern California and his mother begins to become someone else.
There is no father present, and no child support. On one occasion, Lina travels to Reno, Nevada, pleading with her deadbeat dad for help, and returns with only a $300 check. The absence of any sense of their father’s identity, of the rich culture and history of his native country, forms part of the backstory, as if this physical and cultural void carves out a hole in their American lives—an abyss most urgently felt by the children, who are like orphans now that their mother is in an asylum. We learn that Diane partially grew up in an orphanage, and we begin to think we understand her madness; at least it seems to have a root cause, a place where we can begin to contemplate how a mind goes missing after decades as a mother, a nurse, a taxpayer, perhaps a voter: a woman who still has a future in Los Angeles.
The mother’s loss of self only punctuates what was already a kind of listlessness, a lack of energy and determination, in her children. Life happens to them, it seems. Walter goes to college because that’s what he is expected to do. Lina dutifully works at the ice cream parlor and contributes to the household income, even as her mother writes bad checks against her daughter’s checking account, which the bank closes; predictably, Lina never confronts her mother about this small betrayal, even though that money should have been her savings for Barnard. Lina winds up working for the May Company instead, visiting her mentally unhinged mother every Sunday in the mental facility.
There is a quiet, almost forlorn quality to the narrative; the descriptions, rigorously unsentimental, bring to mind Joan Didion’s stark evocation of California madness in Play It as It Lays (1970), in which a single mother is admitted to a psychiatric hospital. Here, too, there is an inherent loneliness to the characters, as well as a sense that we will always have more questions about the Aziz family than answers. Simpson captures the languid expanse that is Southern California, the feeling that Los Angeles is too vast, and too vague; as a result, Californians seem to be unfinished Americans, like Norman Rockwell paintings missing the faces.
Diane is brought in on a 5150, an involuntary commitment—a 72-hour hold during which the psychiatric hospital ensures that you’re not a danger to yourself or others. She resists at first but then agrees to voluntary commitment to the facility in Norwalk, the Metropolitan State Hospital: “At first, Julie told him, his mother fought. Even after she’d agreed, she went back and forth. She wouldn’t sign the paper to be a voluntary admit. Finally, she did.”
Her mother’s best friend, Julie, is a fellow nurse and an adoptive mother to her kids. She tells Lina, “I haven’t heard a diagnosis. Everyone says she needs a rest.” But Lina thinks her mother already had a rest as she had been lying in bed at home for weeks, not returning to work. When they go out to Norwalk for a family visit, Julie explains, “Most of the people here have bigger problems than your mom […] But your mom knows, hospitals have the acute and the chronic, and at first, your eye goes to the worst.”
Diane is put on Elavil and maybe lithium or Thorazine. These drugs repress your feelings, cut you down, manage you—but you’re no closer to being cured. To what extent do you become mentally deficient, a virtual vegetable, when you’re on psychotropic drugs in an institution? The kids see One Flew Over the Cuckoo’s Nest (1975) when it comes out a year after their mother’s institutionalization, and they don’t buy it; the environment and the patients depicted don’t match up with their experience of their mother’s life in Norwalk. Lina says, “Those people weren’t real […] They were comically crazy.”
Walter writes to his mother regularly. Of course, he receives no return letters. When you’re the relative of someone who has been committed, all you want to do is help. You hope that you can, but really, there’s nothing you can do. When someone becomes mentally unstable, all you can do is become a member of their support system, but they will have to find their own way out of the dark forest. And it will take years. Some never make their way out. Aware of the long time his mother is taking to recover, Walter asks, “Do you think Mom’s getting better?” Julie replies, unsure: “It’s hard to tell […] I think so.”
A student in premed, Walter takes an interest in architecture and design. Anxious to be of some use to his mother, he looks into the nature of asylums and learns about a Quaker physician named Thomas Story Kirkbride (1809–83) who became obsessed with designing “hospitals for the insane” and “believed the hospital building itself helped the healing.” Eventually, Walter creates a life for himself working with buildings and community projects, and like his siblings Lina and Donnie, he becomes a regular at their mother’s Norwalk hospital complex, getting to know the nurses and doctors, and some of the other patients. He even hopes that Diane’s main psychiatrist, Dr. Moss, will fall in love with his mother, who is still an attractive woman in her forties. The doctor advises, “Your mother is settling in […] I gave her headphones to listen to music, but she doesn’t like them.” He adds, “We’re still adjusting the medication. She hears voices. They taunt her, put her down. It’s difficult to quiet those without making her what your sister calls ‘doped up.’ The drugs are big hammers we’re using on a needle.”
A fourth of the way into the story, we get a DSM diagnosis: “296.33, major depressive disorder.” “Eventually,” the novel advises, “these terms would become blankets to throw over obscure painful shapes.”
¤
To what extent are we aware of our illness? When you interact with people suffering from mid-stage dementia, you realize that they are often unaware of their own memory lapses; they are unable to take in the breadth of their own illness. With mental patients, at times they know. As Diane says at one point, “I’m trying to hold on to my mind.” And Walter replies, “I know, Mom. You have to keep trying.” But it can be a futile attempt.
There are people who have suffered mental breakdowns and managed to hang on to their lives but became walking shadows of themselves. They strain to convince you that they are fine, that they are managing, that they are not bipolar or schizophrenic and don’t need therapy, nor do they need to take medicine that has been prescribed for them. It is an inversion of gaslighting.
In its own quiet way, Commitment is a page-turner and an emotional roller-coaster ride—all the more so if you’ve ever dealt with mentally unsound or addicted people in your immediate family. As in life, Simpson’s readers will find it unclear to what extent mental illness can actually be managed. The dutiful daughter goes to see her mother, visiting from her New York sojourn at Barnard, and wonders if any of her visits have ever made a difference. Were they important “if the self was no longer here, or if it swam inside somewhere loose, unattached, beyond reach?” In Lina’s view, “Julie rails about the stigma. She says, If your parent had cancer … but, you know, sometimes I think this really is different. Cancer takes over cells but this, it infects love. She turns away from love.”
For his part, Walter confides in Dr. Moss as if he were his own therapist: “She wanted a husband. Our dad didn’t work out, but she revered that kind of life. Marriage. Family.” He worries about the state his mother is in when he visits her:
She was heavier than she’d been and careless of herself. And she seemed less interested in them, her children. Walter accepted this, too. Maybe she was, as the doctor once said, still in the beginning of her illness. Walter no longer blamed Dr. Moss. He was just a man, guessing, too. Hoping for the best as they were. Perhaps the illness had a life even he couldn’t see. This was the end of a belief Walter hadn’t even known he possessed; that someone was watching, someone knew, someone powerful was on his side.
For years, Lina worries that “her mother’s illness was inside her, biding its time.” She and her New York fiancé quarrel:
They fought until he handed her the letter, a carefully worded note about the heritability of mental illness. His mother hadn’t wanted her son to marry into insanity. She was thinking about grandchildren. Lina shouldn’t have blamed her. What if it’s in me? had been Lina’s own constant terror. She wanted a better life than the one her mother was living. Was that treachery? Betrayal?
Lina thinks that “she need[s] to justify being luckier than her mother.” Like Walter, Lina wants to help, searching for answers that can address her mother’s disease:
She set out to learn the history of treatment for mental illness. From what she could tell, humans began studying medicine in Mesopotamia. […]
Lina read about bimaristans, dated to the lifetime of the Prophet Muhammad, who taught that God would not create a disease without creating a cure. […]
People could go to the bimaristans for physical or mental illness. They served all people regardless of citizenship, race, religion, age, or gender. Nobody was ever turned away. This discovery pleased her, though she wasn’t Muslim and had grown up without her father.
Walter, meanwhile, comes to accept their lives as bereft children. “You got to stop waiting for her to come back the way she was,” he tells his sister. “We’ve got to move on.” He realizes that he is beginning to live life as though his mother were gone. He forgets her birthday and then plans to send something, but “it wouldn’t matter that he was late; he doubted she kept track anymore.”
And yet, the children live for years in the hope that their mother will recover, that she will move out of the hospital and back in with her friend Julie, or with one of them. At what point do you decide you’re going to accept what appears to be the inexorable reality? When do you understand that your life has changed forever—that you’ve lost this person? The next logical thought might be: Is an insane person akin to the living dead? If they are no longer themselves, are you harboring hope for the return of a person who has become a mere husk? These questions are enough to drive you around the bend.
And yet the reader of Commitment wants to read to the end in the hope that Diane will recover her senses; we want to believe that a miracle is possible. It makes me wonder where human beings acquire all this unreasonable hope. Maybe we have no choice but to hope for better days ahead, because the alternative offers only a bleak outcome. In the end, what we do is cope, and our commitment in life has to be how well we do that.
Commitment makes it clear that one’s entire family is unavoidably impacted when someone has a breakdown. First, there is all the management a family has to do for a mental patient, all the adjustments, including the need to articulate to outsiders that your parent or sibling or other loved one is down for the count. Then there is the fear that you may someday become unstable yourself.
¤
To what extent do you become your diagnosis? What is the danger that your illness becomes your identity? According to Irish neurologist Suzanne O’Sullivan, author of It’s All in Your Head: True Stories of Imaginary Illness (2015), the danger that you will always identify with—and be identified as—your diagnosis is stark. In a 2021 interview, O’Sullivan explained:
I want people with severe depression to get a diagnosis of depression, get the appropriate treatment. […] No one can argue severe depression is extremely serious and needs medical help. But it’s in that very borderline area, over-diagnosing depression can have long-term implications for a person, first in the embodiment of the identity of being a depressed person. It’ll never leave your records and it will never probably leave your unconscious identity, either.
In Strangers to Ourselves, Rachel Aviv observes that “[p]sychiatrists know remarkably little about why some people with mental illnesses recover and others with the same diagnosis go on to have an illness ‘career.’”
It becomes increasingly likely in Commitment that Diane’s diagnosis will define her for the rest of her life. And yet one reads on, hoping that she will recover her mind, that she will be released back into the world. As I closed the book, I asked myself if my feelings of hopefulness were what had spurred me forward, more than the narrative momentum. I have in my own family individuals who suffer from mental illness, one in denial and the other in treatment; one is blithely unaware of himself as suffering from disease while the other knows that, without addressing it, the danger is that she could one day lose everything. As a concerned family member, hope is my last resort.
¤
Jordan Elgrably is a writer living in Montpellier. He is the editor of The Markaz Review.
LARB Contributor
Jordan Elgrably is the Editor of The Markaz Review. He's at work on a novel about Syrian refugees, and a collection of interviews with novelists among whom are James Baldwin, Nadine Gordimer, and Milan Kundera. He divides his time between California and Montpellier, France.
LARB Staff Recommendations
Psychiatric Hubris
DESPERATE REMEDIES, subtitled “Psychiatry's Turbulent Quest to Cure Mental Illness,” is a depressing book. Its author, Andrew Scull, is a prominent...
“Scientific Nightmare”: The Backstory of the “DSM”
Andrew Scull gives stellar marks to Allan Horwitz’s history of the DSMs.
Did you know LARB is a reader-supported nonprofit?
LARB publishes daily without a paywall as part of our mission to make rigorous, incisive, and engaging writing on every aspect of literature, culture, and the arts freely accessible to the public. Help us continue this work with your tax-deductible donation today!