From the very beginning of Miriam Toews’s All My Puny Sorrows, it’s clear that the narrator’s older sister, Elfrieda, will kill herself. The tone is by turns frantic and elegiac, full of both hope and dread; the tense is by turns anxiously present and reminiscent of both the recent and distant past. Although the possibility that she won’t go through with it animates the novel’s plot and protagonists, that hopefulness ultimately exists apart from Elfrieda, who is, for all that we learn about her extraordinary gifts, ultimately a cipher.

Leveled at a writer less gifted than Toews, this might be a criticism. All My Puny Sorrows is her sixth novel and a singular achievement, so unexpectedly free of the usual wilting sentimentality and sweeping platitudes that we use to speak about death, family, and the much dramatized yet little understood phenomenon of mental illness.

Narrated by Yolandi Von Riesen, who goes by the nickname Yoli, All My Puny Sorrows has been characterized as “darkly funny”—a cliché that does justice neither to the novel nor its protagonist and her humor, which is more than just a voice, perhaps a genre unto itself. “Darkly funny” is a placeholder term, a phrase we use to indicate that the novel is funny while also being “about suicide.” It connotes lofty aspirations, both intellectual and aesthetic; it might mean that the novel is a deep and involved examination of suicide from a perspective that is somewhat academic, which is to say that the book contains many literary references and is written from the point of view of an experienced and studied outsider—someone who is not suicidal. But All My Puny Sorrows is not actually academic, or darkly funny; it is merely and wonderfully a novel that tells us something close to the truth.

All My Puny Sorrows is a portrait of an idiosyncratic, intellectual family. During the sisters’ childhood, the family consists of Yoli and Elfrieda—who also goes by Elf—along with their loving mother and father; during the crises of Elf’s final suicide attempts and for the majority of the narrative, it includes Yoli’s two teenage children, Elf’s husband Nic, an aunt as hearty and jolly as their mother, and more. The girls are raised in a small Mennonite village in Canada, though it’s not really explained why; the insular, stuffy requirements of the village elders are always brushed off, ignored, or rejected, sometimes to the point of temporary excommunication. To Yoli, her older sister is the embodiment of brilliance and beauty, from childhood occasionally seeming like a revolutionary as well as the “center of the spinning world.” As an adult, Elf is a glamorous classical pianist apparently in possession of an otherworldly talent. She also has a working knowledge of what seems like every book she’s ever read and a plethora of foreign languages; she’s been married for years to Nic, who is besotted by her and unwavering in his devotion, even in the face of Elf’s increasingly harrowing psychological torment; she is very thin and elegant and looks much younger than her age.

By contrast, Yoli presents herself as hapless and harried, twice divorced and financially unstable. Unlike Elf and Nic, who have no children, Yoli has two; they seem to exist in a teenage frenzy of text-messaging and growing-up-too-fast that Yoli feels she can’t quite manage. She earns most of her living writing young-adult books about a character named Rodeo Rhonda and lives in awe of her superior older sister.

Still, this is not and was never going to be the story of how a beautiful, world-renowned pianist comes back from the brink of despair to play the greatest sonata of her life while her supportive and tireless sister remembers tearfully how she helped her through her darkest hours. In a review of the novel in The Washington Post, Ron Charles wrote that “what really confounds [Yoli] is the depressive’s maddening self-absorption,” and this is partially correct: Yoli is confounded—but not by Elf’s “maddening self-absorption.” This is a jab rooted in nothing but a conventional, superficial conception of “the depressive” as a person trapped in her own mind, rather than a person suffering from an illness. Much of Elf’s life as we experience it takes place in a hospital bed, where she refuses the classically gross hospital food and is subjected to the classically frustrating hospital bureaucracy; combined with the lifelong struggle, she sounds more like a person living with a chronic condition and less like a bad caricature of Sylvia Plath.

Charles’s characterization also suggests that Yoli spends a lot of time “madden[ed]” by Elf’s impenetrable psyche, trying to grasp it or empathize with it so that she can change it, which is not what ultimately happens. Yoli presents the situation as an ontological impasse: “She wanted to die and I wanted her to live and we were enemies who loved each other.” Even when Yoli is desperately trying to ensure her sister’s continued existence, there’s the sense that her efforts are futile, that what is going to happen will happen regardless of her attempts to will or reason or fantasize or blindly hope her way into an alternate reality in which she tirelessly and tearfully coaxes one beautiful, world-renowned pianist back from the brink of suicidal despair. What Charles calls an “almost plotless” novel is nevertheless progressing toward something: will she or won’t she—and if she won’t, there’s still always the possibility that she will. Various members of the family sit with Elf in the hospital and update one another in “a state of suspension”; they wait and wait, for about two-thirds of the novel, for something to happen. But there are only two options for what that could be, and as long as Elf has not yet killed herself, the Von Riesens will live in that state of suspension.

Elfrieda isn’t actually the “center of the spinning world,” but for a while, she is the center of the dizzying existence that her sister inhabits. In one scene, Yoli is talking to Nic about whether her sister will be able to perform on an international tour, and they feel guilty about not telling Elf’s agent that she has again tried to commit suicide and very well might have to miss the tour, for which significant preparations have already been made. There’s a tense moment of quiet reflection, after which Yoli asks Nic if “he is also feeling the earth rotate on its axis.” He reminds her that they’re in a revolving restaurant.

* * *

A revolving restaurant that feels like the world is a great metaphor for this book: It’s a concentrated space, kind of wacky, kind of disorienting, in which serious talk can nevertheless go on inside, though that is also kind of wacky and disorienting. What steers All My Puny Sorrows away from the sentimentality common in books “about suicide” is its pace. Throughout the novel, things happen suddenly, both because things just happen suddenly in life and because Yoli’s tendency to get worked up and go off on a tangent means that she narrates in long, sometimes worried musings disrupted by non sequitur references and staccato bursts of action or tone-shifting detail; we often learn of events only after they’ve already happened suddenly. In one hospital scene, Yoli is telling Elf about her life in Toronto and goes on an extended riff about getting her tattoo removed. The image is of a jester, done by “a biker” in exchange for “twenty bucks and a bag of weed,” and it’s meant to symbolize how she and her ex-husband “together would slay hypocrisy and the duplicity of the world with jokes and magic.” (“Afterwards they put Polysporin on it and a bandage and gave me a mint and told me not to shower or exercise for two days and to continue putting Polysporin and fresh bandages on it twice a day for a week. I didn’t bother with any of that.”) Yoli segues into discussion of her “hapless love life” and summarizes a recent e-mail breakup. Then, “out of the blue,” she relates, “like that volcano in Pompeii, Elf asked me if I’d take her to Switzerland.”

Switzerland being a place where physician-assisted suicide is legal, this request briefly but suddenly reroutes the novel from the unresolvable suspension of the keeping-someone-not-dead problem to a moral dilemma and mission: Yoli has to decide whether to concede defeat to the enemy she loves.

In another hospital scene—there are many—Elf is angry because a Mennonite pastor from their parents’ old church “managed to talk his way in past the nurses’ desk” and proceeds to proselytize her, assuring Elf that if she “would give her life to God she wouldn’t have any pain…. Could they pray together for her soul?”

What did you do? I asked Elf. I hope you told him to go fuck himself. You should have screamed rape….

I recited a poem, said Elf.

What? I said. A poem? You should have strangled him with your panties!

Philip Larkin, she said. I don’t have any panties. They’ve taken them away from me.

After Elf recites the Larkin poem for this more receptive audience—it’s “Days”; very appropriate—comes the big reveal. Yoli asks what the pastor said.

Nothing, said Elf.

Tell her why nothing, said my mom. She shook like old times. She covered her mouth.

Because by the end of it I had taken off all my clothes, said Elf.

* * *

The phrase “all my puny sorrows” definitely exemplifies Yoli’s quirky, self-deprecating tone. “Puny” could come from the Miranda July lexicon, but instead it’s taken from Samuel Taylor Coleridge’s “To a Friend, With an Unfinished Poem,” which inspires the adolescent Elfrieda to graffiti an abbreviated tag (“A.M.P.S.”—it’s under the book’s dustcover) in red paint on “natural landmarks” around the Mennonite community of East Village. In an exchange that models many of the childhood interactions between Yoli and Elf (or at least models the way the older Yoli relays them), the curious younger girl asks her wiser older sister which natural landmarks she intends to deface, and Elf replies with a dismissive wave of the hand; the execution isn’t as important as the idea itself. “Like the water tower, she said, and fences,” before making “a sudden karate-chop slice through the air and then star[ing] into the distance as though she’d just heard the far-off rattle of enemy fire.”

Maybe there’s something to be said here about abbreviations—the sisters’ nicknames, the novel’s title—and the power they have to signify things much larger and more complex than the three or four letters suggest. That the novel very closely mirrors the poem from which it takes its name might, in other books, have set off this reader’s sentimentality radar, but it works: because it’s sad, because it’s both particular and universal. Coleridge is writing an “aiding verse” to a friend whose sister is ill, saying he can empathize: “I too a sister had, an only sister…. To her I pour’d forth all my puny sorrows… / And of the heart those hidden maladies / That e’en from friendship’s eye will shrink ashamed.” Just as Coleridge begins his poem with an unnecessary apology for his failure as a writer to provide distraction from “anxious thought / Of dissonant mood”—“Thus far my scanty brain hath built the rhyme / Elaborate and swelling; yet the heart / Not owns it”—Yoli’s references to her own “scanty brain” are both true and false. Toews’s hapless narrator isn’t always reliable, at least when it comes to her haplessness. After Elf reveals that she performed her invalid’s subversive striptease to scare the pastor away, she explains to Yoli: “I was trying to be like you…. It was all I had.”

It’s the unyielding impasse of their situation that leads Yoli to decide—after much fraught consideration—to try to fulfill her sister’s request rather than fight with her to fight for her life. And because Elf feels like her sister is all she has, Yoli can’t mention to their family or to Nic her plans to help Elf kill herself.

Except in her darker, questioning moments, Yoli doesn’t really engage with what she calls her sister’s “pain”; it’s simply Elf’s “unfathomable sadness,” and ­Elfrieda is so clearly sketched as both unfathomable and unfathomably sad that there’s no question of getting it. You want to shake her, or shout at her, or sit next to her hospital bed and pleadingly tell her how much you love her huge green eyes and transcendental piano playing and ability to conjure smart references from what seems like the complete time line of literary history—but that’s because it’s not hard at all to empathize with Yoli and the sadness and anxiety and fear and powerlessness of knowing one of your best people wants to renounce her personhood.

Perhaps Toews is able to resist the temptation to try to empathize with and change Elf because she is past the stage of desperately attempting to understand. In 1998, Toews’s father—like the sisters’ father in the book—committed suicide by walking in front of a train, and two years later Toews published a memoir about the experience. But rather than write about her own grief, Toews tried to access her father’s: Swing Low: A Life is told from the perspective of Mel Toews, who was diagnosed with severe manic depression (now bipolar disorder) when he was 17. Although he achieved a level of normalcy that his doctors had warned would probably not be possible—a wife, a career, children, stability—after retiring from his job as a schoolteacher, he plunged into the severe depression that led him to suicide. Most of Swing Low is in Mel’s voice, as Toews imagines it; in the prologue, she explains that her father was “a man who felt he had failed on every level,” and Swing Low is her “attempt to prove [him] wrong.”

It’s tempting to read this novel autobiographically, and Toews has acknowledged that—her own older sister committed suicide as well, in 2010—but it’s also irrelevant. Although Sorrows is tribute of sorts, it is not an attempt to prove anyone wrong. The unfathomable “Why?” hovers close over both Swing Low and Sorrows, but in the latter it’s not fueling a desperate search for a thesis or proof. Why would someone with such a nice life want to give it up? Neither book can answer this question—we have long known that we will never really understand other people.

The first time Elf is released from the hospital, she finagles a discharge by affecting (or maybe not!) a new beginning, one day saying that she “woke up feeling like a different person.” The nurses take this as a good sign, and the hospital “really need[s] the bed.” That night, the family celebrates with Indian food and wine, with Elf presiding over the dinner “smiling, a little shy, beautiful and serene, as though she alone holds the answer to the riddle of the Sphinx.”

Listen! I want to shout at her. If anyone’s gonna kill themselves it should be me. I’m a terrible mother for leaving my kids’ father and other father. I’m a terrible wife for sleeping with another man. Men. I’m floundering in a dying non-career. Look at this beautiful home that you have and this loving man loving you in it! Every major city in the world happily throws thousands of dollars at you to play the piano and every man who ever meets you falls hard in love with you and becomes obsessed with you for life. Maybe it’s because you’ve perfected life that you are now ready to leave it behind. What else is there left to do? But I’m finding it hard to make eye contact with Elfrieda.

When the hospital releases Elf a second time, it’s a surprise for her birthday, and against Yoli’s instructions: Yoli has begged the staff not to let her leave, often waking in the middle of the night to call the hospital aides and make sure that her sister is still there. Ironically, she’s been “so obsessed” with keeping Elf in the hospital until she can figure out a way to pay for their trip to Switzerland (they can’t use Elf’s joint bank account; Nic would notice) that she forgot about the birthday. Yoli hears the news of the temporary discharge from her mother, then sits down in a novelty chair shaped like a hand (which her daughter “had found in somebody’s garbage”) and says, “[W]ell, then she’s gone.” Yoli takes her daughter to play tennis, knowing there’s nothing she can do, and by the end of the next paragraph, her phone is ringing with “bad news.”