Susan encounters both societal and personal pressures to conform to specific cultural norms. Her social class, geographic location, and gender impose various limitations on her life. As a middle-class resident in the suburbs, she is expected to adhere to certain cultural standards. For instance, she is anticipated to own and carefully maintain an expensive, spacious home, which requires substantial time and financial commitment. This suburban existence distances her from the more vibrant city lifestyle, restricting her social interactions to other middle-class homeowners and their household staff.

The most significant societal constraints Susan faces are those due to her gender. Unlike Matthew, societal expectations confine Susan to the suburban home, as was customary for women in mid-twentieth century England. Before marrying Matthew, Susan had enjoyed a dynamic and varied city life while working at an advertising firm in London, granting her a degree of freedom. However, upon marriage, she made a “concession to popular wisdom” and, alongside Matthew, chose to buy a house and start a family.

Susan not only accepts these restrictions but also reinforces them. She readily assumes the roles of housewife and mother, as her culture considers this the “intelligent” choice. She meticulously organizes her life according to “sensible discrimination,” which requires “abstinence from painful experience.” By doing so, she avoids challenging societal norms that could create difficulties for her or her husband. She strives to achieve “everything right, appropriate, and what everyone would wish for, if they could choose.” Ironically, Susan truly has no choice. To sustain a “balanced and sensible family,” she allows society to dictate her life.

Although Susan admits that she and Matthew "had everything they had wanted and had planned for," she quickly experiences a feeling of emptiness and restriction. As her two youngest children begin school, she realizes she has lost her personal identity to prioritize her family and struggles to regain it. To achieve this, Susan must reject the traditional roles she has previously embraced. This implies that if she no longer adheres to her roles as a wife and mother, she will be viewed, by conventional standards, as acting irrationally and unwisely. Lessing prompts us to question which perspective is more rational—Susan’s, where discovering an authentic sense of self is crucial, or Matthew’s, where any deviation from societal norms is labeled as "madness." This conflict encourages readers to reconsider the definition of "intelligence" within the context of the Rawlings’s marriage.

The tragedy in “To Room Nineteen” revolves around Susan's pursuit of her true self, which ultimately drives her to madness and suicide. Ironically, the realizations she gains during this journey highlight her inherent sanity. Susan cannot live without a sense of freedom, a basic human necessity. Denying this crucial need, as Susan does for many years, can be considered a form of madness. Thus, when she finally claims her right to experience and fulfill this desire, she is actually acting logically. This ironic relationship between sanity and madness becomes most evident in the story's concluding pages.

To preserve the freedom she discovers in Room Nineteen, Susan invents a “rational” narrative for her time there. Her imagined affair provides a believable reason for her departure from her conventional roles as a wife and mother. Susan recognizes Matthew's need for a rational explanation for her absences, a behavior that justifies and aligns with his own infidelities.

Susan acknowledges the irony of her situation in the room when she exclaims, “Oh, how ridiculous! How absurd! How humiliating!” The irony intensifies with the depiction of her suicide, which becomes a “fructifying dream that seemed to caress her inwardly, like the movement of her blood.” Susan's tragedy is her belief that suicide is the only path to true selfhood and freedom, leading her to drift “off into the dark river” of death.