The ways in which society interacts with mental illness is one of the main themes within the novel. The stigma surrounding mental illness is harmful to the individuals who have mental illnesses, as it encourages others to view them through narrow, stereotypical lenses. Additionally, stigma discourages open conversation surrounding the reality of mental health conditions, which prevents people from learning and gaining empathy through understanding.

Lucia is diagnosed with schizoaffective disorder, a mental health condition that manifests with symptoms of both bipolar disorder and schizophrenia. As Lucia attempts to live a fulfilling life, her condition is continuously used as a barrier to prevent her from doing what she wants. In some cases, these choices are made for Lucia’s safety, or the safety of those around her; in others, Lucia’s natural independence is judged or stifled and blamed on her condition. Through Lucia’s experience, the author questions the way that society as a whole perceives and treats people with mental illnesses.

Lucia points out the hypocrisy within the healthcare system, which encourages people to assert their identities outside of their illnesses while focusing solely on treatment. While in Crote Six, the psychiatric ward of a New York hospital, Lucia refuses to take her medication.