At the start of the novel, Daniel lists all the names his older brother calls him: “Uber nerd. Dink. Sally. Lame Wad. Pretty much everything but ‘Daniel’” (20). Naming is an expression of social authority and power. It is also a way of identifying and demeaning that which is different, and reaffirming existing hierarchies of social norms. Fear of being named and stigmatized causes anxiety for those growing up with mental health issues. Sara is known as “Psycho Sara,” which reinforces Daniel’s fear that someone will discover his condition and label him accordingly. He is even more reluctant to talk with anyone about the suffering that is blighting his life.

Labeling by medical authority is not wholly positive either. In a parodic mirroring of the list of names Steve gives Daniel, Sara says, “I have general anxiety disorder, bipolar disorder, mild schizophrenia, and depression” (93). It is not clear that such diagnoses have helped her, but they have led to her taking five pills a night. Daniel says, “I had kind of thought that knowing what I had and being able to call it something would make it better” (227). However, the mere labeling of a condition does not alleviate pain.