Esther and Jacob Blau drive their 16-year-old daughter Deborah to a mental hospital for treatment after a failed suicide attempt. Deborah, suffering from schizophrenia, retreats into a world of her own making, the Kingdom of Yr, when the real world proves too frightening and confusing. Deborah is pleased to see that there are bars on the hospital's windows, but her parents cringe when they hear a high scream inside.
Jacob and Esther decide to tell Deborah's younger sister Suzy and Esther's parents that Deborah is at a convalescent school. Meanwhile, Dr. Fried contemplates taking on Deborah's case despite her busy schedule. She loves working with patients because they can examine sanity in a way that sane people cannot. As she muses that the world outside is often sicker than the world inside a mental hospital, she recalls treating a patient named Tilda in Nazi Germany.
In Yr, Deborah named herself Januce. She accidentally wrote this name on one of her school papers, a grave mistake because it revealed a clue of Yr's existence in the Earth world. Afterward, Yr created the Censor to guard its secrets from Earth. During her first session, Deborah accuses Dr. Fried of wishing to make her "friendly and sweet and agreeable and happy" with telling lies. Dr. Fried explains that she does not think that Deborah's complaints of illness are lies. She believes that Deborah is indeed sick, but not physically. She promises that hard work and good treatment can make her well.
Esther and Jacob feel as if they failed their daughter in some way. When Esther writes to request a visit, Deborah tells Fried that she will see her mother, but not her father because she fears that he might take her from the hospital out of misguided pity and love. Jacob is hurt and angry to learn of Deborah's refusal to see him. Suzy, although she has recently come into her own, must still rearrange her social life around the whims of Deborah's illness.
Esther tells Dr. Fried about her family history before visiting Deborah. Her father was a Latvian immigrant with a clubfoot. His anger and resentment drove him to seek an education and build a fortune in the United States. He purchased a home in a rich neighborhood where he hoped that his children would gain admittance to the American elite. However, his neighbors were rabidly anti-Semitic, so they never accepted his family. Esther's parents disapproved of Jacob, but when Deborah was born blond and fair, the family rejoiced at its good luck. Although Jacob struggled to make a living as an accountant during the Depression, Esther's parents lavished expensive clothing, nannies, and toys on Deborah. Esther and Jacob were forced to move in with Esther's parents, much to Jacob's shame and unhappiness.
When Deborah was 5, she suffered from incontinence that no physical punishment could correct. It was later discovered that a tumor was the cause, not laziness. A renowned specialist performed a successful surgery, but Deborah suffered excruciating pain for some time afterwards. After the stillbirth of twin boys, Esther became pregnant with Suzy, but she tried to maintain a smooth, calm face for Deborah. Jacob obtained a lucrative account and bought a house of his own, but he later discovered that the account was based on a vast chain of fraud after a year. They sold the house, and Esther's parents gave them their house. Meanwhile Deborah attended a summer camp for three years before her parents learned that it was rabidly anti-Semitic. The Second World War brought financial difficulties, so Jacob and Esther were forced to sell her parent's house and move into an apartment. Deborah became passionately interested in art, so the family assumed that her sensitivity and frequent insomnia were only the signs of an artist's temperament. Soon thereafter, Deborah attempted suicide.
Esther now feels guilty for placing Jacob second in her affections after her father. She now understands that Jacob was humiliated all those years to live off her parents' charity. Dr. Fried assures Esther that she and Jacob should not blame themselves for Deborah's illness. She warns Esther that Deborah is extremely sensitive to lying, so she should be careful to tell the truth.
I Never Promised You a Rose Garden portrays mental illness as a problem that concerns not just the patient, but the patient's family and the team of medical authorities dedicated to treating the victims of mental illness. Greenberg tries to garner sympathy and respect for sufferers of mental illness and their families by illustrating the difficult struggle they face. Treatment is expensive, thereby placing it out of the reach of many sufferers. However, even families with the means to pay for treatment must struggle to overcome their own prejudices regarding mental illness and cope with the prejudices of others.
Deborah's parents want her to get well, but they know little about the reality of mental illness beyond the prevalent negative stereotypes of patients and mental hospitals. They fear the hospital as a labyrinthine, medieval prison for dangerous raving lunatics. Nevertheless, they have chosen to place their trust in their family physician, Dr. Lister, who recommended that Deborah be left there for treatment. The struggle to counter their irrational fears and prejudices is by no means easy. They fear the reaction of their relatives should the "secret" of Deborah's illness be known. They face self-doubt and self-blame now that Deborah has been diagnosed with schizophrenia. Nevertheless, Deborah's parents are willing to make the leap of faith required of them if their daughter is to receive treatment, an admirable act of courage and love.
Greenberg clearly does not glamorize, nor does she over-simplify, the difficulties that face mentally ill patients and their families. The medical staff members at the hospital likewise face a great deal of difficulty treating their patients. They have to counter the fear and doubt of their patients' families and the patients themselves. It is a stressful, emotionally difficult profession that often requires them to oppose a family's well-intended, but frequently destructive, wishes for their loved ones. Greenberg memorializes the courage and perseverance of dedicated therapists and psychiatrists in Clara Fried, Deborah's empathetic, sensitive, brilliant doctor. Treating the mentally ill is often an art as much as it is scientific endeavor, requiring emotional strength, intelligence, and intuition as well as education and experience. The relationship between the doctor and the patient is a complex matter, of which clinical training is only one part.
Dr. Fried practiced in Nazi Germany, so she knows that irrational prejudices can converge to produce a society seemingly gone mad with fear and hatred, making the inside of the mental hospital look sane by comparison. She knows that people all too often misuse the terms "sane" and "insane" to bolster their so-called "rational" beliefs, often based on irrational prejudice. Therefore, Greenberg wishes her readers to consider "insane" and "sane" as subjective words, not clinical terms with an absolute value or an absolute truth. Deborah is mentally ill, but to call her "insane" would be tantamount to belittling her problem, exiling her to a realm beyond hope or treatment. Dr. Fried, on the other hand, views Deborah as hopeful case who has many good years ahead of her if she receives effective treatment.
Ironically, Deborah and her family have been the victims of irrational anti-Semitic prejudices in the United States. Therefore, Dr. Fried's experiences in Nazi Germany prove invaluable to her relationship with Deborah. Again, the relationship between the doctor and the patient is a complex combination of factors not entirely encompassed by the doctor's clinical education.
Likewise, Deborah's illness is also affected by a complex combination of factors that influence how she expresses her illness: her tumor at the age of five, her grandfather's martyr complex, her father's shame at depending on her grandparents financially, and the anti-Semitic prejudices of her peers and neighbors. Over the years, Deborah outwardly expressed her illness through complaints of physical pains only to be told there was nothing wrong with her. She grew alienated and bitter, so Dr. Fried must penetrate through Deborah's barrier of distrust and fear before she can treat her illness. This requires an emotional intelligence and empathy that few people can learn through clinical training.