When Deborah's tumor was discovered, she felt violated when the doctors examined her, and enraged when they told her that there would be no pain. She tells Dr. Fried that an intern explained that they lied to her so that she would not be afraid. Deborah utters a word of Yr's language during the session. Terrified at her indiscretion, she flees into Yr completely.
Deborah meets Carla, another patient on her ward. Carla's mother shot Carla, Carla's brother, and then herself, but Carla survived. Inside the mental hospital, Carla and other patients are free to call themselves "crazy." Yri language describes Deborah's pain and suffering more accurately than Earth language. Nevertheless, at Dr. Fried's urging, she struggles to describe her feelings in English. When Suzy was born, Deborah horrified the family by declaring that the wrinkled, red baby was ugly. Her family has stood aloof from her since that day while they all loved Suzy, beautiful and carefree, unconditionally. When she started school late, her classmates also stood apart from her. Deborah feels that her mother had recognized the "fatal taint" in her and tried to ameliorate it by taking her classmates out on an excursion. As she recounts the anti-Semitic taunts of her neighbors and peers, Deborah is grateful for Dr. Fried's expression of indignation.
Later, the gods of Yr shout that Deborah is not "one of them." When Deborah slashes her arm with a piece of tin, she is moved to the Disturbed Ward, where she is pleased to find that all pretensions to normalcy are absent. She begins telling Dr. Fried about Yr. At first Yr was a comforting haven, but it has become a source of pain, fear, and tyranny. Afterwards, Deborah suffers a psychotic episode, so the staff places her in restraints. Deborah explains to Dr. Fried that the gods of Yr told her that Three Changes and Their Mirrors would precede her Death. As Deborah recounts three separate incidents in her life, later mirrored by three other incidents, Dr. Fried suggests that Deborah has created a meaningful connection between these events in order to understand and survive in the confusing, inexplicable real world.
The patients on Deborah's ward single out a particular attendant, Hobbs, for abuse. The patients understand that Hobbs fears their insanity because a seed of it exists inside himself. Meanwhile, Helene, a volatile patient, violently attacks Deborah. As in the real world, the attacker receives more attention that the victim. Earlier, Helene showed Deborah a picture of a college classmate. Deborah realizes that Helene attacked her in order to erase that moment of vulnerability.
During one session, Deborah furiously sketches a portrait of her Yri self. Dr. Fried is excited that Deborah has lost her apathy in her attempt to prove that Yr exists. Meanwhile, Carla joins the Disturbed Ward because she wants to stop hiding her "insanity." The other wards are too invested in keeping up the appearance of normalcy. They learn of Doris Rivera, a patient who became well enough to leave after three years at the hospital. The gods of Yr shout that Deborah can never go out into the world again, so Deborah suffers another psychotic episode along with a number of other patients. Carla says that they were all afraid of the threat of having to be well that Doris Rivera represented. Deborah curses Carla and then apologizes because what Carla said might be true.
Meanwhile, Esther and Jacob worry over Deborah's transfer to the Disturbed ward. Suzy shouts that everyone is always worrying about Deborah. Esther visits with Dr. Fried, hoping that she will be allowed to see Deborah, although there is a rule against visits on the Disturbed Ward. In another session, Deborah declares that her essence is poisonous, so she destroyed her sister Suzy. Dr. Fried suggests that she is attempting to hide from the truth of what she actually did to her family, what they actually did to her, and what she is doing to herself. Deborah confesses that she tried to kill Suzy after she was born. Her mother discovered her just as she was poised to throw Suzy out a window. She was never punished, and her parents never spoke of the incident.
Deborah's early childhood surgery clearly had an important influence on how Deborah later expressed her mental illness. The suffering caused by her mental illness expressed itself in phantom physical pains that are clearly "translations" of the physical pain she suffered as a result of her tumor and subsequent surgery. However, when she visited doctors about these pains, no one recognized these pains as symptoms of a mental illness rather than the complaints of a hypochondriac. Therefore, Deborah was continually told that there was nothing wrong with her at all. The combination of these factors has made it difficult for Deborah to trust anyone.
Deborah has known that she is ill for a long while, but she has been unable to convince others of the existence of her illness until her failed suicide attempt, a cry for recognition of her suffering and for help. Her relationship with Dr. Fried is still in its developing stages, but Dr. Fried acknowledges the truth of Deborah's conviction that she is sick and has been sick for a long while. Her job now is to explain the nature of the illness to Deborah and to help her fight it.
It is important to consider Yr as a symptom of Deborah's illness. Yr is also sort of map to Deborah's illness. It has its own language and its own logic, a logic that replaced the confusing, seemingly irrational logic of Earth, a logic that Deborah has come to view as a structure of lies and deception. Yr's language expresses the suffering and pain that others have told her are nonexistent. It would be too simple to dismiss Yr as an "imaginary world." It is real for Deborah. Likewise, the phantom physical pains were real for her. Both these pains and Yr are symptoms of her mental illness, although she did not know this before she was diagnosed with schizophrenia.
Dr. Fried accepts the "reality" of Yr, an important action on her part because it is crucial to Deborah's ability to trust her. She helps Deborah to read the logic of Yr in new ways: to use it to understand her illness and how to fight it. The Three Changes and Their Mirrors is on one level an expression of the worsening state of Deborah's illness. This prophecy of doom gives Deborah a comprehensible narrative that explains her sense of foreboding. Dr. Fried encourages her to re-interpret Yr as a means to give comprehensible meaning to the real world's often confusing, illogical laws. She also prompts Deborah to examine the prophecy of doom as an expression of her illness's progression.
Deborah's psychotic episodes often correspond with moments in which she reveals details of Yr to Dr. Fried. Although it may look like her illness is getting worse, it is actually a sign that she has begun to fight it. She has begun to resist the tyranny that Yr exerts over her actions and thoughts. For years, she hid Yr, but now that she is inside the hospital, she no longer feels the same pressure to hide her illness--to live a lie. She can suffer from her illness openly, and therefore, she is free to address it through treatment.
Greenberg also prompts her readers to re-interpret the often frightening, seemingly irrational actions of mentally ill people. On the surface, the torment and abuse that the patients unleash on Hobbs may seem completely inexplicable and irrational. However, through Deborah's perspective, we learn that there is a logic behind their behavior. Hobbs fears his own mentally unstable characteristics. He wants the patients to act outwardly more "insane" than he does so that he can safely draw a distinction between himself and them. The patients sense this desire, so they give him what he wants from them. At the mention of Doris Rivera's successful transition, several patients, including Deborah, suffer psychotic episodes. On the surface, the two things may seem unrelated. However, the rash of psychotic episodes is an expression of the patients' fears and doubts regarding their own abilities to make the same transition.