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Ruth is the protagonist of The Bonesetter’s Daughter, and the plot is driven by her struggle to find a sense of connection with her mother and greater confidence in her own identity. Ruth often feels frustrated and embarrassed by her mother because she has always wanted to blend in and receive the approval of others. When Ruth thinks about her childhood and adolescence, she dwells on the ways that LuLing failed her. Ruth can recognize that her mother worked very hard to give her economic stability and a good education, but she cannot feel true gratitude because she is preoccupied with longing for affection and emotional intimacy, which she does not believe she experienced. Ruth often compares her life to the lives of those around her, and this leads her to feel like she is missing out on things. At the same time, she lacks the agency to make any changes which could improve her life or relationships.

As the novel progresses, Ruth experiences personal growth when she asserts herself and takes action. The fear of losing her mother eventually motivates Ruth to get LuLing’s life story manuscript professionally translated and to move in with LuLing for several months. Before that, Ruth had been stuck in a rut, passively waiting for something to come along and change the nature of her relationships with her mother and partner, Art. Ruth’s choice to move in with LuLing gives her additional perspective and understanding in both relationships. She gains many new insights into LuLing’s history, and she develops better communication with Art. This new understanding empowers Ruth to live the life she wants. She develops the confidence to assert herself in her relationship with Art, and she takes steps toward writing her own book instead of revising the stories of others. Once Ruth learns about the courage of the generations of women who came before her, she begins to see herself as more resilient and capable. Ruth stops fixating on self-pity and regret and starts trying to live her life in a way that would make her strong mother and grandmother proud.

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