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 when Deborah is 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.
Clara 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.
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' fear and doubt regarding their own ability to make the same transition.
Deborah is pleased that McPherson treats her with the respect one accords an equal when he requests that she cease tormenting Ellis. Ellis, like Hobbs, gets what he wants from the patients. They recognize his martyr complex, so they go out of their way to reinforce it. McPherson admonishes Deborah for being so self-centered as to think that she and the other patients have "a corner on suffering." He not only believes that she is capable of empathy and moral behavior--he expects it of her. He does not treat her as a helpless invalid, but he is not insensitive to her suffering either.