I Never Promised You a Rose Garden is a semi-autobiographical account of a teenage girl's three-year battle with schizophrenia. Deborah Blau, bright and artistically talented, has created a world, the Kingdom of Yr, as a form of defense from a confusing, frightening reality. When Deborah was five, she underwent surgery to remove a tumor in her ovaries, a traumatic experience that involved a great deal of physical pain and shame. During her childhood, Deborah suffered frequent abuse from her anti-Semitic peers and neighbors. When Deborah first created Yr, it was a beautiful, comforting haven, but over time the gods of Yr became tyrannical dictators who ruled Deborah's every word and action.

The novel presents the issue of mental illness from multiple viewpoints. Deborah's three years in the hospital provide us with a portrait of mental illness as it is experienced by the patient. Deborah's parents, Esther and Jacob, are torn between their love for their daughter and their shame at the stigma of her illness. Nevertheless, they find the courage to allow Deborah to continue treatment even when there are few signs of recovery for a long while. Deborah struggles with guilt and resentment at her parents' disappointed expectations for her while her younger sister Suzy copes with her frustration at having to arrange her life around Deborah's illness.

Deborah's strong-willed, empathetic, brilliant therapist, Clara Fried, slowly wins Deborah's trust. She never forces Deborah to accept her point of view. Over the course of three years, she helps Deborah gain the courage to fight her illness. Her goal is to give Deborah the ability to choose between the reality of Earth, despite all its faults and problems, over the phantoms of Yr. Meanwhile, Deborah develops friendships of a kind with the other patients in the hospital despite their fear of emotional investment in other people. Although she fears the reality of Earth, Deborah eventually earns a GED and resolves to win her struggle against her illness.

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