Mental health is a motif that appears numerous times throughout the novel. Different characters levy “crazy” as an insult against those with whom they do not agree. Grandmother, for example, uses synonymous terms to describe Miss Duvall and Chester, saying, “Not with that lunatic and her crazy companion out of the picture” (91). These names are harmful to the people they are being used against and to people who do suffer from mental health problems. Hahn hints lightly at the possible harm that can be caused at the use of such words through Travis’s treatment of his sister. Travis has no qualms thinking of Corey, “Psycho was more like it, but why spoil things with the truth?” (27). After Chester claims that Corey “is disturbed,” Corey becomes extremely upset by the implication (65). Despite how upset she is, Travis tells her, “Of course you’re disturbed, I’ve known that since the day Mom brought you home from the loony bin” (65). Corey ends up storming off, her feelings hurt by both Travis and Chester. Despite Grandmother’s subsequent telling-off of Travis, she is just as guilty of levying mental health as an insult toward others.

The novel contends with topics around chosen and coerced suicide.