As the observer of the mental ward and its patients, Susanna maintains a distance and detachment from the events she reports, even those that involve her. At once a manifestation of her affliction and a narrative stance that will not take sides, her detachment from the many emotional scenes invites readers to draw their own conclusions. She aims to show different sides of the same coin, and even offers two opposing versions of the fateful initial session with the psychiatrist who has her admit herself to the hospital. As memory is faulty and factual evidence exists to offer different versions of the experience, Susanna illustrates throughout that there are no easy answers, appearances can be misleading, and even established knowledge can be wrong. While she does not accuse the medical establishment of wrongdoing, she questions whether her diagnosis of borderline personality would stand in a more permissive and less gender-biased society. At the same time, she openly admits that she was suffering emotionally, as was evidenced in her habit of banging her wrists, and suggests that her time at McLean did help her manage her affliction. Once released, she must deal with the stigma attached to mental health issues and confront those who want to confine her to stereotypical female roles. Realizing the line between normal and not might be ever-shifting, she nonetheless vows never to cross it again.
Susanna initially admires and enjoys Lisa Rowe's pranks, as they show Lisa's unbroken spirit of rebellion against the oppressive rules in the ward, allowing her a modicum of control over her environment. She is the unchallenged leader of the other female patients on the ward, the one who regularly interrupts the dull routine to suit her whims, and manipulates even the head nurse into submitting to her requests. However, when she applies the same ingenious tactics to humiliate Lisa Cody, and shows pride in driving her away from McLean and to an addict's life on the street, the depth of her disdain for others becomes clear. She is a sociopath indeed, lacking a conscience, and her dark side can strike at any moment. When Susanna runs into her years after their release, Lisa has seemingly embraced suburban life and is raising a child on her own. Still, her somewhat erratic behavior offers a glimpse of a potential storm brewing underneath a responsible facade.
Like many of the other patients, Georgina seems deceptively normal and well-adjusted. She has a long-term relationship with Wade, a mental patient on another ward, engages in friendships with the other girls (particularly with Susanna), and engages in domestic activities such as cooking and baking. As is shown throughout the memoir, however, appearances are deceiving. Her stoic reaction to burning her hand suggests that she is cut off from her emotional world. The social awkwardness that appears years after she's been released relegates her to the margins of society.
Polly enjoys hero status among the girls. They believe it takes more courage, resolve, and endurance to set yourself on fire than to take a few pills; once the match is lit, there is no turning back. Polly's scarred skin proves that. At first, Polly seems to have adjusted to her disfigurement, but she suddenly breaks down and laments her scarred face, realizing it means she will never escape the moment of despair that drove her to try to kill herself. She is trapped in her skin—quite literally so.
Unlike most of the girls, Daisy receives regular visits from her doting father who brings her a steady supply of chicken. Such outside support suggests a chance at a successful life, and the girls are sad and jealous. However, her compulsive need to eat a certain number of chickens and hold on to the carcasses suggests the severity of her mental disturbance, which is exacerbated by the fact that she is unfriendly, rude, and does not want to interact with the other girls. When her father buys her an apartment, she seems to escape to freedom. However, she kills herself on her birthday, suggesting on the one hand that the appearance of normalcy can be deceiving, and on the other that McLean is a place that not only confines them but also shelters them.