Content Warning: The source material contains depictions of physical and sexual violence against minors. It also depicts suicide, drug abuse, acts of terrorism, violence, and murder.

The novel explores the ways that trauma continues to impact people long after the actual traumatic event. The trauma of child abuse is central to the story. The novel portrays the physical damage done to children’s bodies by sexual abuse; in one case, Miss McNulty’s child dies of these injuries. Through Tom and June, the novel also shows that the psychological impact of this trauma can continue long after physical injuries have healed. In his old age, Tom displays behaviors typical of PTSD, such as intense flashbacks, confusion, and unpredictable surges of emotion—several times, he cries suddenly and uncontrollably. For a long time, it seems like June has made peace with her past, but when Tom investigates an associate of her abuser, she breaks down: Tom describes her sitting still for hours in the living room, and later, she violently kills Matthews. After this, she seems well again for some time, raising a happy, loving family; but she dies by suicide once the children are older, showing that her trauma remained under the surface even during the happy times of her life.