Mental Illness
Esme's mental health issues could not be characterized as madness because at many times in the novel they seemed to be character issues - in that her character was not what their parents required in a child of theirs - rather than bona fide mental disease. This is the primary theme of the novel; not just mental illness, but the definition of it, and who is entitled to set the parameters of what constitutes this. Esme had some emotional and mental challenges; she could possibly have been somewhere on the autism spectrum or had a degree of attention deficit disorder, which would explain her behavior at times being a little outlandish. She may also have suffered from PTSD after her traumatic experiences which would account for the episodes that her parents called madness. The theme also deals with the use of the term "mental illness" as a weapon that could be wielded in order to exert total control over a person who resisted control, or to get rid of a person whose presence was awkward or disquieting. Despite this theme on the novel, mental illness did not seem to be a theme that was paid much attention to within the institution that Esme was confined to as there is virtually no mention of any treatment or attempts to improve her mental health.
Family Secrets
The Lennox family is one of secrets and mysteries, and this is largely due to the fact that they rewrite any part of their own history that makes them uncomfortable. The damage that the secrets kept by one generation can do to subsequent generations is one of the key themes of the book. Esme is a well-guarded family secret and even her own son (who would be considered her nephew) has no knowledge of her. This secret impacts the life of the next-but-one generation when Iris' life is upended upon Esme's release. The theme also shows that the secrets kept from the outside world are seldom successfully kept from oneself and Kitty is more than able to recall the events surrounding the traumatic removal of Esme's son despite the secrecy around it.
Women's Lack of Rights
The novel shows how pitifully few rights women of the time had. A woman in Esme's generation was rarely able to leave home and live as a single person until the right man came along (or not) but was the property of her parents until she married at which point she became the property of her husband. Women were also held back as shown by Esme's plea to be allowed to stay on at school and go to university being turned down flat - her father saw no reason for a woman to be educated to an advanced level and even saw shame in a woman having a job or a role beyond that of wife and mother. The lack of power over oneself as a woman is also very much evident in the book as nobody bothers to talk with Esme when she is committed to the hospital; they merely take her father's word for it that she is mentally ill and do not think to get Esme's own input on the matter because as a female, her opinion was not considered relevant or important.
