The title I Never Promised You a Rose Garden comes from a therapy session Deborah has with Dr. Fried. It's a powerful moment that comes at the halfway mark of the novel.
Deborah is struggling to decide if the real world would be worth giving up Yr, especially since there is so much injustice and evil in the real world. Remember, Deborah's story is happening not long after World War II. Her family is Jewish, and she's very aware of the Holocaust. She's just as much aware of the prejudice she faced in her own neighborhood growing up.
At the hospital, Deborah faces a new kind of prejudice from some of the staff and from people on the outside once they've learned she's been in a mental hospital; she learns just how much people mistrust and misunderstand the mentally ill. They mistreat them, too—like when Hobbs smacks Helene in the face when she's restrained in a cold-sheet pack.
Deborah feels compelled to bring that incident up in therapy to see if Dr. Fried can do something about it. She wonders aloud whether it's worth it to side with a world that is capable of such cruelty.
Dr. Fried admits that she can't promise justice: "'I never promised you a rose garden. I never promised you perfect justice…' (She remembered Tilda suddenly, breaking out of the hospital in Nuremburg, disappearing into the swastika-city, and coming back laughing that hard, rasping parody of laughter. 'Sholom Aleichem, Doctor, they are crazier than I am!')" (13.41).
Dr. Fried makes no promises. She remembers a patient she treated back in Germany who was released from the hospital there only to see the Nazi madness erupting all around her. Dr. Fried knows that Deborah is right, that the world can be cruel. She knows firsthand.
But Dr. Fried also knows the advantages that come with mental health, so she continues to encourage Deborah: "My help is so that you can be free to fight for all of these things. The only reality I offer is challenge, and being well is being free to accept it or not at whatever level you are capable. I never promise lies, and the rose garden world of perfection is a lie…and a bore, too!'" (13.41).
Dr. Fried never promised Deborah a rose garden, but she still wants her to try to plant the seeds of one—because she might just get better and learn how to be happy. Even if that happiness will include struggles.