Take a story's temperature by studying its tone. Is it hopeful? Cynical? Snarky? Playful?
Introspective, Compassionate
Variety is the spice of life, right?
Because this book is written in third-person omniscient point of view, the tone changes depending on whose head we're in at the moment. The two main tones come from Deborah and Dr. Fried.
Deborah's Head
Deborah's insights are introspective in tone. She's constantly questioning and evaluating herself, her motives, her senses, her identity. Even when Deborah speaks her thoughts out loud to others, there's always some deep thinking that has preceded her speech.
When Helene tries to get on her nerves and bully her, for example, we get an understanding of Deborah's introspection when she processes what's going on: "Deborah recognized the voice and knew the tremendous strength of violence in Helene, but now laughter came welling up naturally as if she had always had it as a friend. 'Do you think you could compete with smallest nightmare of its dullest day?'" (15.29-30).
Deborah tells Helene that nothing she could do could compete with Deborah's own sickness and darkest demons. That takes guts to say out loud, but we see how she got there.
Dr. Fried's Head
When we're with Dr. Fried, the tone is always compassionate. The doctor feels for everyone in this story, and she can understand others' perspectives, even when the reader might want to judge them.
For example, Esther Blau is overprotective and delays getting her child help when she showed symptoms of mental illness for years, but Dr. Fried doesn't judge her for it, even privately to herself. She addresses the situation with kindness: "Dr. Fried looked at Esther and listened to the words of love and pain coming from the carefully composed mother of a girl sick to death with deception. The love was real enough and the pain also" (5.58).
It takes a well-adjusted person to be able to see so many different points of view. Dr. Fried's gentle tone prevents us from being judgmental; she gives us the opportunity to feel empathy for troubled characters we might not normally care much about.