Religion and shame
The main premise of this novel is simply that a certain Mennonite community had an extremely negative influence on her life. This had a lot to do with her family, but it also stems from the culture of the religious community and their propensity for extreme strictness. Nomi ends up with a warped sense of shame, because all the people she trusts most in the world have told her that God will hate her if she decides to do what she wants instead of blindly trusting a catalogue of religious rules.
Repression and freedom
Nomi's point of view is elaborated through important scenes that expose various tensions and issues in her sense of self. She is in a serious conundrum of external and internal trust. When she trusts herself, she feels agony relating to a belief that she is being stifled, but when she trusts others, which is very natural and sometimes helpful in the novel, she feels that she is simply not living up to the ethical standards of a holy life. The emotions she feels prevent her from understanding her true beliefs.
Mental health issues
These constructive themes point the reader toward the central theme of the book which is to obey one's own need for mental health. When Nomi decides to betray her religion for a chance at true love, she realizes that the boy was not as interested in permanent relationship as she was. He cheats on her, but she has already betrayed her strict religious upbringing to sleep with him and be on birth control. This shows two serious mental health concerns: the pain of being betrayed by a sexual partner, and it also shows that deep down, Nomi does not really believe what she is told to believe. When her body told her to do something else, she did it. That means that her religious shame has effected her mental health by way of cognitive dissonance.
