The influence of organized crime in the neighborhood
The book's central feature is that the family is uniquely afflicted by a particular person, a kingpin named Whitey who involves the boys in the drug trade, brutally initiating them into gangs. The girls aren't immune either—one sister, Kathy, ends up addicted to Whitey's angel dust. Even the mother ends up taking a bullet from a gang.
Mental health issues in the family
Unfortunately, many of MacDonald's siblings died way too early, but interestingly, they almost only die by their own hand. This is likely because they feel condemned to die in a bad neighborhood, or because their family issues and personal issues drive them to suicidal depression. Kathy's addiction is a mental health issue, as is Davey's battle with schizophrenia.
The hope for a life outside of Southie
One of the sad ironies of South Boston is that the people who live there are so proud of their heritage and their culture in Southie, including All Souls Night for instance—and yet almost every person with hope is hoping to escape the vicious cycle of poverty that people in Southie are trapped in.
Racism as an institution
When the city makes the dubious, suspicious move of busing black students to white schools, allegedly to desegregate them, the effect is that there are race riots and lots of people get hurt or even killed. Another issue treated by the story is the bias against Irish Catholics in New England, especially racism against Irish neighborhoods.
