The family system
The family system is demonstrated by the book, because a lonely little girl tries to connect emotionally with her parents, but they are so beaten down by their lives, which are incredibly lonely in an ironic twist of fate, that they don't see their own daughter's pain. They know she is emotional, but since Naomi's mother is depressed, she doesn't really have a good sense of emotional balance by which to judge Naomi's emotions, so she doesn't realize that Naomi's has also slipped into a depression. This makes Naomi dream she were a girl whose parents treated her like a real human being, who took her emotions seriously, and who were friendly with her. So the theme is that done correctly, a family can support one another through life, instead of being dragged apart by their own private suffering.
The lonely perspective
This story is about a very lonely young girl. Not only that, it is about the wear and tear of that chronic frustration, depression, and anxiety, because loneliness takes a toll on Naomi's perception—not just her life, but her actual perception of reality. This is because she knows instinctual, in an emotional way, that she should have more meaningful relationships, but since her loneliness began as a child, she doesn't have any season of social success in her past to refer to. So her imagination gets involved and makes the loneliness even worse. By the time she realizes that she cannot save her friends from life's misery, she also realizes that secretly, she thought that her friends were going to save her, but that was actually never the case. She realizes that friendships are more about having someone to share one's suffering with than they are about anything else.
Love and healing
Naomi wants to be a heart surgeon. Why is that? It is because her father had a heart attack when she was young, a symbol of his stressful, difficult, lonely life perhaps. So in a deep way, she resonates with her father's story, because she too feels her life is difficult and lonely. Perhaps by fixing her father, she can mend her fate as well. At least, if she could figure out how to be in community together, they could see their problems together. She is presenting us with her personal vision for love and healing, from her imagination, basically.
