Charlie's primary internal struggle indicates that he is having issues with self-image, self-worth, and perhaps self-esteem. In his effort to be "like" others and to seek friends through obtaining some level of normalcy, Charlie reveals his own insecurities. He shows that he feels outcast and negatively different from the world around him, despite his revelation and response toward the end of this story.
He serves almost as a poster child for any modern-day adolescent wrestling with their own issues of image, value, and popularity in the above described sense.
Charlie struggles so much with a need to be accepted and to be "normal". He spent his childhood being abused by his mother because he was different and she couldn't face it. As an adult, he hates that he is not equal to his "friends" and peers. He wants the surgery because he wants to:
to be smart like other pepul so I can have lots of friends who like me.
Like all humans, he just wants to be a part of a group. However, when he is "smart" enough to understand what his peers are really like, Charlie starts to understand that being accepted isn't necessarily a positive goal. Why desire to be accepted by people who aren't humane in their treatment of others? However, he still desires to be "like others" and tries desparately to research and discover the flaw in the operation. It is only when he realizes that there is no fix that he must face up to his internal problem. It is then that Charlie overcomes his conflict and accepts himself and understands that other people will and this is enough. He also learns from his own internal conflict to be accepting of other people who might be:
not so smart like you once thot they were.