I think that Anderson's work attempts to "speak" about a condition that is subjective, but one that has external consequences. Lia's anorexia is a condition that she alone sees. No one else sees her as fat or overweight, yet what she sees is a mass of bulk that must be eradicated. Her attempts at establishing a facade remove any objective hint that there is something wrong with her. In fact, the only connection that Lia had in order to make her subjective experience something external was with Cassie, who ends up dying due to her own demons. The idea of anorexia is shown as one where an individual afflicted with it is a "ghost with a beating heart." The lack of external intervention due to a lack of awareness or an unwillingness to care helps to further Lia's obsession with weight loss. The admission that she will never lose as much as she wants helps to begin the process of moving from the subjective into the realm of the external. Yet, Anderson does not suggest that this is an easy or guaranteed process. Look at Cassie as evidence of this. In the end, the book strives to "speak" about how a private issue has public implications, and how individuals have to make the attempt to hear the cries of others' suffering in the hopes of removing subjective torment into external healing.