Some of the most pervasive imagery in the novel centers on the idea that something is making both Mississippi and its people sick. Illness is everywhere in the novel, from Kayla’s stomach bug to the cancer that eventually kills Mam, and even characters who are otherwise healthy are slowly poisoning themselves with drugs. Ward also depicts the land itself as toxic and unwell, most obviously in her account of the aftermath of the Deepwater Horizon oil spill: Michael describes dolphins “wash[ing] up on the beaches in Florida, in Louisiana, in Alabama and Mississippi: oil-burnt, sick with lesions, hollowed out from the insides” (226).

The significance of this motif varies according to context. Given the association between caretaking and feeding in the novel, it’s significant that much of the sickness in the novel involves poisoning, choking, or vomiting, all of which in one way or another disrupt or undermine healthy eating processes. For example, when Jojo fears Leonie will accidentally poison Kayla with the blackberry tea (and reveals that she in fact has poisoned him this way in the past), it’s a reflection of her broader deficiencies as a mother; although Leonie does love her children, she does so in a selfish way that often does harm to them, as when—jealous of Jojo and Kayla’s closeness—she lashes out at her son.