One of the most important themes throughout the novel is grief and the way it manifests itself physically in the bodies of those who are suffering. Numerous characters or people discussed in the novel suffer psychosomatic symptoms and engage in ongoing efforts to combat the manifestations using therapy and other treatments.

The story opens with a discussion of Cambodian women in California who suffered so much violence under the Khmer Rouge that they cried themselves blind. Elsewhere in the text, other characters develop physical pains and lose their senses when they suffer emotional pain or loss. The narrator, after the suicide of her friend, begins to experience pain for which she knows there is no physical cause. The severity of her grief is enough to overcome her self-awareness and her cynicism: Grief and its associated physical symptoms become all consuming.

Even Apollo appears to suffer from physical manifestations of grief. After losing his beloved owner, the dog sinks into a depression. He lingers and slinks around the house, devoid of energy. At times, he sulks; at other times, his manner changes completely, and he howls and suffers from fits. Although she is unsure whether dogs can comprehend death and whether Apollo understands what has happened to his master, the narrator feels certain that he is in mourning.