No transsexual characters or themes appear in the film. The protagonist's arc centers on recovering from familial abuse and addiction through writing and swimming, without any transgender elements.

The movie does not contain any action or adventure elements.

The film adapts Lidia Yuknavitch's memoir without altering the genders of key characters, such as the female protagonist Lidia, her female sister and mother, and male father and partner, matching the source material's depictions.

The film adapts Lidia Yuknavitch's memoir, with white actors portraying the white protagonist and family members, as well as historical figure Ken Kesey. No characters from the source material are depicted as a different race.