A normal man, even if he be small, needs a head circumference of at least 53 sm, whereas a woman gets along well with 51 cm. Thus, for the tasks of a woman's life, a brain that has room within a head of 51 cm is sufficient. But for the tasks of a man's life it is not enough. With 51 cm one can be an intelligent woman, but not an intelligent man. This is the social milieu we are made aware of, and which we never leave, once we enter the Steilacoom Territorial Asylum.
Women are better at being women.
I think the basic trust necessary between patient and doctor has been somewhat violated. In this way B.J. proves to himself that he exists. When Chin and Sarah leave the Asylum, B.J. comes along, doubting his existence and his perceptions. From this point, early in the book, the action never stops. Chin, Sarah, and B.J. journey through a complex and fully-realized landscape in the territory around Seattle.