The quote from Nora Ephron's book "Heartburn" reflects on the limited options people face when dealing with mental health institutions, often colloquially referred to as "loony bins." It suggests that choices in such serious matters can be starkly reduced, highlighting the challenges individuals encounter in difficult situations.

This statement may also imply a critique of the mental health system, where individuals seeking help may feel trapped by a lack of quality alternatives. Ephron’s work often combines humor and poignant observations, making her reflections especially impactful when addressing societal issues.