However, progressive ideological elements appear prominently through casting and character design: nearly every major Usher sibling and several supporting figures are explicitly LGBTQ+, including Victorine LaFourcade (T'Nia Miller) in a lesbian relationship with surgeon Alessandra Ruiz (Paola Núñez), whose conflict over unethical trials directly fuels the 'Tell-Tale Heart' episode plot; Napoleon 'Leo' Usher (Rahul Kohli) as bisexual living with boyfriend Julius while cheating with a woman; Perry Usher (Sauriyan Sapkota) as pansexual hosting a queer orgy rave; Camille L’Espanaye (Kate Siegel) as bisexual engaging in workplace threesomes; and detective Auguste Dupin (Carl Lumbly) with a husband. These identities shape multiple arcs and subplots without trauma-focused coming-out stories, normalizing non-traditional relationships as routine.

Diverse actors fill key roles in this modern setting, and the volume of queer characters is repeatedly highlighted by reviewers as a deliberate, standout feature of Flanagan's adaptation. Themes include critiques of capitalist excess via the opioid empire, but identity politics remain secondary to the horror premise rather than foundational.