Progressive elements are limited to the explicit portrayal of Theodora 'Theo' Crain as a lesbian, introduced in episode 1 taking home a woman from a club and shown in subsequent romantic entanglements, including a functional relationship that resolves positively at the end with her throwing away her gloves. Creator Mike Flanagan described making Theo's sexuality overt as 'freeing' given societal changes since the novel, with no trepidation, and noted a diverse writers' room focused on dysfunctional family dynamics rather than activism.

No race- or gender-swapping of book characters occurs, the all-white Crain family aligns with the source, and themes of mental health and loss lack systemic oppression framing or identity politics as central drivers. Audience reception showed no notable backlash or review-bombing tied to ideology, with praise for the rep as incidental rather than preachy.