Christopher McVey has discussed the nature of Ondaatje's use of metaphysical aspects of body, history and nation in the novel.[16] Amy Novak and Mirja Lobnik have separately analysed aspects of the treatment of memory in the novel.[17][18] Thomas Harrison and Rachel Friedman have each examined the references and use of Herodotus in the novel.[19][20] Madhumalati Adhikari has critiqued the treatment of the Second World War and its effects on the characters of the novel.[21]
A major symbol of the novel is the desert. It serves as a representation of the characters' war experiences and how they came to gather in the villa. A passage in the novel notes "The desert could not be claimed or owned."[22] Carravaggio had stepped away from the war for a brief time when he drifted into the villa and encountered an old flame, Hana. Kip elects to stay in the villa, a straggler from his unit, to continue searching for explosives. He also finds there is a serene sense of acceptance in the villa and that the people need him. Hana is devoted to her patients, to the very last. Thus, she stays behind in the villa hospital when numerous others abandon it. Almásy himself is forced into the villa, essentially because the desert took him when his plane was shot down.
A psychoanalytic analysis of "The English Patient" helps us to understand the meaning of Michael Ondaatje's emphasis on his characters' differences and appearances. He may have been thinking about how melting pot civilisations begin by different cultures working together in spite of each other's background. Note how each central character living in the reconstructed villa is almost as opposite of each other in appearance as they could be. Hana was young, healthy, and capable of caring for more than one person at a time, but she mainly attended to the English patient. In contrast to Hana, the English patient was handicapped and on his death bed. But little did Hana know, in the English patient's past, he had worked with the Germans on other desert expeditions way before their paths had crossed. However, his amnesia could not allow him to remember such things at the moment. In other words, Hana was caring for someone who was partly responsible for her village's demise. The moral of this is that Hana, the English patient, Kip and Caravaggio had fewer physical resemblances to each other than they had had of humanistic desires. Thus, Michael Ondaatje may have wanted us to see that what's on the outside does not matter as much as what's on the inside when rebuilding a village, city or country.[23][24]
The emotional heart of this novel is found at the core of the character's want and need to survive, which in turn is the eternal damnation they find by everything seeming so bleak. Within this, the desert is a large symbol. As the Villa San Girolamo is an abandoned, war ridden place, it is also a place that seems like a cage, with no chance at happiness in sight. The war may be over, but the characters feel trapped in a sense. The desert within the novel is a place of freedom, a place that cannot be claimed or owned by any one person. The desert is everlasting, and can never be wavered. This is unlike the war that these characters had become extremely traumatised from. It is a vast nothingness that will always remain nation-less. A place that these characters can seek out in their minds, when there is nowhere else to turn for hope.[25][26]
