For the most part, the setting of this novel is the Hôtel de Lamballe. It was once a Paris residence of the ancien régime but by 1892, the date of the action, it is a maison de santé under the direction of the real-life alienist Dr Blanche, father of Jacques-Emile Blanche, the popular and snobbish portrait painter of the XVIth arrondissement. Three characters dominate the narrative. The eponymous Adam Gould is a failed Irish seminarian whose family problems – illegitimacy and a father who, to raise money to meet his mounting debts, abandons his common-law wife, Adam’s mother, in pursuit of a lucrative match, thus precipitating her suicide – have driven him to move to Paris and take up a job in Blanche’s clinic. 

The second of the trio is the witty, good-natured Monseigneur de Belcastel, who has become one of the patients of ‘Dr Blanchisseur’ (the alienist has earned this nickname because of his willingness to wash away potential scandals or crimes with a diagnosis of insanity) in order to escape