Johnson's experimental novel focuses on an evening in a geriatric home, where a house mother tries to amuse eight patients of varying mental and physical capabilities. The novel is comprised of nine sections, one for each character. Each section has twenty-one pages - except for the last section, the House Mother's section, which has twenty-two. Each section includes a short case sheet before the narrative, ostensibly as an introduction to the mental and physical state of each character. They seem to function as a rationale for the narratives following them. The narratives themselves are written in stream-of-consciousness style, following the characters' thoughts and spoken words as they occur.
You'll notice as you read that the events are static throughout each narrative: what happens on page seven of one narrative occurs on every page seven. Your understanding of the evening's events evolves slowly, one piece at a time, as you read each section. Also, the narratives start with the most lucid and able character (Sarah Lamson) and work their way through increasing levels of dysfunctionality and abnormality, culminating in the House Mother's narrative.
It is a very involved way of reading, of course, and one cannot help but feel sympathy for the characters as they see the world through each individual set of eyes, minds, and impairments. The House Mother's narrative is, again, an exception. Delving into her mind is absolutely repulsive. This technique would work, except for page twenty-two: Johnson speaks through the House Mother, reminding us that she is a construct and that, as the author, he has full control over the novel. It's an interesting move, but at the same time, it invalidates the universe of the novel by removing our suspension of disbelief. For many readers, this move renders the entire novel meaningless.
Also, the stream-of-consciousness style detracts from character development. The main concern of the narratives was memories of the past and reactions to the present, so there is little room for meaningful characterization. I still developed sympathy for the characters, but it felt contrived, especially since we as readers are forced, by the last page, to become aware of the fact that Johnson is using techniques.
With techniques aside, the contrast between the cold, scientific distance of the case sheets and the human warmth behind the first eight narratives, and the contrast between the patients' sympathetic narratives and the house mother's disturbing narrative, reveal a criticism of how ineffectively society deals with deterioration of the body and soul. During Victorianism, people with mental illnesses and venereal diseases were sent to asylums, where they were sequestered from the general population that had no understanding of their conditions. Now that science has evolved and has a complex vocabulary for nearly every condition known to man, society has adopted those terms. However, these technical terms are more comforting than enlightening: we have some control over ourselves, their existence assures us, we have found some semblance of order in the vast universe. And yet, we are still insulated from the horrible reality of illness because we give power to these meaningless words (many of which, in the case of the novel, are high-flown technical terms for well-known conditions). This labeling and empirical "knowledge" neglects that there is humanity behind these conditions, and that there are very real people suffering in ways that the healthy cannot understand. Scientific language has become the modern-day insane asylum. Johnson illustrates that point well, even though the novel suffers from a couple poorly devised techniques.