Written over a period of almost thirty years, it combines realist and dystopian surrealist depictions of his home city of Glasgow.

Lanark is eventually swallowed by a mouth in the earth, and awakes in the Institute, a sort of hospital which cures patients of their diseases but uses the hopeless cases for power and food.

The book follows Thaw's wartime evacuation, secondary education and his scholarship to the Glasgow School of Art, where his inability to form relationships with women and his obsessive artistic vision lead to his descent into madness and eventual suicide by drowning.

Book Four sees Lanark begin a bizarre, dreamlike journey back to Unthank, which he finds on the point of total disintegration, wracked by political strife, avarice, paranoia and economic meltdown, all of which he is unable to prevent.

He finally finds himself old, sitting in a hilltop cemetery as Unthank breaks down in an apocalypse of fire and flood, and, his time of death having been revealed to him, he ends the book calmly awaiting it.

The connection between the two narratives is ambiguous; Gray said that "One is a highly exaggerated form of just about the everyday reality of the other"[6] (for example, Thaw's eczema is mirrored by Lanark's skin disease 'dragonhide').

He also referred to his own experiences in the media industry which he states is reflected in Lanark's numerous encounters in labyrinthine buildings with individuals talking in jargon.

More immediately evident inspiration can be seen in the cathedral and necropolis episodes in Unthank, whose proximity to an urban tangle of roads is mirrored in Glasgow's real-life Townhead area.

[12] An adaptation entitled Lanark: A Life in Three Acts, written by David Greig and directed by Graham Eatough, was produced and performed at the Edinburgh International Festival in 2015.