An official of the verisylum claims that lying is an illness specific to modern life, and informs Sim of the strange and seemingly arbitrary rules that everyone inside the building must follow.

Sim must uncover the cryptic meanings behind the verisylum and the mysterious figure of Samedi before the end of the seventh day, when it is predicted a catastrophe of biblical proportions will occur.

Caryn James, writing in The New York Times, praised the novel: "Like the early Thomas Pynchon and more lately Colson Whitehead, Mr. Ball creates a world nearly identical to ours, which operates on one significantly different principle: Your most paranoid fears are likely to be true.

"[1] The New Yorker wrote, "The hero's struggle to decipher the rules of the sanitarium is rendered in a series of exquisite set pieces, each one a clue in a puzzle whose solution is ultimately immaterial to its beauty.

"[2] Writing in The Millions, City on Fire author Garth Risk Hallberg noticed many of Ball's influences, including Kafka's The Castle and Murakami.