The novel follows the conversations, fantasies, and the emotionally dissociated states of a group of psychoanalysts gathered during a nocturnal pancake supper.

[1] The New York Times called it, "A Freudian free-for-all,"[2] and George Saunders hailed it as, "one of the most pleasure-giving, perverse, complicated, and addictive novels in the past 20 years," in his article for Salon, which later became the book's introduction.

The conversations amongst the psychotherapists at these biannual pancake dinners are generally dedicated to “the seemingly everlasting task of reconciling classical metapsychology to our particular branch of Self/Other Friction Theory.”[4][5] The narrative may be divided into three levels: what is happening in the diner, what is happening in Tom's "transient psychotic state", and what he imagines his wife, Jane, is doing at home.

In the diner, the insecurities and neuroses of the psychotherapists in attendance are on display in their conversations, as interpreted by the relentlessly psychoanalyzing voice of the narrator.

In Tom's "transient psychotic state" he is floating on the ceiling, with the obese Bernhardt trailing along behind him as a silent, psychologically symbolic patriarch.