The novel revolves around the lives of the Lambert family, an old-fashioned midwestern couple and their three adult children. The parents, Alfred and Enid, are dealing with Alfred's Parkinson's disease and their own marital problems, while their children are each facing their own personal and professional crises. The narrative explores the themes of family dynamics, societal expectations, and the struggles of modern life. The story climaxes with the family's last Christmas together at their childhood home.

This novel is a contemporary, multicultural exploration of family life, love, and identity. It follows the lives of two mixed-race families, the Belseys and the Kipps, who are linked by their shared professions in academia and a complex web of marital and extramarital relationships. The story is set against the backdrop of Wellington, a fictional New England town, and explores themes of race, class, and cultural clash. It also delves into the world of academia, examining the politics and conflicts that arise in that environment.

The novel follows the life of Patrick Melrose, a man battling with his drug addiction and his troubled relationship with his parents. Patrick tries to come to terms with his mother’s decision to leave her estate to a New Age foundation rather than to him, her only son. The story delves into the complexities of inheritance, parenthood, and the lasting impact of childhood trauma. The narrative shifts between the perspectives of Patrick, his wife, and their two young sons, providing a multi-dimensional view of the family's struggles.

The narrative is set in the 1960s in Glasgow, Scotland, and follows the life of a young man named Thomas Clay. Clay is an aspiring writer who is struggling with writer's block while dealing with the impending birth of his first child, the destruction of his tenement building, and his wife's hospitalization. The novel provides a humorous and poignant look at the hardships of urban life, the complexities of personal relationships, and the struggle for artistic expression amid the chaos of everyday existence.