America

This is the novel's broad-strokes setting, and is portrayed as having been quarantined and isolated from the rest of the world as a result of a fatal, brain-destroying "sickness" that the authorities are desperate to keep from spreading beyond its borders. There is a sense that much of the novel, and its considerations of the sickness, are metaphors for a kind of moral "sickness," of thought and collective memory, in the collective American psyche.

The Hospital

This is the setting for the novel's first half. It is both claustrophobic and mostly empty, It is presented to Joy as a place of safety and freedom from the life-threatening dangers of "the sickness," but it eventually comes to feel like a prison. It is an extended metaphor for the psycho-emotional "prison" Joy feels she has been placed in by the twin traumas of having been abandoned by her mother and...