In the summer of 1954, U.S. Marshal Teddy Daniels and his new partner arrive at Ashecliffe Hospital for the Criminally Insane on Shutter Island. They are tasked with investigating the disappearance of a murderess who vanished from a locked cell within the fortress-like facility.

Lehane's atmospheric noir isolates the reader in an oppressive atmosphere of paranoia, code-breaking, and psychological manipulation. The ultimate reveal forces a total re-examination of the protagonist's perception of reality.