The novel is in the third person point of view, but at the same time allows the reader into the minds from the perspective of the different characters. For example, at times when the narrator is telling the story, he allows us to hear the thoughts of the character in the first person. The novel swings back and forth between the present and the past. The present represents the time after Dr. Larch founds St. Cloud's. The past represents the time leading up to the founding of St. Cloud's.