The Fifth Sacred Thing by Starhawk is a post-apocalyptic novel set in 2048 in California. While the rest of the state is dystopian, living in fear and in poverty under the military and religious control of the Stewards and Millennialists, the main characters of the novel live in the City (what was once San Francisco), an egalitarian community in harmony with the Four Sacred Things that sustain life - earth, air, fire, and water. The novel's perspective shifts between three characters from the same household, the Black Dragon House: Maya, Madrone, and Bird.

Maya is one of the elders in the City, having lived in San Francisco in the 1960s and having witnessed the revolution of 2028 in which residents resisted the military dictatorship of the Stewards, established their own consensus-based system of government, The Council, and have subsequently worked together to reverse the environmental degradation of the land, water, and air. Maya spends much time communicating with the spirits of those from her life who have died, particularly Johanna and Rio, two of her lovers.

Johanna's granddaughter Madrone is one of the healers in the City. Her knowledge of medicine goes beyond an understanding of traditional and herbal treatments. he connects with her patients spiritually, entering a trance state in order to evaluate her patients on a metaphysical level. A powerful healer and dreamer, Madrone's services are in high demand, both in the City and as the novel progresses in southern California, among other rebel groups.

Bird, Maya's grandson, has been imprisoned by the Stewards in the south for ten years when the novel opens. Initially, his memory is foggy and he is uncertain of who he is. However, he overcomes the physical and mental pain incurred by his captors and manages to escape and return to the North.

Bird's return to the City coincides with rumors of a pending invasion by the Stewards and in order to learn more and to make alliances with rebel groups, the Council and the community decide to send Madrone south. While on her journey, Madrone acts as an evangelist of sorts, spreading the message to both active rebel groups in the hills and dissenters within the city that there is a viable alternative to the racist, sexist, and fundamentalist system of the Stewards and Millennialists.

While she is gone, the Steward army invades but residents of the City resist using nonviolent non-cooperation rather than violence. Although the army does respond with violence nonetheless and many residents are killed, some of the soldiers, seeing the racial and cultural harmony of the City as well as the equitable access to water and other resources, begin to question their leaders and some desert. The Stewards recapture Bird and attempt to force him to betray the City by revealing its "secret weapon." The Stewards can neither break the spiritual strength of Bird nor of the City's residents. A widespread mutiny among the soldiers alongside the City's nonviolent resistance blocks the Stewards' plans to destroy the City.