In 1856, the young doctor Nathaniel Kerner makes his way north to Crakethorne Manor in Yorkshire: his first placement as an alienist or mad-doctor. He hopes to find an asylum full of progressive ideas and enlightened leadership, but it soon transpires that the enlightened spa treatments and extensive gardens described in the brochures are fictions. Instead Crakethorne is governed by the unstable Dr Chettle, who eschews modern notions of treatment in favour of the questionable science of phrenology. His new home isn’t all that Nathaniel would have wished. And yet there is one aspect which captures his imagination: Victoria Adelina Harleston, his beguiling patient.