The book's first three movements consist of the erotic fantasies and case history of one of the novelist's conception of Sigmund Freud's female patients, overlapping, expanding, and gradually turning into almost normal narrative. But then the story takes a different course with the convulsions of the century, and becomes a testament of the Holocaust, harrowing and chillingly authentic. Only at the end does the fantasy element return, pulling together the earlier themes into a kind of benediction.
The book begins with a long poem, "Don Giovani", full of erotic imagery and near-incoherent description. Following this is a prose version of the story that we learn is written by a young woman who is a semi-successful opera singer who comes to Sigmund Freud for analysis as she suffers from acute psychosomatic pains in her left breast and her womb. Her character and the pseudonym Anna G. might draw on examples of real case studies (Freud's "Wolfman" also appears as a peripheral character in the novel), but the novel is indeed fictional. Thomas lets the reader in on Freud's analysis, as well as his ambiguous feelings towards his patient. At several stages, Freud is ready to throw up his hands and tell her that he won't continue his treatment as he feels she is not forthcoming enough to make any real progress. He always relents, however, because he senses that "Lisa" (the opera singer's real name) has enough redeeming attributes to warrant his time.
As the novel progresses, the reader learns more and more about Lisa's past and the seminal childhood incident (occurring when she is three years old and vacationing with her parents in Odessa) that estranged her from her mother, and more particularly, from her father. This provides the central motif of the novel as well as Lisa's Cassandra-like ability to see the future through her dreams and her imaginative powers.
The novel also makes use of epistolary form with postcards from the fictional hotel guests included as part of the narrative.
Many attempts were made to make the novel into a film. These included attempts by Bernardo Bertolucci with Barbra Streisand, by David Lynch with Isabella Rossellini, by Simon Monjack with Brittany Murphy, and by Emir Kusturica with Nicole Kidman.
On 1992, London, artist Maty Grunberg created a portfolio "Don Giovani" (woodcuts, limited edition); text - "Don Giovani", the opening poem of the book.