Over Max's narration of the preceding decades of his life, he offers outsider's snapshots of San Francisco and all of America across the late 19th and early 20th centuries. Throughout, Greer uses the literary device of reverse aging to interrogate the evolution of social conventions, the finitude of a human life and the decay of memory. Max wants love. But his curse destines him to deception. He loses his wife, Alice, changes his name and remains hidden from his own son to keep his true identity secret. Only his lifelong friend, Hughie, stands by Max and can see the person inside the anachronistic body. Like the best science fiction and myth, the novel uses its central conceit to reveal human prejudice and explode all assumptions of normalcy to profound effect.
Love is a destructive force in The Confessions of Max Tivoli. But Greer recognises that in the failure of love is also hope. He artfully captures Max's fragile world with a delicacy that never crosses into sentimentality but also avoids the monumental scale of tragedy. As Max says near the end of the novel, "It is a brave and stupid thing, a beautiful thing to waste ones life for love." A journey with Max, while brave and beautiful, is hardly a waste.