Montano's Malady begins in Nantes on the west coast of France, where José, the narrator, has left his fairly routine writer’s existence in Barcelona to visit his son Montano. Both José and his son suffer from a form of “literature-sickness;” in the case of Montano, the malady is writer’s block. For José it's an inability to think of the world in any terms other than literary. When the visit goes awry and with it José's hopes that this visit may be the cure they both needed, our hero, or a version of him, sets out on a quixotic search for meaning in a world with or without literature. His adventures carry him to the coast of Chile, where he meets the vampiric Felipe Tongoy, an actor from the films of Fellini and the "ugliest man in the world." Tongoy becomes something of a Sancho Panza to the narrator’s Quixote, and accompanies the narrator and his wife Rosa to a lonely, almost barren island in the Azores, where they meet a former writer who has abandoned literature in favor of laughter therapy, and then on to Budapest for a distinguished literary conference and the narrator’s unorthodox speech-as-nervous-breakdown.

By the end, after many detours and much circling back, José finds himself as the only non-German-speaking writer at a bizarre writer’s conference. Alone at night in the Swiss Alps, he attempts to commune with the writers who have inspired his battle "against the enemies of the literary" and reconcile his dreams for literature with the competing limitations of his own mundane life as a writer and husband. Montano’s Malady is a touching and perhaps hopeful inquiry into what it means to be a reader, or writer, in an increasingly unliterary world.