He writes fantastic characters and then proceeds to torture you with the awful things that happen to them. Tackling the most difficult of subjects is one thing. But to present in such a way, so deep inside the main character's fractured mind, that you cannot tell what is happening and what is dream, is masterful.
Genuinely horrifying either way, this story works on so many levels. I have discussed this book with several friends and we all came away with different takes on this novella---except we all agree that we were squirming throughout. It is a deep and very uncomfortable read---we can all agree on that.
Dark fiction at its best by one of the best---who still just keeps getting better with every book.