This is probably the most disturbing book by Palahniuk. It consists of a series of short stories connected by a common thread, and there is a range of quality. Some stories are pretty mediocre while others are very powerful and deeply disturbing. Some stories could be called "horror" or "science fiction" but it is mostly about commentary on society and the psychopaths among us, which is a common theme in Palahniuk's writing.
The most artfully disturbing story for me was the one about the Nightmare Box, which has enough hints to make it deeply creepy while never revealing what actually happens so each reader can imagine their worst possible nightmare. Cassandra in this story takes part in a few others, less good ones, and eventually we learn that she was a previous partner of Mr. Whittier, the guy who organizes the 3 month writers retreat, which is the thread that connects all the stories, i.e. each story is told by one of the retreat participants, something like Decameron or Chaucer, or the Mary Shelly retreat where she wrote Frankenstein.
The participants are addressed by nicknames in the connecting story which is very distracting, though in the actual stories they tell their real names are used. The 3 month retreat is a total isolation without an opportunity to leave early, which results in multiple murders, mutiliations, psychotic breaks and cannibalism. In a previous retreat, also organized by the psychopath Mr. Whittier, the participants played tic tac toe on the chest of Cassandra by carving the board and pieces with knives into her skin and flesh. The X player won.
Mr. Whittier is a special type of psychopath, 13 years old with an aging disease that makes him look 80 and death soon approaching he uses his condition to elicit sex from attractive female volunteers in the care home where he is institutionalized. After having rowdy sex with them, he then blackmails them with constitutional rape to extort money under threat of telling the police and their families. He organizes the retreat to prove to God that all humans are psychopaths deep inside and because of his obsessive fear of dying alone.
The story of the murder of the aging child actor and framing him with child porn of prepubescent Czech girls being anal-raped by grown monkeys and prepubescent Russian boys performing oral sex on old men is also especially disturbing because of the deeply sick themes, which also could be completely based on reality. Also the story of the post-op trans woman being stripped naked, held down and hand raped by a group of women attending a women's support group is deeply disturbing, especially in today's context, 20 years after it was written.
The most famous story in the collection is "Guts" which is very disturbing when read on its own (as Palahniuk has done in many public readings while asking the audience to hold its breath) but when put in the context of the other, more disturbing stories in the book - it doesn't even break in the Top 3. It is about a boy who masturbates naked at bottom of a pool while sitting on the pool exit valve. His anus gets sucked into the exit valve and while swimming up as not to drown, the boy's entire rectum is pulled out of his body, his anus still attached to the exit valve. This necessitates a surgery to remove most of his rectum and he cannot digest heavy food like meat for the rest of his life. His nickname is Mr. Gut-Free.
Overall, though the quality varies, this book contains some of the most powerfully disturbing scenes in modern mainstream literature. Not for the faint of heart.
