I am really struggling with how to rate these extreme horror books, I gave this one four stars because it had me gagging so often, and that rarely happens. I also felt my own jaw literally dropped as I read some of these scenes. I don't think that gross really covers it, but it's a good start. It's incredibly demented, and I could have done without the whole God thing, but I understand why it was there so I'm not going to knock it for that. However, the sexual abuse is above and beyond, and I don't want to spoil it just know that if you're sensitive to sexual abuse regularly this is not the tip of the iceberg it's all of the stuff that comes after. do not jump into this book without having an understanding of extreme horror, and you might want to warm up with another Edward Lee's or Wrath James White's books, and maybe even step down to another that doesn't need so much warning. I will say I was surprised, grossed out, and it managed to make me feel a little physically ill, and in my mind that's pretty solid content, if it can cause visceral reactions.