A young man battling extreme mental illness brings his sadomasochistic fantasies to life in Harnisch's (Sex, Drugs, and Schizophrenia, 2014, etc.) latest novel. As this riveting story opens, Georgie Gust, a suicidal Tourette's syndrome patient, tells his doctor he wants to leave the mental institution where he's been committed. When the doctor puts him off, Gust finds himself buffeted by violent fantasies of escape, and he even prepares to hang himself. The novel plunges readers into the mind of a man at war with his own urges, memories, and sexual obsessions. After a scene shift, Gust's chauffeur, Ben, delivers him to his empty home, where Margaret, his only friend, visits to check on him. However, she annoys him because "she seems to care." Later, Gust, a foot fetishist, gives a pedicure to his sexy neighbor, Claudia, in a scene lit with unexpected poetry and poignancy. As the narrative viewpoint flickers among Gust, Ben, and a quasi-omniscient third-person perspective, Gust's voracious appetite for pain prompts him to hire Claudia to torment him. (He has wealthy parents, so he spends cash liberally.) When Claudia's house goes up in flames, she moves in with him, and their sadomasochistic bond descends into extraordinary, hallucinatory violence. In Claudia's hands, Gust discovers new depths of masochism, and she finds joy in tormenting him. Despite the garishness, brutality, and squalor of many passages (which are not for the squeamish), more sophisticated readers will appreciate the extraordinary feat Harnisch has accomplished. He lucidly, poignantly conveys a mind riven with what are, after all, human vulnerabilities: mental pathologies, shameful fantasies, anguished doubts about the natures of reality, love, and memory. In the hands of a lesser writer, these themes would splinter the narrative. Fortunately, the author masters his material; readers will believe the voices that vivify it and compassionately wish them to find the healing that eludes them. An extraordinary, harrowing odyssey into an embattled self, full of humor, compassion, and a rare understanding of mental illness.