Content Warning: This section discusses sexual assault, child abuse, violence, and murder. Stigmatizing language about mental health is reproduced in quotations only.

The novel’s main sources of shock are Mary supernatural and societal experiences as a woman. Much of the novel’s horror comes not from people being murdered but from the frailties of middle-aged female bodies. Mary is tormented by vivid hallucinations whenever she looks at herself or other women: “My flesh sags, crumbles, oozes in clotty, rancid rivulets. My lower lip pulls down, revealing black gums and gravestone teeth. Like a corpse left to rot in the desert sun. […] Kill rip tear peel useless mother motherf—” (19). The imagery creates terror in two ways. Most obviously, it is disturbing and alienating for Mary to see bodies as the site of such destruction. More insidiously, she is forced to hear the way Damon views middle-aged women and the things he would like to do to erase them from the world. However, because it is not yet clear that this inner monologue is generated by a murderer, the text implies that Mary has internalized this misogyny from patriarchal messaging.

The world around Mary contributes to her feelings of worthlessness and insignificance, as the societal implications of being middle-aged also make Mary feel invisible.