My gosh this book is dark and depressing. It is the type of depressing that sticks with you throughout the day. I loved it! 
 It's tagged many times as YA and I have to disagree with that pretty strongly. Sure, some mature teens would probably be fine with it, but I don't think it's suitable for the majority of teens. 
 I don't normally include spoilers in reviews but for those who need to know just what is in this book before they hand it off to their precious and innocent child, some of the topics include:(view spoiler)[rape, incest, men turned into magical bears sporting hard-ons, inappropriate thoughts about said bears, more rape, gang rape of men who are rapists themselves...you get the point. (hide spoiler)] 
 I gave it five stars because I love dark and depressing, and the weirder the better. I just wouldn't recommend it for everyone.