OTTESSA MOSHFEGH IS one of the most talented young fiction writers in the United States. Homesick for Another World, her only published short story collection and one of the best American short story collections published in the last decade, encapsulates the qualities that set her above her peers: her relentless misanthropy, her insistence upon dealing with the disgusting nature of humanity and the human body, her clinical command of her characters’ internal lives, and a sense of black humor that simmers beneath every sentence. The collection’s highlights — “Bettering Myself,” “Mr. Wu,” and “A Better Place” among them — are nothing short of masterful. Her novella McGlue, winner of the 2013 Fence Modern Prize in Prose, is similarly stunning. Sadly, however, Ottessa Moshfegh has yet to produce a novel that rivals her accomplishments in shorter forms.

In Moshfegh’s debut novel, Eileen, the titular narrator seeks an escape from her abusive alcoholic father and her dead-end life in “X-ville” by helping her colleague abduct a woman and force her to confess to knowledge of a dark secret. Moshfegh told the Guardian that the novel “started out as a fuck-you joke” after reading The 90-Day Novel by Alan Watt, and that she wrote it because she was broke and wanted to be famous. Despite a couple of errant prize shortlistings and an undeserved PEN/Hemingway Award, Eileen reads as Moshfegh described it: a rushed, uneven exercise in novel-writing meant to garner her fame and fortune.

Moshfegh’s sophomore novel, My Year of Rest and Relaxation, was a significant improvement upon Eileen but still wasn’t up to the standard set by Moshfegh’s shorter works. The novel’s unnamed narrator decides to abandon her rather directionless and isolated life of privilege to sleep for an entire year with the assistance of an absurd quantity of prescription medication. There’s plenty of hilarious commentary about the art world to be found, plenty of skewering of the practices of psychiatry and psychology, ruminations about pre-9/11 New York City, and a final page that has been both commended and criticized more than the rest of the book combined. But again, Moshfegh produced a novel that fell short of her demonstrated capabilities. Like Eileen, My Year teems with lovely sentences that create a mood but offer little else, and it reads like an expanded short story.

Moshfegh’s newest novel, Death in Her Hands, sits somewhere between Eileen and My Year of Rest and Relaxation. Our narrator is Vesta Gul, an elderly widow living in a cabin in rural Maine with her dog Charlie. At the outset of the novel, while taking Charlie for a walk, Vesta happens upon a handwritten note that reads: “Her name was Magda. Nobody will ever know who killed her. It wasn’t me. Here is her dead body.” The note gradually overtakes Vesta’s life, and her fixation on piecing together the mystery of who wrote the note, who Magda was, and what happened to her becomes a refuge from the larger forces of loss closing in on her existence.

Death in Her Hands feels like a sequel to Eileen. Vesta and Eileen could very well be the same person, given that Eileen narrates the action of her mid-20s from her mid-70s. The Northeastern settings of both novels resonate with the same energy, despite Vesta’s surroundings being rural and Eileen’s being more metropolitan. Both novels lend themselves to the crime thriller genre. Death in Her Hands almost belongs in the realm of Stephen King, given its setting and its heavy reliance on the narrator’s paranoia to drive the plot.

Death in Her Hands has some strengths. The novel works slowly and carefully, tracking a woman’s descent into madness at a nearly excruciating pace. It showcases Moshfegh’s mastery of character psychology, a mastery that has been on display from her early short stories. Moshfegh gives us some helpings of her trademark pitch-black misanthropy through Vesta’s voice, though this kind of writing is less present in Death in Her Hands than it is in any other book she has published to date. When Vesta is shopping at the grocery store, for example, she observes the women around her:

You could imagine the deaths of these dull heifers roaming the Save-Rite, these sad mothers with nothing to do but eat and fold laundry with tiny, stubby fingers sticking out of their huge bloated hands. Their lives must feel like such ineffectual blither blather. Did they even think things to themselves? Why did they look so idiotic, like domesticated animals, chewing their cud until the slaughter, half asleep? I had to feel sorry for those women, imagining each of them strangled and bludgeoned deep in my birch woods, left to rot or to be eaten by wolves.

Vesta’s voice gives way to a total dissociation from reality with about 75 pages to go, and the final stretch of the novel is told in a furious haze of losing consciousness, walking around at night, and other clear indicators of derangement. The novel captivates, bemuses, and confuses during that stretch. It only takes 200 pages of theorizing about who Magda is and what has happened to her to get there.

One of the best sections of the novel occurs after the derangement is made clear. Vesta decides to steal a piece of her neighbors’ mail in a flurry of suspicion, then sneaks onto their property and faints. When she wakes up, the neighbors have found her, but they are dressed as Victorian homesteaders, which confuses Vesta.

“May I ask, are you dressed up for something?” [Vesta asked.]

“I have cancer,” [the neighbor] said.

“I’m sorry to hear that.”

“We’re having a little party, to celebrate me. Better now than when I’m gone … I’m not doing chemo.”

“I see.”

“The Victorians were obsessed with death. It’s the theme.”

“The theme?”

“The theme of the party,” she said.

Vesta doesn’t stick around for the party, but the Lynchian dynamic between Vesta and her neighbors proves to be one of the novel’s more memorable scenes. Despite the fact it’s fairly clear that the sequence is a product of Vesta’s imagination, watching her interact with people and make decisions in their midst presents a welcome departure from the internal postulation we’ve been constrained to for the majority of the novel.

The same goes for Magda’s climactic appearance on a talk radio show Vesta listens to, hosted by a man named Pastor Jimmy:

“Yes, please,” the voice sounded familiar. “What to do when you are angry for good reason?”

“I’m sorry now, what? Are you there, miss?”

“Yes, here I am.” The girl’s voice was raspy, and clearly foreign, heavily accented not like Walter’s, but like Magda’s. I listened carefully. I closed my eyes lying in bed, as though looking at anything would distract me from what I could hear.

“Well, say it again, dear. I didn’t quite get you.”

“Yes, please. What to do when a thing is not so good, and you are angry, but not that nothing is wrong. What to do when, yes, if there is something wrong and for good reason you have anger?”

“Let me see if I understand you correctly, miss—”

“Magda.” Tears came to my eyes. The girl cleared her throat. “Magdalena Tanasković.”

Here Moshfegh pits her trademark black humor against a moment of ecstatic confirmation for her narrator, pulling away from Vesta’s fabricated world to reveal just how unhinged she is. In moments like these, Vesta Gul gives Sara Goldfarb (portrayed by Ellen Burstyn in Darren Aronofsky’s Requiem for a Dream) a run for her money.

Perhaps the most jarring revelations toward the end of the novel pertain to Vesta’s dead husband Walter. Vesta mentions Walter throughout the novel, but in mainly nostalgic ways that signal Vesta’s struggle with his loss. Toward the end of the novel, however, Vesta exposes some of the uglier truths behind their marriage — Walter’s tendency to mock her lack of education, for example, or a peculiar form of infidelity that Vesta finds to be as good as cheating. These painful and welcome reckonings feel more than earned and could have come sooner.

And yet, the fact remains that a crazy woman’s fantasies comprise the majority of Death in Her Hands. Vesta discovers clues that change her theories, and then new clues move the process backward or sideways and seldom forward. The few characters other than Vesta in the novel — Henry, the local shopkeeper, who was shot in the face and has a mangled appearance; Pastor Jimmy; a local police officer Vesta nicknames Ghod — take a backseat to Vesta’s musings. Large stretches of the novel feel intentionally agonizing (we spend 20 pages with Vesta as she types things into AskJeeves.com at her local library). Moshfegh’s use of thematic and linguistic repetition, which in her other works conjures a haunting, cerebral trance, feels just a little too circular this time around. As we listen to Vesta’s continual creation and destruction of Magda’s story, we hear Moshfegh writing through her narrator, which isn’t necessarily a good thing, as one can’t help but wonder if Moshfegh spends so much time describing the endless possibilities spouting out of Vesta’s mind because Moshfegh has nothing else with which to fill the space.

Death in Her Hands feels like another exercise in the end. There is a premise and a narrator. Both are spread quite thin. The concluding sequence shines, but the majority of the novel falls flat. Though Vesta is a more compelling narrator than Eileen, and her story works more effectively than Eileen’s, Death in Her Hands is too light on the bitter bleakness that powered My Year of Rest and Relaxation, and it most certainly does not possess the crafted perfection of Moshfegh’s short stories or her novella.

One hopes that Moshfegh will one day write a novel that rivals the perfection of her shorter works. The wait for that day continues.

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Zack Graham is a writer living in New York.