A film adaptation of the same name directed by Antonio Campos and narrated by Pollock, starred Tom Holland, Sebastian Stan, Robert Pattinson and Bill Skarsgård, and was produced by Jake Gyllenhaal.

As he sits on a bus headed to his home in Coal Creek, West Virginia, he recalls the horrifying things he saw and did during the war.

They preach about letting God cure you of your worst fears and Roy dumps a bin full of spiders on his head, scaring almost everyone in the chapel.

Feeling his connection with God lessen, Roy decides that in order to regain his bond he must crucify something and raise it from the dead.

As expected, Roy is unable to raise her from the dead and they flee the town, leaving Lenora with Emma (Willard's mother).

In Part 2, "On the Hunt," the reader is introduced to Carl and Sandy Henderson, a pair of murderous lowlifes living in Meade who entertain themselves by picking up male hitchhikers and killing them.

In one exceedingly depraved image, Carl takes a photograph of Sandy holding the severed head of one of their victims in her arms as if it were a baby.

After moving on from the Coal Creek Church of the Holy Ghost Sanctified, Roy is replaced by a new preacher, Pastor Teagardin, who lives with his much younger wife, Cynthia.

After Part 6, "Serpents," which follows more of Carl's and Sandy's depraved, murderous rampage, the storylines of the major characters converge in the final section, titled "Ohio."

Writing for The New York Times, Josh Ritter praised the novel, describing its prose as "sickly beautiful as it is hard-boiled.

[Pollock]'s scenes have a rare and unsettling ability to make the reader woozy, the ends of the chapters flicking like black horseflies off the page.

"[2] Lisa Shea of Elle wrote that the "flawless cadence of Pollock's gorgeous shadow-and-light prose plays against the heinous acts of his sorrowful and sometimes just sorry characters.

"[3] Carolyn Kellogg of the Los Angeles Times praised Pollock's narrative method, writing that he "deftly shifts from one perspective to another, without any clunky transitions – the prose just moves without signal or stumble, opening up the story in new ways again and again...

"[4] Jeff Baker of The Oregonian noted that the novel "reads as if the love child of [Flannery] O'Connor and [William] Faulkner was captured by Cormac McCarthy, kept in a cage out back and forced to consume nothing but onion rings, Oxycontin and Terrence Malick's Badlands.

"[5] Publishers Weekly commented "If Pollock's powerful collection Knockemstiff was a punch to the jaw, his follow-up, a novel set in the violent soul-numbing towns of southern Ohio and West Virginia, feels closer to a mule's kick, and how he draws these folks and their inevitably hopeless lives without pity is what the kick's all about.