One thing I can say about this book is that it certainly is aptly named.
The critical praise for St. Aubyn led me to pursue the trilogy of Patrick Melrose novels. I found the first one challenging, but determined I would soldier on. This second in the series didn't offer even the tiniest respite from the painful, self-destructive story about Melrose's drug abuse. Other reviewers found some humor in the writing, but the subject matter was so depressing that I could barely read it.
My rating is strictly based on my revulsion to the subject matter--the writer obviously is talented or the book would not have inspired such a strong reaction on my part.