This is a book that I could very easily change my rating on depending on how I felt, ranging from 2.5-4. I definitely feel like I need to put this down for a year or so, let it percolate, and then reread. This may be the sort of book that improves greatly on rereading.
This is a novel about insanity, and RS Jones nails the thinking style of someone with a particular kind of mental illness (though we never get the specific diagnosis). Emmet, our main character, has paranoid delusions, severe anxiety, plus trauma to deal with. RS Jones focus isn't on Emmett's diagnosis as such, but more looking through the eyes and thoughts of someone who is quite unbalanced.
He's not dangerous, in fact, at the beginning of the book at any rate, Emmet is even functional, in his own way, however he's definitely not healthy. I'm glad for that, because usually in fiction mental illness is treated as a motivator for unhealthy things, rather than a state of being.
And man, it's a hard read. Because Emmet is quite ill, and it's clear that while he might have ways to manage his illness, he's never going to really get better. The way he sees the world is so paranoid and he's aware enough to know that other people don't live the same way, that in some immeasurable way, life is a bit easier for them, but this knowledge doesn't help him.
As for the writing of this book, the first half drags quite a bit, and for most of it Emmet is alone. I think that this section could have been shortened to be more effective--his state from the beginning until he is in the hospital doesn't change very much, and there gets to be a point where it gets repetitive.
However, once he gets in the hospital and is around other people, the book breaks into a sprint, suddenly bringing in all these characters, and the story really comes alive. This is no rehash of One Flew Over the Cuckoo's Nest; there might be questions about how this hospital handles some things, but there is no question that all these people need help in an institutional setting. Also, the patients are more than their afflictions--any one we spend significant time with turns into a fully fleshed being who happen to have mental illness.
I would recommend reading this, but only if you've got the strength for it. This is a painful read, that doesn't offer easy answers. I respect it.