Sean Phillips is isolated from the world. His physical world is his apartment, his human contact the nurses who come daily to attend to his physical needs. This isolation has been constant since his teenage years, when an event left him so horribly disfigured that most people find it difficult, if not impossible, to look at him and interact. Sean's real world is a mental one, and he spends his days in a land he created and inhabited and which now provides his only outside human contacts and his living. The world is a fantasy game called Trace Italian.

This is not a video game with gorgeous scenes and gory action. It is a game to be played in the player's minds. They send Sean mail with their next move; in return, he sends them possibilities they can take moving forward from which they choose and mail back to him. It is a slow-paced game due to format, and Sean has players who have been involved for years. He likes to imagine what individual players are like, how they look, what they do otherwise, and what their next decisions will be. It is a world in which he has absolute control.

Things change when a teenage couple named Lance and Carrie start to play the game. For some reason, after months of play, they decide to turn the game from a mental one to a physical one. They go to Kansas where the game is set and strike out in the unpopulated land there. When they come to an unfortunate encounter, Sean is held to account for the game that spurred them on. As he looks back on Lance and Carrie and what went wrong, his thoughts go back to the event that changed his own life forever and his part in that event.

John Darnielle is a musician and novelist. He is the main driver behind the band Mountain Goats and the chief lyricist of that group. This interest bleeds over into the novel as it is written in almost a stream-of-consciousness mode that is both intriguing and pulls the reader into an unique mind. The view into the mind behind Sean's isolation is a chilling one, and the reader will finish the novel a changed person. The book was longlisted for the 2014 National Book Award for fiction and was the winner of the 2015 Alex Award for adult books that speak to young adults as well.

For readers who are parents of alienated children, it gives insight into that isolation and rejection of society that is one of the most difficult things to try to understand and change. For those who are themselves isolated, it gives a voice and a way to connect with someone who has done the worst and come out the other side a bit stronger, thus providing some hope. This is a stunning book that will not be soon forgotten. It is recommended for readers of literary fiction and for anyone struggling to understand someone alienated from society.