It's a stunning achievement when an author creates an inherently unlikeable anti-hero, and his enabler, and then allows them to tell an exceedingly creepy story which turns out to be literate, compelling, provocative and engrossing. I felt the heebie-jeebies at several points but it would have taken a natural disaster in my neighborhood to make me stop reading this astonishing first novel.
Our anti-hero is Norton, an eminent and dangerously narcissistic scientist. Picture Sheldon Cooper from "Big Bang Theory" and you have the basis for this character. Add "well intentioned" evi to the narcissism, plus the literary power to tell his own story to his own advantage, and rather than feel joy for his well-deserved self-destruction, we instead might feel some pity for this chretien. Not a lot but his undoing is his own creation and it is tragic for all concerned.
Further, I always enjoy the brazen & unreliable narrator and Norton is one of the best I have encountered since "As Meat Loves Salt". Delusional, self-righteous, dangerous, compelling.
Additionally, the author writes in a clear but enriching manner. Her characters include anthropologists and other scientists so the level of discourse is high and rewarding. She introduces many usual words and finding their meaning is one of the small delights of this book.
Since the book concerns the discovery of a compound which will greatly extends life, Yanagihara has many opportunities to explore the themes of human morality and ethics for scientists. Neither of these themes are overbearing but again, they are rewarding elements in an excellent read.
This book can be enjoyed from many perspectives, not the least of which as a literary power-house which will likely grasp you, inform you, creep you out, then live in your memory for a bit while the dust settles.