I think 3 out of 5 may be high for this one. This was not the read I had hoped for. Some of the time it wasn't even interesting, let alone scary. I did keep reading, because I had it find out if he was crazy or not. There were many parts that were predictable, even if the ending was not one that you could have seen coming. Now the parts I liked. I did like seeing the world through the eyes of the character when he was on and off his meds. And the ending (climax to finish) was strong and interesting. I recently had a conversation with a writer friend, who looked at me and simply said “make it worse”. This is something Atkins did well I thought, in completely destroying the main character's life in the first few sections of the book. Will I read another by this author? Probably not. If you are at the library, and happen to see it, read the first few pages, and see if it grabs you, maybe it was just me. But I wouldn't go hunting for it.