There's an element of parody to this jet-black comedy, but the film is so creepy that it gets under our skin. And even if it feels a bit ridiculous, the story challenges us with an exploration of bullying and social pressure that's deeply unsettling. All while writer-director Bates gleefully keeps us off-balance with a shifting mix of broad comedy and growing horror.
It's also a deranged coming-of-age tale about Pauline (McCord), a teen outcast who delusionally believes that she is destined to be a great surgeon. This is mainly because she wants to cure her sister Grace (Winter) of cystic fibrosis. So she teaches herself surgical skills by piercing her nose, among other things. She also propositions a hot classmate (Sumpter) about losing her virginity, partly because this is in her master plan and partly to annoy his mean-girl girlfriend (McCook), and he doesn't refuse. Meanwhile, her mother (Lords) makes it clear that she doesn't like Pauline, treating her husband (Bart) like dirt while doting on Grace.
The film's opening scenes are like a Todd Solondz movie, with grotesque characters saying staggeringly rude things to each other. And as events unfold, each person develops some complexity that makes them intriguing. It also helps that scenes are packed with lively side characters played by starry veterans. McDowell, Matlin and Wise play school employees who are baffled by Pauline's refusal to toe the line. And Waters is dryly hilarious as the sardonic priest Pauline is forced to see for counselling.
But as the story continues, it gets seriously depraved. Pauline's medical dreams are horrifically gruesome, and we begin to wonder - and dread - whatever she's planning next. Where it all ends up is perhaps too abruptly awful, almost like a cheap, unexpected punchline that plays on shock value without giving us anything more to ponder. But then how many filmmakers have the skill to leave us slack-jawed in revulsion?