This is a book about suicide and so it is hard to be perfectly objective but – this is her best book since A Complicated Kindness. Some back story: Toews wrote Swing Low, a non-fiction account of the suicidal death of her father. In AMPS (words taken from a Coleridge poem), the story is fiction but heavily influenced by the suicidal death of Toews’ sister in 2010.
Now for the comments: this is a heart-breaking story, that captures perfectly the inherent conflict between two sisters who love each other, but conflict because one wants to die and the other who wants her sister to live. The inevitability of the progression to the suicide is frightening, despite great efforts by many individuals in addition to the sisters. And finally, the picture of the psych staff is unflattering: indifference and ineffectiveness. Save up your energy for this but it is brilliant writing.