We meet Betsy at age 24, musing while en route to greet her just-out-of-jail brother Raymond: ''Usually, I was nervous around Ray, but I wasn't that day. Partly because I didn't live at home anymore and partly because Ray didn't bother me anymore.'' We soon realize that as a narrator, Betsy is a master of detached understatement. That ''bother me'' actually means she endured years of sexual abuse by her drug-addled sibling. Betsy's story veers from her troubled teen years to her increasingly self-destructive early 20s to her time in a mental ward, but Wareham's simple, steady prose and aversion to glass-shattering drama elevate a potential cliche into unsettling intensity.