So many. This IS a grim and gritty crime novel, and Vachss, the author, is a real-life child protection lawyer who is horribly familiar with the worst kinds of child abuse. Any kind of child abuse you can imagine, this book deals with it, especially child sexual abuse and child pornography. Another case Burke deals with over the course of the book involves a toddler who was beaten to death by his caregivers. There is a lot of violence, murder, and basically all the characters Burke considers family are criminals living in society's underbelly. Gangsters and cops in equal measure.

The multiple's treatment is super rushed and barrels towards fusion, which is their major goal. (Considering they're trying to put the kid together enough to go to trial and also not murder anyone else, you might argue that the plot somewhat justifies it.)

Oh, and also this is the kind of book that uses words like "Oriental" and has a voodoo queen character, so you know.