The Spirit Bares Its Teeth, by Andrew Joseph White

In this depiction of alternative Victorian England, there is a Veil which separates the living from the dead and it is the duty of Speakers to guard that barrier.  The Speakers are all men and if a woman should appear with the abilities of a Speaker (signified by having violet eyes), she is persecuted and suppressed.  Silas Bell, a sixteen year-old trans boy aches to become a Speaker himself, but since society views him as a girl, it is impossible.  However, Silas is crafty and bravely impersonates a candidate for initiation.  When he is found is found out, he is sent to Braxton, an asylum and finishing school for girls who haven't learned to accept their place in society.

That's when things start getting very scary.  Silas quickly notices that the Veil is particularly thin around the school, a sign of unsettled spirits.  The Headmaster, it turns out, collects souvenir trophies of  the people he's killed and their desecration haunts the place.  But there is deeper evil afoot.  The students at the school are disappearing in particularly gruesome ways -- through medical experiments conducted in the basement.  But by the time Silas uncovers the full extent of the horror (and the widespread involvement of the men around her) it may be too late to do anything about it.

Beyond the extremely graphic depictions of eviscerations, involuntary surgeries (without anesthesia), and lots of blood, triggers in this novel include rape, molestation, bullying, and self-harm.  In other words, there's an awful lot of difficult material to digest here.  Personally, I found that I needed to take breaks (particularly in the second half of the book where the scenes become notably more intense).

So, why read it at all?  Despite being a painful story, I found it compelling because it is very well written and because much of the tortures described in the book are based on the real abuses committed by the medical profession in the period.  It is a work of fiction, but raises many uneasy questions about how we define abnormality and deviance.  Fans of Michel Foucault's Discipline and Punish will be in their element.  Readers with sensitive feels should almost certainly avoid this book.