The fourth novel in the heart wrenching, almost-autobiographical series Patrick Melrose barely qualifies as a novel. Change a few names, pull apart a few composite characters, and you’d have a precise memoir of a final member from the old British elite generation. Edward St. Aubyn’s fictional avatar Patrick, the great-grandson of a baron, never had to worry financially in his youth — his struggles came instead at the hands of his atrociously abusive parents and the life of addiction and self-destruction that followed. But now, married and with two children, he returns to his childhood estate to care for his negligent mother as she squanders the rest of her fortune on an evangelical Ponzi scheme.

The details of St. Aubyn’s life depicted in Mother’s Milk aren’t as immensely disquieting as the earlier entries in the series, such as the horrific childhood abuse portrayed in Never Mind or the prolonged drug binge that comprises Bad News. But as a rumination on hereditary trauma and generational change, it stands alone.