The novel pits a Viet Nam vet with childhood trauma issues (and Viet Nam torture issues... and psychic precognitive ability) against a supernatural cult of killer women who control the small Pennsylvania town of Bethany's Sin he and his wife and daughter have just moved to. The supernatural cult rides around on horses at night killing and dismembering men. And they intend to induct his wife and daughter into their ranks.
There are many flaws in this novel, a fact of which McCammon himself was later much aware -- for awhile, he all but disowned his first four novels. The wife especially is a narrative problem, a plot object rather than a convincingly realized character. The psychic abilities of the protagonist ultimately seem gratuitous -- the plot could unfold without them, and there's more than a hint of the wild talent vs. supernatural menace concept used much more expertly and organically in Stephen King's earlier The Shining.
McCammon also severely undercharacterizes any possible allies the protagonist might find in Bethany's Sin: there are a lot of characters here, but the novel seems severely underpopulated. And the explanation for the name of the town, when it comes, would only really make sense if the town's origin came at least 100 years earlier. As is, the revelation provokes a bemused, "Really?", primarily because the explanation has been pounded into the wrong-shaped hole by a plot decision that isn't necessary or all that convincing.
But there's also a certain amount of fun here, and signs of a writer finding his voice at points. There's a highly unpleasant rape scene, but it non-stereotypically involves the rape of a male character by a trio women. Scenes set at the blighted wasteland of the dump depict a well-conceived Hell-in-miniature. And the protagonist is an almost emblematically tormented McCammon male protagonist.
The climax owes too much to a few too many action movies and certain pulp cliches, especially those in which a character suddenly turns into a cross between Batman and Sgt. Rock after hundreds of pages of more realistic depiction. That could have been solved with a few more allies for our hero (Stephen King understood this in 'Salem's Lot), but McCammon wouldn't figure out how to create a group hero for purposes of verisimilitude for a few more books.
The wife remains an annoying cipher to the very end, trussed up like Penelope Pitstop when she isn't repeatedly denying the town's essential weirdness. There's a certain amount of enjoyment here, clouded somewhat by some luridly purple descriptive passages and a whole lot of female musk. Lightly recommended.