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Hubert Selby Jr. had always intended to adapt his novel into a film, as he had written a script years before meeting director Darren Aronofsky, who said, “Anyone that reads Selby’s work can see how intense his world is. He writes the most discordant, angry words that tickle the air with some sweet music around it. It’s an unbelievable experience to read his books. I knew that once I made a larger film it would be very difficult to do a project like this. I live my life not wanting to have any regrets, and I knew that Selby was cool, that he’s a badass.”

Before the movie was made, Jared Leto spent time on the streets and starved himself. The director also asked him and Marlon Wayans to stop having sex and eating sugar so their cravings felt honest. Jennifer Connelley and Ellen Burstyn lived in similar situations to their characters and tried to understand the lives they led.

Burstyn is Sara Goldfarb, a widow who lives with her television, watching it nonstop. Leto is her son Harry, a heroin addict along with Connelley as Marion and Wayans as Tyrone. They sell heroin not just for their own addictions but for the dreams they have, whether that’s to open a fashion store or to escape the ghetto. Sara just wants to be on the TV show she’s obsessed with and begins to diet so she looks good for it. Her friend Rae (Marcia Jean Kurtz) suggests she try diet pills; she’s soon crushing amphetamines to the point that even her junkie son is worried. But all she wants to do is get on that show and impress her friends Rae and Ada (Louise Lasser, the former Mary Hartman, Mary Hartman who once had issues of her own). As the time of the show gets closer, she descends into madness. She imagines her refrigerator is attacking her and a trip to the office of the game show ends with her hospitalized and given electroshock therapy.

Meanwhile, a gang war puts Tyrone in prison and with drugs so much more expensive, Harry tells Marion that she should start doing sex work, even sleeping with her therapist (Sean Gullette). By the time it’s all over, she has a pimp (Keith David), he’s lost his arm from using so much heroin and he and Tyrone are trapped in jail. By the end, everyone is lost, trapped in a fetal position, their only dreams ones that will never come true.

Most movies have 700 cuts for ninety minutes. This has over 2,000 as the quick cutting madness and always in-your-face camera shots are disorienting. Released with no rating, this movie in no way allows its actors to have the old Hollywood addiction cliches. Drugs have never felt this horrible. There’s no fun in any of these highs.

There are some really interesting moments in this. Beyond the influence of Perfect Blue for one of the bathtub scenes, when Sara talks about being old, there’s a second when the camera literally slips away from her. That’s because cinematographer Matthew Libatique had started to cry and fogged up the camera and made that mistake. Despite Aronofsky being upset at the time of shooting, that’s the take in the movie. Also, all of Tappy Tibbons’ dialogue was actor Christopher McDonald improvising.

Aronofsky didn’t want to change the book, as he loved the author’s work. He wasn’t sure if Harry lived or died and had asked Selby about the character’s outcome. The author answered, “Of course, he lives.” When Aronofsky asked why he said that, Selby responded that the character had to suffer more. That may be why the director believes that Tyrone is the only person capable of reclaiming his life. That’s why in the final scene, only he has an actual good thought of someone other than himself. He remembers his mother.