The manga is narrated directly to the audience by its main character, a Mad Artist who uses his own blood to paint his terrifying pictures. While he's about to complete his final masterpiece depicting The End of the World as We Know It, he starts to narrate the story of his family all the way from his grandfather to his conception near the end of World War II, his abusive childhood and so on, up to a final twist...
The manga contains some autobiographical elements and was written during a bout of depression in Hino's life, so expect a very bleak general tone and not just random horror and Squick.
The manga provides examples of:
- Abusive Parents: One theme of the manga is apparently the cycle of life. The artist's grandparents often abused his dad, and he in turn beat up his child along with his wife. The artist, on the other hand, is very affectionate to his sons but still murders his entire family in the end... maybe.
- Art Attacker: When he was young the artist discovered that, by using blood in his pieces and praying to the hellish powers, the acts of destruction he depicted became real. He started by burning his neighbors' home, and later we see a montage of newspaper titles depicting all the accidents, chaos and carnage he caused. It's all a delusion on his part. Probably. Hopefully.
- Ax-Crazy: The painter at the end. Literally, he uses a hatchet.
- Big, Screwed-Up Family: Maybe not so big, but still, the mad artist's grandpa was a gambler and a criminal too, his son (protag's father) was a wifebeater and his wife went mad while carrying the artist in the womb, and when he was older tortured him for hours. His brother was a drunkard and a violent bully that later became a delinquent (who nonetheless was the only person to show him some affections) and his sons grew up to became creepy children just like him.
- Body Horror: The artist talks about his grandfather and how he died, being killed by other gamblers that ambushed him. They manage to hurt him lethally, but he is apparently unfazed and starts cutting his own stomach. From the deep cut hundreds of dice spew forth along with the blood, and he starts to pick up handfuls of dice, even putting them in the mouth and eating them before finally dying. The other men are understandably disgusted and horrified.
- Collector of the Strange: The man collects all sorts of deformed animals and fetuses neatly preserved in jars full of formaldehyde. His son helps him with the collection. The daughter keeps other creepy stuff such as Hideshi Hino's manga.
- Covered with Scars: A self-inflicted example. The artist cuts himself because he needs blood for his paintings. He also drinks acid to vomit blood directly on the canvas.
- Crapsack World: To the extreme. Just one example: the protagonist lives near a guillotine, an abattoir, a crematorium, a polluted river full of trash and animal carcasses, and a cemetery where every night beheaded corpses come to life.
- Creepy Child: The painter, his favorite game as a kid was torturing and/or killing little animals, and everybody (including his own parents) thought he was the child of a demon. His sons as well: the daughter is following his steps in morbid art, and the son, while apparently more goofy than creepy, has a lot of questionable habits as well.
- Fetus Terrible: The artist was conceived during World War II, and somehow the radiations from the atomic bombs let him gain sentience while still in the womb, so he absorbed all the depravity and horror of war. When he was born he smiled instead of crying and had blood in his hands. Everyone is terrified and even his father thought for a moment of letting him die.
- The Faceless: Chinese characters in the story are always depicted from the back.
- The Fourth Wall Will Not Protect You: During his delirious dying monologue at the end, the artist remembers that he was talking to the reader and wants to murder him too. The very last image is a splash page depicting the artist's hatchet flying directly at us readers.
- Gonk: The artist's sons, and the man himself. Actually most of the male characters seen are gonkish because of Hino's unrealistic drawing style. Young women are instead always quite beautiful, in an "ancient Japanese drawing" sort of way.
- Mad Artist: One of the maddest ever seen.
- Maybe Magic, Maybe Mundane: Did the artist actually have the power to cause accidents with his art, or was it only a coincidence? It's implied that he's "just" a very disturbed man, though.
- No Name Given: Nobody is named save for the artist's sons, and then again they're maybe just nicknames.
- Omnicidal Maniac: First read the Art Attacker example above. By painting his masterpiece depicting Hell and the end of the world, the artist wants to actually cause the world's end by forcing all the world leaders to unleash their atomic arsenal at the same time.
- Snow Means Death: Every time someone in the artist's family is killed or gruesomely injured, it is snowing.
- Unreliable Narrator: The artist is quite clearly delirious thanks to his insane habits. In the end, when he murders his entire family with a hatchet, we se that they are actually various puppets, dolls and, in one case, a rotten pig's head. So probably he went mad from isolation and blood loss, and most of the murders and chaos he caused were only in his head after all.
- War Is Hell: One of the main themes of the story. The lives of Japanese refugees in Manchuria (including the MC's parents) are depicted in all of their brutality and squalor. There's also the Cold War fear of mutually assured destruction: the artist wants to cause the end of the world by forcing the world's superpowers to unleash at once their atomic arsenals.