The first scene that greets the viewer in The Killing of a Sacred Deer is gruesomely clinical—a top-down view of open-heart surgery, presented in matter-of-fact fashion, set to mournful music by Schubert. It’s an unpleasant image that’s both frightening and fragile, and impossible to look away from. How better to describe the work of the Greek writer and director Yorgos Lanthimos, whose particular storytelling style, exemplified by cult hits like 2009’s Dogtooth and 2015’s The Lobster, feels like a whole genre unto itself? Lanthimos’s new film is somehow even more macabre and unsettling than his previous efforts, and yet I also found myself laughing throughout.

To be clear, The Killing of a Sacred Deer is a drama, and a grisly one at times. But it’s infused with Lanthimos’s unique way of looking at the world, which he populates with characters who speak in a robotic, detached manner. Though Sacred Deer makes more of an attempt to resemble real life (The Lobster was set in a heightened dystopia), it’s like a warped version of a scary story told to children around a campfire, a cautionary myth in which a seemingly perfect family comes up against an inexplicable force of darkness. With his latest movie, Lanthimos has made a tense, heart-wrenching tale with an admirably askance view of humanity that’s a worthy successor to his prior works.

The Killing of a Sacred Deer follows a heart surgeon, Steven (Colin Farrell), who is happily married to Anna (Nicole Kidman), with whom he has two children, Kim (Raffey Cassidy) and Bob (Sunny Suljic). Steven has also taken an awkward teenager named Martin (Barry Keoghan) into his care, probably out of guilt after Barry’s father died under Steven’s knife during an operation; he’s educating the young man in the ways of the world, which in Steven’s eyes mostly involves owning expensive watches.

Quickly enough, Steven’s idyll is shattered, and his family starts to experience strange medical crises, one by one. Martin is somehow connected, though the specifics would be unfair to spoil; simply put, he is the Rumpelstiltskin of this film, taking an almost mystical revenge on Steven for his father’s death. The movie’s title refers to the Greek myth of Iphigenia, who was offered as a sacrifice by her father Agamemnon to satisfy the goddess Artemis after he offends her. But Lanthimos takes this concept in a more personal direction—Martin is no angry goddess, but a confused teenager, lashing out at his mentor in ways neither of them can fully understand.

Most of the movie is set at the hospital where Steven works and where his family is later treated; it’s a beautiful, gleaming facility replete with long corridors. In shot after shot, Lanthimos’s camera glides behind Steven like it’s silently stalking him, an angel of death ready to tap on his shoulder. The Killing of a Sacred Deer is about the moment that tap finally comes, and the film could even be interpreted as a drama about the mysteriousness of illness and death, and the stifling nature of hospitals.

But the movie is also a biting comedy about the emptiness of having more—a cruel (but still undeniably sharp) deconstruction of the enviable life Steven and Anna have built. Lanthimos and his co-scripter Efthymis Filippou’s peculiar approach to writing dialogue stands out because it often makes the subtext text. If Farrell’s character in The Lobster was somewhat of a loser, his character here is more of a fatheaded elitist, unable to admit his own faults and unduly proud of his achievements. Sacred Deer’s delightfully blunt dialogue makes it all the easier to take relish in Steven’s tragic decline.

Like any Lanthimos film, The Killing of a Sacred Deer won’t be for everyone. It’s so mannered and austere in presentation, and so plainly damning of its characters, that it can be difficult to connect with it. But Lanthimos doesn’t just want to torment his heroes, or his audience. There’s an undercurrent of something much more plainly emotional with Martin, as demonic as his actions initially seem. Keoghan (who was the wide-eyed innocent on Mark Rylance’s boat in Dunkirk earlier this year) never loses the kernel of despair and loss that’s driving his actions. Similarly, Farrell and Kidman make Steven and Anna feel like more than robotic ciphers at the whims of Lanthimos’s twisted storytelling. The Killing of a Sacred Deer is humane and satirical, horrifying and hilarious, at once a work of realism and fantasy—Lanthimos, yet again, has found a surreal balance between extremes that perhaps no other director could hope to imitate.