With Kotoko, Tsukamoto switches from tech-noir sci-fi horror to drama, but brings with him all of the narrative imagination of his earlier movies, their hallucinatory imagery, and more than a little of their horror.  Cutting herself in moments of depression, yet sometimes swept up in rapturous emotional highs brought about by her singing, Kotoko is a lead character who’s both sympathetic and terrifying. It’s difficult not to warm to her gentle and creative side, as she appears to improvise songs on the spot and displays a genuine flair for making paper-and-string animal dioramas. But at the same time, it’s similarly difficult not to quake at her brutal shadow, whose sudden outbursts of violence are occasionally terrifying. Not only does Kotoko have the habit of sticking a fork in the hand of any man who tried to chat her up in a bar, her loose grip on reality constantly leaves us wondering what’s going to happen next. Did her son really jam a pencil into his forehead, or was that just another shocking hallucination? Kotoko truly straddles genres. Although best described as a drama, its tone and imagery is straight out of a horror movie. This isn’t merely a character study of a woman suffering from mental illness; it’s a film that uses all sorts of techniques to force the viewer to see the world from the woman’s perspective. Just as Kotoko struggles to separate fantasy from reality, so we’re never sure whether what we’re seeing is purely her paranoid delusion or a subjective take on what’s happening around her. The closest analog I can think of is David Cronenberg’s 2002 drama Spider, which starred Ralph Fiennes as a similarly unreliable narrator. But where Spider prowled, Kotoko repeatedly strikes and retreats, offering up a contrasting sequence of gentle Michel Gondry-like character moments and assaultive imagery. Standing proudly above it all is Japanese folk singer Cocco (who also co-wrote the script) in the lead role. She’s brilliant, and ably straddles the line between pathos and outright menace, serving both as protagonist and antagonist in a captivating performance. Kotoko isn’t a comfortable film to watch, but it’s nevertheless supremely rewarding. The brutality and oppressive intensity of its direction horrifies and astonishes in equal measure. Few filmmakers succeed in getting to the heart of what sufferers of mental illness have to survive through every day, and fewer still make this experience hypnotic or memorable. With Kotoko, Tsukamoto’s done just this. Not everyone will appreciate Kotoko, but few will be able to forget the afterimages it leaves behind. Kotoko is available now on DVD and Blu-ray. Follow our Twitter feed for faster news and bad jokes right here. And be our Facebook chum here.