Mary Mason (Katharine Isabelle) is a struggling med student, passionate about her dreams of being a surgeon, but chronically short of cash. Desperate for money, she answers an ad for fetish models, "no sex required", at the Bourbon A Go Go club, where she meets sketchy club manager Billy (Antonio Cupo), whose audition requirements include neck rubs. Mary is able to make a quick five grand when a club employee is viciously wounded, and the usual on call doctor is unavailable to tend to him. Her successful efforts in the basement surgery generates enough word of mouth that she gets a visit from Beatress (Tristan Risk), a dancer at the club who has undergone multiple plastic surgeries in order to look like Betty Boop.

Beatress has a friend, Ruby (Paula Lindberg), also a body modification fan, who wants to look as much like a sexless doll as possible, and asks Mary's help in accomplishing this. Mary is reluctant at first, but the ready cash on offer is too much for her to resist. Soon enough, her extra funds come to the attention of her instructors, Drs. Grant and Walsh (David Lovgren and Clay St. Thomas), who assume that her newfound lack of financial distress is the result of her going into prostitution. This assumption leads to a somewhat negative experience for Mary, which causes her to drop out of medical school, and lend her talents to the body modification world. Her mind and personality suffer as she performs more and more depraved acts, both seeking out revenge on those who have wronged her, and the unnecessary body mod surgeries. She descends into a dark place, and her world is close to collapse.

The Soska twins know what they are doing when it comes to discomfiting their audience. The gore is realistic and plentiful, but also subtle and understated. The disturbing feelings come more from what we know is happening, and what images our minds conjure up for us, than from what is actually shown on the screen. Many times, the decision is made to imply rather than display, and this works well. This film is about pushing buttons, and showing the depths that desperate people will go to, rather than simply grossing out the viewer. This isn't really a thriller, more of a character study, so the tension is never really ratcheted up that much, but it is constantly there in the background, buzzing around the brain. A feeling of disquiet pervades. And even though we know that Mary isn't exactly an admirable person, we find ourselves wanting her to succeed, to be able to get beyond and rise up out of the awful situation she's put herself in.

This isn't to say that the film is perfect. The narrative wanders a bit, and there are a few subplots that whose purpose is difficult to discern, but it's undeniable that they add to the atmosphere. And atmosphere is what American Mary does best. Katharine Isabelle does very well as Mary, but a few of the side performers leave a bit to be desired, though most do a fine job. The ultimate point is somewhat opaque, if the Soska sisters even had one, but it is an enjoyable ride, for those who like their horror movies on the brutal side. This definitely isn't a film for everyone, but for the right sort of person, it's hard to beat. Highly recommended.