The novel begins with a bondage game between a husband (slightly overweight middle-aged lawyer) and his wife, Jessie. It doesn't end well for the wife. In the aftermath of a hustle she ends up handcuffed to the bed in a house in the middle of nowhere in the state of Maine. Her desperate struggle makes for the major part of the story.
As she tries to free herself, using any elements in her vicinity that may be helpful, her mind is restless. She not only vocalizes her deepest fears but also starts talking with different voices. Her internal dialogue gradually reveals events from her past that shaped who she's become and also give insights into her complex psyche. King goes into details when he describes a traumatic event from Jessie's childhood. I found this part really hard to follow as even thinking about such situations causes uncomfortable feelings, and it gets even worse when they're shown so distinctly. At the same time, various manifestations of fear were really well created.
It is one of these novels where the scary part isn't something unnatural, some more or less tangible evil. The real horror here is the feeling of being completely helpless in the face of approaching death. There are other novels and stories by King that deal with similar situations. "A Very Tight Place" immediately comes to mind. "The Library Policeman" is another one that features similarly disturbing descriptions. It's also hard not to mention "Dolores Clairbone" as it was also released in the same year (1992) and the protagonists of both novels share a very peculiar link.
As disturbing as it gets, Gerald's Game" still reads very well, even though it can make the reader feel as if they were secretly peeping at something forbidden.