Like all dystopian narratives, the feminist variety uses stories about how bad the world might become to point out how bad it already is. Not surprisingly, feminist dystopian narratives are now enjoying a boom, from Hulu’s television adaptation of Margaret Atwood’s 1985 novel, “The Handmaid’s Tale”—Atwood recently announced that she is writing a sequel—to several books by both new and established novelists, including Louise Erdrich’s “Future Home of the Living God,” Christina Dalcher’s “Vox,” and Leni Zumas’s “Red Clocks.” These writers depict a range of inventively punitive societies: in one, women are punished for speaking more than a hundred words per day; in another, the government takes pregnant women into custody to manage a fertility crisis. The novels extrapolate from a very real prospect of curtailed rights, especially reproductive rights, to imagine what it would be like to live in a society of forced marriages and pregnancies. The typical dystopian novel is at least as much about the world it’s set in as it is about the characters who inhabit it.

Sophie Mackintosh’s clever and arresting début novel, “The Water Cure” (Doubleday), although sometimes grouped with the new crop of feminist dystopias, doesn’t much resemble them in this respect. It constructs not a world but a bubble within a world—in other words, a family. Three young sisters live with their parents in a decommissioned seaside sanatorium that was once a grand hotel. They have no contact with the outside; their father, King, leaves in a motorboat every few months to bring back supplies from a mainland they believe to be dangerously contaminated. Men are the primary source of the toxins, and the two elder sisters can remember when their parents provided a sanctuary for “damaged women,” refugees who had been harmed by the male world. The therapies employed were harsh and primitive: patients were ordered to drink salt water until they vomited, and the titular “water cure” entailed a near-drowning. After the patients stop coming, King and his wife, Mother, administer the same cures to their daughters, observing elaborate purification measures whenever the girls come into contact with dead animals or a particularly noxious artifact from the greater world, such as a magazine. Other regular treatments include being shrouded or gagged with lots of muslin; the characters in “The Water Cure” always seem to be running off to collect a bolt of the stuff.

The middle sister, Lia, narrates the novel’s long central section. It comes bracketed by clusters of short chapters narrated by the eldest, Grace, or by all three sisters collectively, but Lia relates most of what happens after a pivotal event: King fails to return from a supply run. Lia is the one who accepts Mother’s explanation for why her older sister is going to have a baby (“Grace asked the sea for one”), and who, some indistinct period of time after King’s disappearance, describes how two strange men and a boy wash up on the beach after a storm. Lia’s age isn’t clear. She herself doesn’t seem to know it. Grace has few memories of the outside world and Lia, like her younger sister, Sky, has none. Most of what Lia knows comes from her parents. But the unreliability of King and Mother soon becomes unignorable; we learn from Grace that every year the family holds a lottery in which a member draws an iron marker assigning another member to be his or her “loved-most”—and, since there are five of them, one person always gets left out. Among the cruellest tests the parents impose is to make one of the two elder sisters kill some small animal in order to spare the youngest from being forced to do it. It’s an exercise meant to harden their hearts to everything but each other. Throughout most of “The Water Cure,” the reader can’t tell whether the daughters really are refugees from a poisoned apocalyptic future or just the unwitting captives of a tiny crackpot separatist cult.

Lia is a narrator familiar from many coming-of-age novels: needy, solipsistic, obsessed with her own body and feelings, absorbed in a morbid form of femininity that prompts her to cut and burn herself. In another era, she would have been called a hysteric and sent away to a more overtly patriarchal version of the sanatorium her parents once operated. Some readers can’t get enough of characters like this, but I confess that Lia often exasperated me and even made me contemplate abandoning the novel once or twice. That would have been a lamentable mistake, for Mackintosh is up to something far more interesting than a celebration of female dysfunction. Still, I sometimes longed for the narrative reins to be returned to the more hardheaded and clear-eyed Grace.

Having drawn the short straw in the family’s most recent lottery, Lia is nobody’s loved-most. She craves tenderness so desperately that it drives her and everyone around her half mad. “Often Grace is repelled by me,” she explains. “I don’t have the luxury of being repelled by her, even when her breath is sour and a gentle scum of dirt clings to her ankles. I take whatever contact I can get. Sometimes I harvest the hair from her brush and hide it under my pillow, when things get very bad.” She can think of nothing else, even as she’s acutely aware of how dangerous her loneliness is. As her parents frame it, the sickness men cause in women takes the form of women’s emotions. “Part of what made the old world so terrible,” Lia explains, “so prone to destruction, was a total lack of preparation for the personal energies often called feelings. . . . Especially dangerous for women, our bodies already so vulnerable in ways that the bodies of men are not.” The “cures” King and Mother administer are meant to purge their daughters of all but a narrow range of feeling, making their sanctuary uncomfortably similar to nineteenth- and twentieth-century institutions designed to render wayward girls and women mild and docile helpmeets. When Grace’s baby is born dead, Mother allows the girls to cry for only five minutes, covered in heavy sheets, “for your grief.”