How does Jack Ketchum use imagery in The Girl Next Door?

Imagery:

"I mean that sometimes what you see is pain. Pain in its cruelest, purest form. Without drugs or sleep or even shock or coma to dull it for you. You see it and you take it in. And then it's you. You're host to a long white worm that gnaws and eats, growing, filling your intestines until finally you cough one morning and up comes the blind pale head of the thing sliding from your mouth like a second tongue."

"It was like Ruth was still in the room, watching...like Ruth was a ghost who haunted us, her sons and me. Who'd haunt us forever if we pushed or disobeyed her. I think I realized then the sharp razor edge she'd honed to her permission. The show was Ruth's and Ruth's only. The Game was nonexistent. And by that reckoning it was not just Meg but all of us stripped and naked, hanging there."