This is, in my opinion, the weakest of the Bedlam City books, but it's still pretty strong. The section on the dangers of astral travel in the city is spot on. The dark forces attracted to Bedlam's madness and misery are brilliantly described herein, and are legitimately monstrous and scary. Death's Other Kingdom is terrifying. The awful secrets are nearly as good as the original book's, the non-powered characters are strong and memorable. The section on the drug trade is excellent information.
It is, however, somewhat let down by the same problem I had with parts of the main book: black humor and deconstruction jumping over the edge into goofiness. The Supervillains remain difficult to take seriously, which undercuts the seriousness of other issues the books tackle fearlessly like racism, sex crimes, and drugs. The section on the past of Bedlam is decent, though I saw little use for it in most campaigns. Most of the adventures were too goofy for my taste, though I could see a few being used.
Overall, it's a must-buy if you want to run a magic-heavy game in Bedlam, and still worthwhile otherwise.