This movie is Eraserhead all over again. Sure The Elephant Man story and characters are overlaid on top of the film, but the visual style is Eraserhead. The sounds are metallic, but organic at the same time. The visuals are in black and white and gloomy with a dream like quality. The characters are real, but frightening.
There isn’t much else to say about this early work of David Lynch except that while it is a different type of story for him, he hits it right on the nose while still leaving his distinctive signature all over the film. See this film, especially if your only familiar with Lynch’s later masterpieces like Blue Velvet and Mulholland Dr.