A psychiatrist's interest in human suffering is not restricted to daily work. Trainees in Oxford, asked to pick out six novels which had been important to them, chose books concerned with “alienation, sexuality and suicide” (Harrison & Day, 1988). Respondents to such a survey in the future might well include The Comforts of Madness (Sayer, 1988), surprise winner of the Constable Trophy for fiction in 1988 and subsequently the coveted Whitbread prize. It is former psychiatric nurse Paul Sayer's first book. He started writing in his twenties after taking a break from nursing to run a corner shop with his wife. In his spare time he read. He explains, “I was standing in the corner shop one day, and I just felt this urge to write” (Winder, 1989). He returned to nursing and at the same time, started to write about a world that was familiar to him.