Misery is perhaps the most thematically satisfying of King’s novels, both rich and unified, as interwoven issues are explored by direct action and by a wealth of metaphorical imagery. One major theme is writing itself; another is control—self-control or its lack, control over others, and the related issue of addiction, to drugs, food, or a story. There are also intriguing but disturbing implications concerning gender and appetite.
Paul Sheldon thinks, early in Misery, that he “wrote novels of two kinds, good ones and best-sellers.” Later, he comes to understand the snobbery of this and to appreciate that popular fiction must have its own integrity, its own quality. One can see the novel originating in part from King’s musings about his own situation as a cultural icon and about what does and does not make good writing. The novel also offers striking descriptions of the writing process, the experience itself as well as its joys and travails.
Annie Wilkes seeks to control Sheldon, but she cannot control herself, while Sheldon, through self-discipline, finally triumphs. She is greedy—keeping Sheldon as her captive, urging him to tell him the ending before he has written it—and, during her depressive episodes, a horrendously sloppy compulsive eater. Annie becomes as dependent on the unfolding story of Misery’s return as Paul is on the care and drugs Annie provides. Interestingly, back in New York after his ordeal, Paul is himself sliding downhill, replacing his painkillers with alcohol, until he begins his next story.
It is easy to see King implying that self-control is a masculine virtue and that appetite and smothering control of others are female vices. Certainly, fat, controlling females are often sources of horror in King’s fiction, such as Eddie Kaspbrak’s mother and wife in It (1986). Still, Annie Wilkes is no embodiment of femininity; she is portrayed in some ways as frighteningly masculine. Moreover, whatever King’s social views, Wilkes herself is sui generis, above all an individual—and above all crazy.
Misery is primarily a psychological thriller; its growing horror comes not only from graphic maiming, but also from its close relationship to reality, A major theme is "reasonableness" of madness. Annie is clearly cunning and crafty, in spite of—or because of—her paranoid delusions. Paul, the captive writer, must learn to be a little self-deluding to understand and anticipate Annie's actions and to write his best novel under her tremendous coercion. The boundary line between reason and madness constantly shifts throughout the novel.
Paul's struggle to survive could be described as a battle of wits and pain. He gives his struggle with Annie and his novel the name, "Can you?": a game of storytelling that he played as a child. Throughout his ordeal he repeats the question as a prayer. That process goads him to survive, because he habitually responds, "Yes, I can."
Ultimately, the survival of pain is misery—a term which accumulates meanings as the novel progresses. Misery is the name of Annie's pig, which reflects brute existence in a painful, thoughtless world, as well as finding the nonsensical in extreme situations. The pig, after all, is named for Misery Chastain, the fictional heroine of Paul's series of best-selling, bodice-busting romances. Writing Misery's Return becomes an escape from Annie's depredations; not only is Paul a Scheherazade to Annie's sultan, but also to his own sense of identity and will to survive. Finally, misery is survival: life is pain. Recurring images such as the sharp teeth and exotic caged birds reinforce the theme that miserable life is better than death.