Much of the novel focuses on Paul's struggle with his fame as a writer versus his desire for independent creativity. At the novel's start, Paul hopes Fast Cars will earn him respect as a serious author. He laments that readers of the Misery series only want a good story and have little regard for his literary technique. However, Annie does have an understanding of writing as a process. For example, she conceives of writers as "God to the people in the story" (39) in the same way a writer might. Thus, Annie holds Paul accountable for anything that happens to Misery. Annie even puts on "an editor's hat" (113) giving Paul suggestions for storylines and holding him accountable to continuity. Because she reflects both his fame and his desire for a discerning audience, Annie attracts Paul despite his compromised situation.

Annie's obsession is a result of Paul's fame. She represents the monolithic obstacle he must overcome in order to write Misery's Return; at the same time, she represents the impetus for the undertaking. As Paul's captor, Annie provides Paul with the physical equipment and environment necessary to write. Much of the novel's second half follows Paul's thought process as he writes the book.