You don't have to be well-read to write here, but it helps

Telling a story from the point of view of someone already dead is an established literary device: The Lovely Bones is one of the more recent examples of books using it. But in The Comforts of Madness Paul Sayer develops the (arguably) politically equivalent of having as his narrator the effectively dead, a catatonic who can't communicate at all, but is merely receptive to the treatment he receives at the hands of others. And what bizarre treatment it is! From the woeful neglect of a hospital ward he's moved to an experimental treatment centre which does its best to break him and reshape him. As the attempts to bring him out of his trance force him to retreat emotionally and mentally, the book hurtles along to its harrowing climax.

The book charts Peter's descent through the mental health system. It's a kind of histrionic One Flew Over the Cuckoo's Nest, hammering home the message that our treatment of the mentally ill is often based on a Foucauldian imposition of our will rather than any consideration of the patient's wishes or interests. Unlike in Ken Kesey's work, here every dial is turned up to its maximum voltage, and the activities of the custodians and guardians are genuinely disturbing: so disturbing, though, that the book rapidly loses any power to shock as a portrayal, however extreme, of genuine conditions. The lunatics may well have taken over asylum in alternative-therapy trials, but they've done it by not acting like lunatics, at any rate not in a way that would prompt the layman to boggle quite so much at them. Sayer is unable to capture the subtleties that might make such inversions seem feasible.

From the beginning, moreover, the book is hopelessly overwritten. One might excuse Peter's internal monologue being one big trawl through a thesaurus, as a compensation for his inability to express himself. But it slowly becomes clear that everyone speaks in a laboured, convoluted, delicate, and often highfalutin manner: from our narrator to hospital porters to consultants and the mentally disturbed army major. This is a book that has been not writ but wrought, hour after hour, pummeled and hammered in an attempt to fashion it into a tool for a very specific job; instead, it has ended up merely flat and flimsy. In its convoluted, inescapable misery, The Comforts of Madness could be lazily tagged as "Kafkaesque". But it's easy to forget that Kafka would always place at the centre of his work a tough kernel of mockery, pouring forth stoic laughter in the face of the absurdity that he saw everywhere else. Only when one reads this book---the equivalent of Kafka with that core torn out of it---does one begin to appreciate the relative levity and relief that it would otherwise afford.