Appearances are everything.  Just ask Norman Bates.  Or Dorian Gray.  You don’t have to ask Annie Wilkes, she’ll come right out and tell you.  What makes Annie more terrifying than the other psychos we have visited is her power.  Paul can’t get out of that bed.  In the beginning, he is powerless by the limits of the car crash.  First Annie controls him through the pills, then, as he’s getting strong, cuts off his foot with an axe.  Being bedridden and trapped adds an element of fear that we haven’t seen before.  Mary in Psycho is vulnerable in the shower, but Norman’s (or mother, whichever name you want to use) attack is swift.  You see Annie coming from a mile away.  Can see her, but can’t stop her.  Like as she’s confronting Paul about leaving the room, she slips in the phrase “pre-op shot.”  He asks, he can’t stop thinking about it, and just like Paul we know something is coming, we don’t know how bad it’s going to be, but we know it isn’t good.  One of my classmates mentioned that Annie is a mother-figure, and that adds to the horror.  All of the psychos we have visited have been men (though just wait until Ketchum’s The Girl Next Door) and the stereotypical view is to see women as less threatening.  Annie was a nurse, a caregiver, and to see that turned on end by her queer views of right and wrong is deeply unsettling.  We spend more time with Annie than with any of the other psychos, get to know her better.  We also see more of her good side, which makes it all so much worse.  The moment when she approaches Paul and tentatively suggests the bees is almost cute, there are times when they have witty banter and you’d think they were friends.  This reminds me of a former boss (also a psycho) and I used to laugh and joke with her in a similar, appeasing fashion.  (I never fantasized about smashing her brains in with a typewriter, but I did wish an awful lot of property damage on her.)

One of the reasons Misery works so well as a novel, I think, is Paul’s reactions to the situation.  There’s no masculine posturing, he doesn’t play the hero, which would get him killed.  He does what he needs to survive, be it drinking the mop water to falsifying the burning of his manuscript.  He’s very realistic about it, not waving down the troopers because he only thinks they have an eight in ten chance of besting her. He’s cautious, and not too proud to beg or scream.

It’s a bit ironic that Paul was something of a womanizer, and he is nearly bested by this solid, domineering woman.  It plays out of a bit of just desserts, revenge for all the times he mistreated women.