It is Waugh's penultimate full-length work of fiction, which the author called his "mad book"—a largely autobiographical account of a period of hallucinations caused by bromide intoxication that he experienced in the early months of 1954, recounted through his protagonist Gilbert Pinfold.

These experiences are mirrored in the novel by those of Pinfold, a successful writer in the Waugh mould who, as an antidote to his lassitude and chronic insomnia, is dosing himself with a similar regimen of drugs.

This cocktail brings about a series of hallucinatory episodes during a sea voyage taken by Pinfold for the sake of his health; he hears voices that insult, taunt and threaten him.

Commentators have debated whether the novel provides a real-life depiction of Waugh, or if it represents the exaggerated persona that he cultivated as a means of preserving his privacy.

Gilbert Pinfold is an English novelist of repute who at the age of 50 can look back on a varied life that has included a dozen reasonably successful books, wide travel, and honourable service in the Second World War.

His reputation secure, he lives quietly, on good but not close terms with his neighbours; his Roman Catholicism sets him slightly apart in the local community.

The main inquisitor is a man named Angel, whose voice and manner disconcert Pinfold, who believes he detects a veiled malicious intent.

He was also drinking heavily, the effects of which were aggravated by a large intake of chloral and bromide washed down with crème de menthe—a treatment for insomnia that he concealed from his doctors.

[10][11] A shortage of cash was the principal reason why, in 1953, Waugh agreed to be interviewed on radio by the BBC, first in the Overseas Service's Personal Call programme and then in the Frankly Speaking series.

[21] On board, his strange behaviour became an increasing concern to his fellow-passengers, and the letters which he wrote to his wife Laura from the ship alarmed her—Waugh appeared to be in the grip of a persecution mania in which he was beset by threatening, malevolent voices.

[24] There he was persuaded by his friend, the Jesuit priest Philip Caraman,[n 3] to accept treatment from Eric Strauss, the head of psychiatry at St Bartholomew's Hospital.

[28] In the three months following his return to his home, Piers Court at Stinchcombe in Gloucestershire, Waugh was inactive;[29] when he resumed work his first task was to complete his Sword of Honour novel, Officers and Gentlemen, which occupied him for most of the rest of 1954.

In January 1957 Waugh rewrote the ending, creating a circularity with a return to the words that introduce the novel, and also gave the book its subtitle, "A Conversation Piece".

[46] Waugh confirmed the autobiographical basis for the novel on several occasions; at the book's launch on 19 July 1957,[49] to Robert Henriques in a letter of 15 August 1957 ("Mr Pinfold's experiences were almost exactly my own.

[51] As well as the congruence with real life of specific incidents in the book, Pinfold's age and his domestic and professional circumstances as revealed in the first chapter closely mirror Waugh's.

The fictional counterpart shares Waugh's aversions to modern life; he hates "plastic, Picasso, sunbathing and jazz—everything, in fact, that had happened in his own lifetime".

The poet John Betjeman is represented as "James Lance", Waugh's priest Philip Caraman is "Father Westmacott", and Christopher Sykes is "Roger Stillingfleet".

[56] The name "Margaret", awarded to Pinfold's gentler tormentor, was that of Waugh's second daughter for whom, he wrote to Ann Fleming in September 1952, he had developed a sexual passion.

[68] In the novel, Pinfold initially dismisses the Box—described as resembling "a makeshift wireless set"—as "a lot of harmless nonsense",[62] but, like Waugh, he is driven to revise his position in the face of his persecution by the voices.

He believes that "Angel" is using an adapted form of the Box, as developed by the Germans at the end of the war and perfected by the "Existentialists" in Paris—"a hellish invention in the wrong hands".

As with earlier novels, the "Catholic gentleman" is subject to a degree of ridicule and mockery;[71] the voices speculate that Pinfold is Jewish, that his real name is "Peinfeld" and that his professed Catholicism is mere humbug invented to ingratiate himself with the aristocracy.

[62] While the Church was encouraging its adherents to engage with society and political institutions, Pinfold, like Waugh, "burrowed ever deeper into the rock, [holding himself] aloof from the multifarious organisations which have sprung into being at the summons of the hierarchy to redeem the times".

Waugh was dissatisfied with the illustration that the publishers finally produced, and on 17 June 1957 wrote to Ann Fleming complaining that McDougall had made "an ugly book of poor Pinfold".

[76][77] The Daily Telegraph had partly revealed the book's principal theme three months earlier: "The publishers hope to establish 'Pinfold' as a household word meaning 'half round the bend'.

[49] To further stimulate sales the dust-jacket also emphasised Waugh's experiences of madness, which brought him a large correspondence from strangers anxious to relate their own parallel experiences—"the voices ... of the persecuted, turning to him as confessor".

[90] John Betjeman, reviewing the book for The Daily Telegraph, wrote: "The Ordeal of Gilbert Pinfold is self-examination written as a novel, but unlike other such works, which are generally dreary and self-pitying, this, because it is by Mr Waugh, is readable, thrilling and detached".

[94] The Times Literary Supplement's reviewer R. G. G. Price deemed it a "thin little tale", while acknowledging that Waugh as a comic writer could reasonably be compared with P. G. Wodehouse in terms of originality and humour.

B. Priestley, in a long essay in the New Statesman entitled "What Was Wrong With Pinfold", offered the theory that Waugh had been driven to the verge of madness not by an unfortunate cocktail of drugs but by his inability to reconcile his role as a writer with his desire to be a country squire.

[101] In September 1977 a staged version of the book, written by Ronald Harwood and directed by Michael Elliott, opened at the Royal Exchange theatre, Manchester.

[102] The play was brought to London, and performed at the Roundhouse Theatre in February 1979, where Michael Hordern's depiction of Pinfold was highly praised—"a man suffering from chronic indigestion of the soul".