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In this chapter I consider one of the necessary conditions for being a novelist, the ability to open up and sustain a fictional world. My approach will draw from psychopathology, phenomenology and neuroscience. Using the phenomenological concept of “multiple realities,” I argue that the novelist is in some ways like and in some ways unlike someone who experiences delusions insofar as the novelist can enter into a sustained engagement with an alternative reality. I suggest, however, that, compared with the delusional subject, the novelist has better control of the mechanisms that allow for this sustained engagement.