In a novel that is somewhat structured around metafiction, with An Imperial Affliction playing a starring role in the fiction we're reading, Van Houten is its keenest representative. As such, he reveals the magical power of fiction while simultaneously demystifying the romance attributed to authorship. For most of the novel Hazel considers Van Houten a veritable god, or at the very least, a powerful prophet. An Imperial Affliction is Hazel’s personal bible. The novel speaks to her about terminal illness in ways that no other medium, or person, or support group ever do. The act of reading Van Houten’s novel is so incredibly personal to Hazel that she mistakenly conflates the novel’s magic with its author’s greatness. However, when Hazel first meets Van Houten, the magic feeling becomes deflated. She sees him for the sloppy and often mean-spirited drunk he really is. She learns that an author is nothing more than a human being, with human qualities and problems.
Van Houten wears a lot of masks throughout the novel. One of his most crucial roles is to depict the variety of ways in which people deal with pain. When we learn that An Imperial Affliction is really a fictional account of the life of Van Houten’s daughter, Anna, who died from cancer at a young age, we are able to see the author more sympathetically. He is the real life tragic version of the fictional Anna’s mother in his novel. It makes him the living embodiment of Hazel’s greatest fear: that her parents will be so distraught by her death that they will not be able to go on.