You are not alone, and you are not a selfish pig

A review of The Selfish Pig’s Guide to Caring by Hugh Marriott

In response to comments and emails about my newsletter on ‘Are you a carer?’ (May 13, 2026) I thought I would do a book review on ‘The Selfish Pig’s Guide to Caring’ by Hugh Marriott. I have recommended this book to my patients, their families, and, in particular, their carers for years. I would recommend it to all people with MS who have disabilities and need some help, their families and in particular their carers.

Book review

If you are caring for someone with MS — a partner, a parent, a sibling, a friend — this is a book you ought to know about. It has an irreverent title and the rare quality of saying out loud the things most carers only think in private. The Selfish Pig’s Guide to Caring, in my view, is one of the most useful books for a carer. It does not purport to cure anything or complete the endless number of benefit forms. But it does something valuable: it will make you feel less alone.

Why this book exists

Marriott did not set out to be an author on caring. He became a carer when his wife, Cathie, was diagnosed with Huntington’s disease, and he very quickly discovered what millions of others know: that the role of being a carer arrives without training, without a manual, and almost always without warning. There are an estimated six million unpaid carers in the UK alone, and yet the practical and emotional reality of what you do is barely acknowledged, let alone discussed honestly. Marriott wrote the book he wished someone had handed him at the beginning of his journey.

The premise is captured in the title. Carers, by definition, are the opposite of selfish pigs. They give up sleep, careers, friendships, holidays, hobbies, and often their own health, for someone they love. And yet — and here is the catch — they are forever guilty about not doing enough. Marriott’s central, liberating argument is that you must, occasionally, be a Selfish Pig. Not because you are one, but because the only way to keep caring sustainably is to look after yourself first. A burnt-out carer helps no one. The aeroplane oxygen mask analogy applies to caring, too.

What he is willing to say

What sets this book apart from the well-meaning leaflets in the GP or neurology outpatient waiting room is that Marriott refuses to be polite about the hard bits. Like me, he does not pull his punches or wear rose-tinted glasses. He talks about the feelings that no one will admit to: resentment, exhaustion, sexual frustration, the terrible fleeting thought that life would be easier if the person you love simply weren’t there any more. He calls these the things that “come in the night”, and he is absolutely right that almost every long-term carer has had them, and almost every long-term carer believes, wrongly, that they are alone in having them.

Marriott’s matter-of-fact discussion of these feelings is, for many carers, the first time anyone has given them permission to be human. That permission is worth the cover price on its own.

He covers, with the same directness:

• The grief of watching the person you love change, while everyone around you insists they are “still the same person”.

• The peculiar invisibility of carers — to friends, to neighbours, to officialdom, sometimes to the cared-for person themselves.

• Sex and intimacy, which most books on caring step around as if it were radioactive.

• The exhausting choreography of dealing with Social Services, benefits, hospitals, and the legions of professionals who descend on your life with clipboards.

• The need, occasionally, to laugh — at the absurdity, at yourself, at the situation. Marriott’s gentle humour is itself a form of resistance.

He also brilliantly gives the cared-for person a name. Rather than the clinical “service user” or the saccharine “loved one”, he coins PIGLET — Person I Give Love and Endless Therapy to. It is funny, affectionate, and slightly subversive, and it captures the essence of the relationship better than any official terminology.

Why this matters for MS

Caring for someone with MS rarely arrives in a single dramatic moment; it accumulates. A little more help with the stairs. Then with the shopping. Then with dressing. Then with continence. Then with cognition. Each step is small enough that the carer slides into the role without ever quite noticing they are now doing it full-time. Many MS carers I have spoken with describe a kind of bewilderment — how did this become my life? — combined with the absolute certainty that they would not have it any other way.

Marriott understands this. He understands that caring for someone with a progressive neurological condition is not a sprint or even a marathon; it is something more like a very long, unpredictable walk in weather you cannot forecast. You need different equipment for that. You need pacing. You need to enjoy the views. You need to know where the rest stops are. And you need company.

The motivational core

I want the carers reading this newsletter to hear, above everything else, this: the feelings you are having are normal. The exhaustion is normal. The flashes of resentment are normal. The grief — anticipatory, real, complicated, sometimes a relief — is normal. The guilt about feeling any of these things is also, sadly, normal, but it is the bit that Marriott most wants you to put down.

You are not failing. You are doing one of the hardest jobs in the world, with no training, no salary, and very little recognition. Millions of other people are doing it alongside you, right now, in flats and houses up and down the country, feeling the same things you are feeling. That is not a sad fact. It is a quietly hopeful one. It means there is a vast, mostly invisible community of people who would understand you immediately if you spoke up.

And here is the bit that the title is really getting at: looking after yourself is not a betrayal of the person you care for. It is the single most important thing you can do for them. The hour you spend on a walk, in a café with a friend, at a yoga class, asleep in the afternoon — that hour buys you the energy for the next week. Refusing to take it does not make you a better carer. It makes you more exhausted. Marriott gives you permission on every page to take the hour.

What the book is not

It is fair to say what this book is not, so you know what to expect. It is not a benefits guide; you will need the Carers UK or MS Society websites for that. It is not a clinical primer on MS; you have other resources for that, including this newsletter. It is not relentlessly cheerful in the way some self-help books are; Marriott is far too honest for that. And it is not, very deliberately, politically correct. He uses the language carers actually use when they are talking among themselves, and some readers will occasionally wince. That, I think, is the point.

What it is is a companion. The sort of book you keep on the bedside table and dip into when things are particularly bleak at three in the morning. The sort of book that makes you laugh out loud, and then makes you cry, and then makes you feel, for the first time in a long while, properly understood.

Practical suggestions for using it

A few thoughts on how to get the most from it:

• Read it slowly. A chapter a week, even a chapter a month, is plenty.

• Lend it to the person you care for, if they would like to read it. Many people with MS find it useful to understand what the caring role actually looks like from the inside — it can shift the conversation in your household.

• Lend it to your friends and family who don’t understand. Marriott is much better at explaining the carer’s experience than most carers have the energy to be.

• Underline the bits that resonate. When the dark days come — and they will come — flick back to them and remember you are not the first person to feel this way.

A final word to carers

If you take only one thing from this newsletter, take this: caring is not a competition, and it is not a measure of your worth. You are not required to be a saint. You are required only to be a person — a tired, fallible, real person — doing your best for someone you love. You are doing extraordinary work. You are not alone. And, in the sense Marriott means it, being a Selfish Pig now and again is not a character flaw — it is a survival skill. Use it.

I cannot recommend this book highly enough.

The Selfish Pig’s Guide to Caring by Hugh Marriott is widely available in paperback and e-book.

If you are a carer and reading this, please also know that the MS Society and Carers UK both run carer support services, peer groups, and helplines. Reach out. The community is bigger than you think.

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Please note that the opinions expressed here are those of Professor Giovannoni and do not necessarily reflect the positions of Queen Mary University of London or Barts Health NHS Trust. The advice is intended as general and should not be interpreted as personal clinical advice. If you have any problems, please tell your healthcare professional, who can help you.