I meet him and his wife, Flora Drew, who has translated all his work for the past five years, in a cafe in London's fashionable Maida Vale. Drew is interpreting as Ma has not absorbed much English. 'I've been here for more than five years and I don't really understand anything,' he said.

Stick Out Your Tongue was written after Ma returned from a long journey that ended in Tibet in the summer of 1986.

'I went because I was hoping to breathe the fresh air of freedom, but I found it was more restricted than anywhere else I had seen,' he said.

He was familiar with political control, but there was also religious control on a level he had never seen before. 'There was a sense of despair and disillusion and I spent two months writing it down.'

The book begins with a sky burial, in which corpses are hacked into small pieces and fed to the birds, which is based on his own experience.

'My clothes were stained with blood and the stench wouldn't leave for six months, no matter how often I washed them.'

The main change he made in the written story was in the narrator's attitude. 'In real life I felt horrified the whole way through, but my narrator was dispassionate, just an observer.'

Stick Out Your Tongue was translated into French in the 1990s. But Ma's English agent was initially more interested in the journey that led to the book than in the book itself. He asked Ma to write the synopsis of a travel book, which later became Red Dust, winner of the Thomas Cook Travel Book Award in 2002.

The book described the absurdities of his life working as a propaganda office photographer and the surreal nature of his adventures, which included almost dying of thirst in the dried-up gold rivers of western China and pretending to be a feng shui master.

Drew said: 'Creating Red Dust was a strange experience. We were writing it and translating simultaneously. As a translator, I had no idea where it was all leading to.'

The problems of translation in Stick Out Your Tongue were different. 'It is brutal language in the original and I had to be faithful to that. I couldn't make it more gentle just because I was putting it into English.'

The images in Stick Out Your Tongue are as brutal as the language. There is a scene in which a girl is forced to commit incest with her father and another in which an adulterous woman tries to steal a golden crown from the top of a pagoda, is stuck there by magical forces and is last seen as a battered piece of wind-dried skin, flapping in the breeze of righteousness.

How did Drew feel about being alone, day after day, with such images? 'I found it beautiful,' she said, surprisingly. 'If you look past the violence and read it in a poetic light, you can move beyond it. You are reading it as a metaphor, not as a documentary.'

They were shocking stories, she agreed. 'And they stick in your brain.'

Drew and Ma met in Hong Kong in early 1997. Ma had been living here since 1986 and Drew was making a documentary about the handover for an American TV station. 'I was looking to film someone who was doing something as a protest. And someone told me about Ma Jian and an artists' happening he was organising,' she said.

Did she fall in love immediately? 'No, that came later. But I read his books carefully and if I hadn't liked them, I don't think we would have met again.'

His next book is not about travel, nor is it about London. It is about a man in a coma and it is, of course, a metaphor.

'Some friends in China have a lot of freedom on the surface but they have no mental freedom and it surprises me that they can live that way,' Ma said. 'For them, material wealth is very important.'

Has Ma avoided that by coming to London? 'In the west you can live in a coma like people live in China, or you can go on a search. But at least you have a choice. In China, you don't. In the 1980s, in Beijing, people had a sense of curiosity, but now they don't even seem to have that any more.'

He goes back every year.

'But each time I feel I belong there less ... I think a dissident shouldn't belong to any society, least of all his own.'

The coma book has taken him 10 years to write. 'It is due in two weeks and it's already past its deadline. I have almost entered a coma myself, I have been working so long on this.'

It was not so much writer's block as baby block, he said. He and Drew have two young children. 'It's very difficult to write about a man in a silent coma while I'm living in a noisy nursery. Yesterday, I was writing about my character lying unmoving in bed in a hospital to the backdrop of our baby screaming. And I realised the section I was writing I had already written a month ago.'

He likes to work until three or four in the morning and wake up late.

'But now I have to go to bed by 12 because I know I'll be woken up early by the children. And my study has television supposedly for videos of Tiananmen Square, but now it has Disney films playing the whole time,' he said. 'It's so hard writing about a massacre when Flora is putting the baby on my lap.'

Ma Jian appears at the Man Hong Kong International Literary Festival on March 6, Fringe Theatre 7pm. $120