"The biggest challenge was to study the psychological literature of that day so that none of my characters would not know more than they could have known in terms of psychology."
—Caleb Carr
In an interview with The Record , Carr stated he wanted to entertain the reader, while also staying faithful to the time period. Carr, a historian by training, wanted to find a form of writing where he could meld his interest in fiction with his knowledge of history. "The one thing I wanted to show was that people back then are a lot more like people today than we realize," said Carr. Carr researched the science and literature of the time period and noted, "The biggest challenge was to study the psychological literature of that day so that none of my characters would not know more than they could have known in terms of psychology. We're talking about a time when [Sigmund Freud] had just published his first book."
Author Paul Levine compares Kreizler to Sherlock Holmes and Sigmund Freud. He likens The Alienist to Ragtime by E.L. Doctorow; both stories fuse historical fiction with real characters from the time period. Levine notes the story serves as a "painless history lesson", and comments that the juxtaposition of J.P. Morgan's lifestyle with " the teeming tenements where police dare not enter", serve as "reminders that crime and class distinction are hardly new".
Carr has said that "The Alienist is about how violent behavior is perpetuated from one generation to the next."
The Alienist "explores the causes of insanity and criminality, and ultimately the nature of evil".
Another theme is destiny, and the novel investigates New York City's destiny, "saying its basic character and problems have endured over history".
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