More Than It Hurts You, the latest from the author of Chang & Eng, uses a child’s helplessness to examine adult horrors.

How did you decide on Munchausen by proxy, a syndrome where parents harm their own children, as the novel’s engine?

A doctor friend’s mentor is the premier Munchausen by proxy doctor in the Pacific Northwest. The mentor had a case where he knew that a family was doing serious harm to their child—I think the mother was injecting the baby with feces, or something like that. He tried to get the child removed from the home, and the family, intelligently, went to the press. The press vilified the doctor, and the kid got to stay with the parents. I thought it was a good story, but as I started writing it, it didn’t have the weight that I wanted.

Was that the motivation for making the parents Jewish and the doctor black?

It was. I grew up Jewish on Long Island, and I was always kind of mystified by the schism between the black and Jewish communities, given their tight alliance in the civil rights movement. The story started to resonate much more when I hit on that configuration.

Did you see Obama’s speech?

He touched on things that I was trying to get at, except he did it in two days and 20 minutes, and it took me three years and 350 pages. [laughs] Explaining, or trying to explain, white anger to the black community, and black anger to the white community—and trying to do it in a way that understands both sides. That Obama got into the minds of white people who have racist thoughts struck me as a kind of a novelistic gift.

After two historicals, what made you write a contemporary novel?

As I was writing, I was rereading Updike’s Rabbit books. The way he refracts contemporary American history and all of these American contraries through this one character was part of what inspired me.

How does Munchausen by proxy fit in with that?

It’s all kind of vague, the connections in my mind. Reality TV is in there somewhere, and there’s a way in which, once I was pretty deep into the book, I started to see the Iraq War as George Bush doing Munchausen by proxy on a country—inflicting violence to get attention, on a horrific scale. But I always liked that quote from Saul Bellow: half an idea is better than a whole idea. You can just tell your story and be passionate about it and not try to bang people over the head with the message. It will inform the story just the same.