Descriptions of Altamont are based on Wolfe's home town of Asheville, North Carolina, and the descriptions of people and family led to estrangement from many in his hometown. Though often regarded as a "sentimental tale of growing up," the novel is characterized by a "dark and troubling" depiction of the times, "full of loneliness, death, insanity, alcoholism, family dysfunction, racial segregation and a profoundly cynical view of World War I." Rarely named but frequently alluded to, the infectious disease tuberculosis (consumption) casts a "death’s-head shadow" over the novel. Wolfe would later die of the disease.