She has described it as "an exploration of the illusions, hallucinations, errors of judgment in individual lives, the central scene of the novel being an opium addict's paradise.

Nevertheless, the full manuscript was something of a surprise when delivered in February 1964: When the final great batch of typescript arrived, I looked with some apprehension at the number on the last page.

[2] According to the dust jacket, At one time in the Gare Lazare in Paris, seven suitcases of the manuscript were lost—but were retrieved by seven men from Cook's with seven wheelbarrows.In a 1993 interview, Young confirmed the story.

Minna K. Weissenbach, a rich patron of Edna St. Vincent Millay, also known as the opium lady of Hyde Park, was the inspiration for Catherine Cartwheel.

[11] As she worked on The Accidental Tourist, Anne Tyler cured spells of writer's block by reading pages from Miss MacIntosh at random.

Marguerite Young is unquestionably a genius.A novel of massive achievement.The most important work in American literature since ... Moby-Dick.A work of stunning magnitude and beauty....in the great styles of Joyce or Broch or Melville or Faulkner...a masterwork.Miss MacIntosh, My Darling stands out in my mind as the most significant innovative novel since Ulysses and The Waves.In her zeal to demonstrate that nothing lives except in the imagination, Miss Young, with superb virtuosity, may have written a novel that in the profoundest sense does not exist.