In an interview in Black Issues Book Review, Pearl Cleage reveals that the idea for What Looks Like Crazy on an Ordinary Day came from her desire to write about a character whose doctor informs her that she is HIV positive
Cleage was amazed at how many people she saw in denial about HIV and AIDS, so she created a character who has no choice but to deal with it. This character, Ava, not only comes to terms with her HIV-positive status, but she also finds a way to recreate and reclaim her life. What Looks Like Crazy is Cleage's first novel. Known for her plays and essays, Cleage felt that this particular story required the novel form to explore the culture of Idlewild and the psychological workings of her characters. Idlewild is an actual city in Michigan that was established after the Civil War as an African-American community. The city was a thriving resort during the 1950s and 1960s, but then it began to decline in popularity. Although Cleage began writing What Looks Like Crazy in the third person, she realized that her skills as a playwright would make a first-person point of view a natural choice. She told Black Issues Book Review, "As a playwright, I'm used to writing in dialogue." When Oprah Winfrey chose the novel as one of her book club selections, sales sharply increased, and Cleage quickly reached a wider audience. In 1998, What Looks Like Crazy stayed on the New York Times bestseller list for almost ten weeks. In 2001, Cleage saw publication of a follow-up novel titled I Wish I Had a Red....