The story of Ethan Frome had initially begun as a French-language composition that Wharton had to write while studying the language in Paris, but several years later she took the story up again and transformed it into the novel it now is, basing her sense of New England culture and place on her 10 years of living at The Mount, her home in Lenox, Massachusetts. She would read portions of her novel-in-progress each day to her good friend Walter Berry, who was an international lawyer. Wharton likely based the story of Ethan and Mattie's sledding experience on an accident that she had heard about in 1904 in Lenox, Massachusetts. Five people total were involved in the real-life accident, four girls and one boy. They crashed into a lamppost while sledding down Courthouse Hill in Lenox. A girl named Hazel Crosby was killed in the accident. Wharton learned of the accident from one of the girls who survived, Kate Spencer, when the two became friends while both worked at the Lenox Library. Kate Spencer suffered from a hip injury in the accident and also had facial injuries. It is among the few works by Wharton with a rural setting. Wharton found the notion of the tragic sledding crash to be irresistible as a potential extended metaphor for the wrongdoings of a secret love affair.
Lenox is also where Wharton had traveled extensively and had come into contact with at least one of the victims of the accident; victims of the accident are buried in graves nearby Wharton family members. In her introduction to the novel, Wharton talks of the "outcropping granite" of New England, the austerity of its land and the stoicism of its people. The connection between land and people is very much a part of naturalism; the environment is a powerful shaper of man's fate, and the novel dwells insistently on the cruelty of Starkfield's winters.