There are many things one could note about Joyce Carol Oates’s long writing career — including, most strikingly, its legendary prolificness. Gifted with a protean talent, she has shifted with ease from one literary genre to another, be it novels, short stories, memoir, poetry, children’s books, essay collections, plays or librettos.

To the envy, admiration and annoyance of less fluent authors, Oates has clearly never suffered from writers’ block. When she is not writing in longhand, she is busy on X and Substack, airing her opinions on Donald Trump and the events of the day. For a time she also wrote suspense under two different pseudonyms.

Indeed, there is something almost compulsive, verging on the hypergraphic, about her need to write. It seems to come to her as readily as breathing, and leaves one wondering whether she ever stops long enough to brew a cup of tea. (One of her few diversions is running.) Now 85, Oates shows no sign of slowing down: “Butcher” is, by most accounts, her 63rd novel, and the book has the feverish energy, narrative propulsion and descriptive amplitude — sometimes to excess — of much of her earlier work.

Even when Oates isn’t writing in an explicitly Gothic mode, as she did in “Bellefleur” (1980) or “My Heart Laid Bare” (1998), she has always been interested in intimations of the sinister, the way it suddenly hoves into view on an ordinary summer day. “At the periphery of many of my poems and works of fiction, as in the corner of an eye,” she once observed in an essay, “there is often an element of the grotesque or surreal.”

The title of “Butcher,” the very starkness of it, gives a clue to the lurid, bloody tale Oates has in store. Like several previous works (her seminal 1966 short story “Where Are You Going, Where Have You Been” and the 1992 Chappaquiddick reimagining “Black Water,” for example), it is inspired in part by real figures who committed real crimes — including, in this case, an undertrained doctor named J. Marion Sims, who in the 1840s began performing experimental surgeries on women recovering from difficult childbirths.

Here, the “Butcher” of the title is now called Silas Aloysius Weir, who for 35 years oversees the New Jersey State Asylum for Female Lunatics, where conditions range from abysmal to horrifying. His medical instruction is minimal, consisting of only four months of training at an inferior school, though he is happy to tell everyone that he comes from a distinguished family (one of his uncles is a renowned astronomer at Harvard, from which two brothers have also graduated; Weir seems to be the bad egg).

Silas becomes heralded and then ultimately detested as a pioneer in the field of gyno-psychiatry, through which misogynistic scrim he views the vagina as “a veritable hell-hole of filth & corruption” and the female genitals as “loathsome in design, function & aesthetics.”

It is a time when the seat of hysteria is thought to be the uterus, and pesky clitorises — “the offensive little organ at the mouth of the vagina … like a miniature male organ, with an obscene fire lit from within” — are held accountable for obstreperous behavior in young women and snipped without a second thought. Various ailments are treated, without aid of anesthetic, by scalpel and sometimes a shoemaker’s awl, and the most frequent cure-all is phlebotomy, or bloodletting (“When in doubt, bleed”), even if in many cases it causes death. The arsenal of drugs includes laudanum, foxglove, mercury, belladonna, “small quantities of arsenic” and cocaine drops.

“Butcher” is told by different narrators, all of whom cast alternating lights on Weir and his God-given (or so he believes) commitment to the patients in his care. From the start, we are given a sense of his unease and unattractiveness: “His head was overlarge on his stooped & spindly shoulders; his stiff-tufted hair of no discernible hue … his eyes rather deep-set in their sockets, like a rodent’s eyes, damp & quick-shifting.” (Reading, I wondered whether a rodent’s eyes are, in fact, deep-set; from the little I have spotted of them, their eyes seemed flat against their heads. But that is a quibble.)

When his use of a pair of pliers to reposition a 5-month-old’s cranial plates results in the infant’s death — even though he relieves his guilt by noting her “very poor stock, virtually subhuman” — Weir is forced to leave his community. Shortly thereafter, he is called to the asylum, where, relying on the assistance of an experienced midwife, he delivers a baby for an orphaned albino Irish servant named Brigit, who is also purportedly deaf and mute. (The child, naturally, is immediately taken from her.)

Eventually, Brigit becomes his assistant, and Weir becomes obsessed with her otherworldly beauty — “Those staring eyes! The faintest blue, uncanny” — believing that there is a special unspoken communion between them. One of those men whose ignorance is matched by his arrogance, he hopes to achieve worldwide fame by finding a way to cure madness by literally cutting it out of the body, and as the novel proceeds, his approach becomes only more brazen. He uses a tarnished tablespoon for intimate examinations as well as heated forceps, confident in his knowledge that “the interior of the vagina is known to be insensitive to sensation, like the birth canal. There are no nerve endings in these organs.”

His ambitions seem limited only by what he can achieve in a series of increasingly depraved experiments, conducted in his private laboratory. Finally, though, the inmates revolt, in a scene that Oates delineates with grotesque specificity. “Butcher” is undoubtedly one of her most surreal and gruesome works, sparing no repulsive detail or nefarious impulse.

In the end, though, the purview of the novel is larger than one might think, becoming an empathic and discerning commentary on women’s rights, the abuses of patriarchy and the servitude of the poor and disenfranchised. Oates, as is her wont, succeeds in creating a world that is apart from our own yet familiar, making it impossible to dismiss her observations about twisted natures and random acts of violence.

My prevailing question about Oates is where her imaginative fantasies derive from, which has always seemed a mystery to me. We don’t get a sense of who she is behind her writing the way we do with, say, John Updike, John Cheever or Alice Munro. But this unyielding impersonality may be the way that she wants it: In the same essay collection I quoted from earlier, she offers, “Elsewhere I’ve stated that JCO is not a person, not even a personality, but a process that has resulted in a series of texts.”

We have become so used to the notion of the recognizable auteur blazing through the artifice of fiction and calling attention to his or her self that Oates’s approach — not dissimilar from the novelist Gustave Flaubert’s insistence that “an author in his book must be like God in the universe, present everywhere and visible nowhere” — feels like a singularly uncommon one. Long may she run.