I started reading The Deep Places, Ross Douthat’s astonishing new memoir, while sunk into a large chair in a small room in the basement of a medical-imaging center on the Upper East Side of Manhattan. Like all good horror stories, The Deep Places begins in daylight, the better to accentuate the darkness that will soon fall: Here are Ross, who is a columnist for the New York Times, and his wife, Abby, a brilliant science writer, leaving behind the muggy thicket of Washington, D.C., for a New England farmhouse, complete with sunken stone fences and apple trees and promises of children running happy and free while adults plant lovely gardens and count their blessings.
Before the Douthats could even pack, though, I was interrupted by a nurse carrying a small case. Inside it was a bulbous syringe made of metal, a cylindrical and menacing contraption that looked as if it belonged on the Magic Mountain, not in an upscale medical suite across the street from Sotheby’s. She injected me with what she assured me, in a cheerful tone, was just radioactive sugar and told me that, as I would continue to be radioactive for a little while, it would be better if I didn’t return home to my young children for at least eight hours. Then she left me with a gargantuan bottle of barium—drink it as fast as you can, she said, and you won’t even notice the taste—and my book.
If you’re looking for a pithy summary, here goes: Ross finds something he thinks might be a boil. It’s painful, but he thinks nothing of it. Then his symptoms worsen. There’s pain in his chest and a gagging feeling in his throat and a stabbing sensation in his spine. “So I began going to doctors and taking tests,” he writes. “I saw an internist, a neurologist, a rheumatologist. I had my stool and urine tested repeatedly, I had batteries of blood work done, I underwent cranial and abdominal scans and a tilt table test.” Nothing is found. As far as medical science is concerned, Ross is healthy. But the pain grows sharper, and soon its source is revealed—it’s Lyme disease.
Or maybe “revealed” isn’t the right word. A test for Lyme comes back negative, and a course of antibiotic treatment works for precisely one day before the symptoms spiral. Ross, with the Internet as his Virgil, descends into purgatory to greet the lost souls—some wretched, some wicked—that inhabit the various circles of the strange lands of suffering. We meet doctors who developed renegade courses of treatment, healers who use magnets or intravenous infusions or specific sonic frequencies to eradicate the tick-borne invader, and more than a few medical-establishment types who think it’s all hokum and that Lyme is a condition made up by bored suburban housewives desperate to inject their vapid lives with a dash of drama.
This is where I must inform you, reader, that nothing in the review that follows will bother much with objectivity. For one thing, it’s because Douthat writes with such radiant grace, allowing doubt and sorrow to slowly wander where other writers might’ve unleashed a quickening rage or pleaded for sympathy. More important, however, it’s because I, too, have been stricken with the same disease, suffering not as terribly as Douthat but enough to recognize how piercing and true is his meditation on a condition, chronic Lyme, most of the medical establishment doesn’t even believe really exists.
In the book’s early chapters, Douthat approaches his illness as you’d expect of a Harvard-educated member in good standing of the upper middle class: I’m sick, he thinks, and science will find a way to cure me. But “science,” he soon learns, is a complicated construct, “filtered through fallible institutions, politicized processes, and bureaucratic incentives.” Public health officials set clumsy criteria for defining Lyme, which then affect official diagnoses, which, in turn, determine which studies get funded and which do not, which leaves hundreds of thousands of people howling in pain with no recourse and no sense that anyone is listening to them.
At least 30 percent of Lyme patients are still misdiagnosed with false negatives, and little to no research exists to help chronic patients, like Douthat or me, understand why they’re experiencing strange symptoms for months or years after their bacterial infection is officially treated. It’s all in your head, Douthat’s doctors tell him before offering Xanax or the phone number of a good shrink. I’ve heard the same thing more than once.
At any other point in time, a book like The Deep Places might’ve sunk to the bottom of the reading pile, a niche title for people who, for one reason or another, have a particular interest in the subject matter, the author, or both. But then came COVID-19, and suddenly Douthat’s book wasn’t really about chronic Lyme anymore, or at least not entirely.
“My own case to one side,” he writes, “the coronavirus era soon came to feel like a shattered mirror of the tick-borne epidemic and its controversies, with different pieces of the Lyme wars reflected and refracted in different aspects of the worldwide COVID crisis. Things that came as a surprise to people for whom modern medicine was still a stable floor—the testing that didn’t work, the confident medical advice that had to be reversed and then reversed again, the wild uncertainty about how, and for how long, a single pathogen’s symptomatic effects might manifest themselves—were completely unsurprising to me by now.”
Having watched our self-appointed intellectual betters dismiss too many Lyme treatments that, upon independent inquiry, turned out to be grounded in observable reality, Douthat wasn’t surprised that too many theories initially dismissed as conspiratorial—see under “Wuhan lab leak”—eventually emerged as plausible and even probable.
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Our collective story, then, begins where his personal account ends. Ross gets better, but the long and lonely nightmare that had sucked up more than half a decade of his life is now our everyday reality. Read the book with this in mind, and you realize that it’s a travelogue capturing not one destination but two.
The first, to borrow the title of one chapter, is “the country of suffering,” the state of experiencing both chronic pain and the suffocating feeling that no one around you knows how to help or even relate. The second, to borrow the title of a recent essay in Tablet by Alana Newhouse, is an America where everything is broken. Douthat’s day job as a columnist peeks through the cracks of the book, with the occasional reference to the national drama unfolding alongside his medical ordeal, the rise of Donald Trump. He’s too soulful a storyteller to lump both together crudely—the vicious little tick and the divisive politician—but he doesn’t have to; the sense of a nation collapsing under its own delusions is palpable.
The men and women who glance at Douthat’s charts and then dismiss his suffering, you realize, belong to the same benighted class—rich in education and disposable income, impoverished when it comes to self-awareness and humility—as the political prognosticators who snoozed as millions of Americans struggled with painfully real hardships, and who were then surprised when the body politic became gripped with what still feels like a chronic inflammation.
This same brood of smug Brahmins still produces the news we read, the curricula we administer to our children, and the movies we watch late at night when we’re tired and need a short escape. Its members, flashing their credentials, are still the ones diagnosing us when we’re sick and shaping our economic reality when we’re healthy. And if you’ve read Douthat’s book or paid any attention to them these past two years of crisis, you know that they’re not in the business of listening to you or learning from their own mistakes—which is why, everywhere you look, everything seems as if it just doesn’t work, or at least doesn’t work for you.
Chronic patients have this realization thrust upon them. We have no choice. When one lovely and caring physician informed me that I was functionally sick—by that point, I’d lost more than a third of my body mass and four months to extreme pain, and was now living with no appetite, a gaggle of gastrointestinal catastrophes, and a monthly bout, like a menstrual cycle, of high fevers and uncontrollable shaking that goes on for days—but medically healthy, I froze.
What he was really telling me, I understood, wasn’t just “we don’t know what’s wrong with you.” What he was saying was “we have no way of knowing what’s wrong with you.” The first statement leaves open the possibility of discovery—the pendulum will swing and a wise diagnostician will emerge in the third act with a eureka and a happy ending. The second demands a radical readjustment of expectations, an understanding, as metaphysical as it is practical, that the crisis we face is profound, systemic, and all-permeating.
“When the crisis simply continues without resolution,” Douthat writes, “when the illness grinds on and on and on—well, then a curtain tends to fall, because there isn’t an obvious way to integrate that kind of struggle into the realm of everyday life.” Family members and friends don’t know what, exactly, they’re supposed to do to ease a loved one’s suffering. And sunny Americans accustomed to thinking that theirs was a nation that could buffer them from any real hardship and offer them meaningful if not always perfect remedies to problems physical and emotional don’t know what, exactly, they’re supposed to do to fix all that they now see shattered.
How do we do it? What’s the prescription? Read Douthat, and let him tell you that it’s all in the journey. First, you acknowledge the depth of both the dysfunction and your own despair. Second, you learn to see others you might’ve never otherwise considered worth noting, to say nothing of embracing.
In one of the book’s most moving passages, Douthat goes to see a woman he calls the Magnetizer, whose treatment and opinions alike veer way off the course of anything accepted by the medical consensus. His prior, pre-sickness self, he candidly admits, might’ve dismissed the woman as a fringe figure. “My new self, though,” he writes, “regarded her radical openness rather differently—as a feature of the kind of mind that was more likely than the rest of us to grope its way to veiled or disreputable truths.” Give that mind too much freedom, he admits, and it might spiral into hazy claims about chemtrails and black helicopters in the sky. “But exclude such openness entirely,” he continues, “and you end up with the mindset that I had encountered across my months of frustration, where the absence of an exact test result matching a set of bureaucratic criteria meant that doctor after doctor would spread their hands, hint that you were crazy, and abandon you to pain.”
The Magnetizer did no such thing, which brings us to the book’s third and final prescriptive point of light: Once you acknowledge the brokenness, and once you learn to listen to the people your privileged position in life taught you to ignore, you realize just how many are huddled right there with you, ready to rebuild whatever had fallen apart.
I finished the book in outdoor cafes and on park benches, walking around town and waiting for the poison to pulse out of my body so that I could safely return home and hug my wife and my kids. At some point, the doctor called with very good news: The test results came back, he said, and we can cross lymphoma off the list. I said I felt relieved but then reminded him I was still experiencing all the same symptoms that brought me to him in the first place. He said something about more tests, and I could tell he wanted to get off the phone. As far as he was concerned, my case was closed, happily so. I said something about Lyme, and I could feel him stiffen up on the other end of the line. He said something about there being no evidence and no reason to waste time, something about science. I thanked him warmly, hung up, and clutched Douthat’s book. I was still sick, but I wasn’t alone.
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