Ross Douthat’s new book, a memoir of his experience with chronic illness, is far more than that simple description would suggest. It recounts, in excruciating detail, his journey with Lyme disease, which began in 2015. It tells of the pain and doubt and circle of suffering that ripple out beyond the sick individual; like pebbles disturbing the surface of a pond, like the monotonous drip of water onto the forehead, the sorrows of sickness inevitably touch the ones we love, or rather the ones who love us. Anguish irradiates.
That term is apt, in fact, because radiation is ambivalent in its effects. Agony shines forth a kind of negative light, and no one in the vicinity is shielded from its rays. Moreover, exposure to radiation is often therapeutic or medical in character; in that sense, it might stand for the experience of undiagnosed chronic illness, since what one feels is something akin to an invisible invasion of one’s body, even one’s very self. Finally, radiance suggests illumination. And that is exactly what Douthat seeks in his experience. He wants it to mean something.
As for most Christians, the meaning Douthat initially sought, far from being a project of the will, was instead a petition to receive. A bona fide member of the elite, having climbed to the top rung of the journalistic ladder, he was repeatedly reduced to mere begging. Walking along the Maine shoreline, bent over with emotional and physical exhaustion, he breaks down sobbing and lets out “a desperate, rasping croak”: “Help me, God. Why won’t You help me?” He receives a kind of reply in the moment, but by and large his story is one of groping in the dark.
The result is that The Deep Places is itself Douthat’s patchwork attempt at answering his own question. In part a pilgrim’s deconstructed theology of suffering, in part a revised theory of medical epistemology, the result is tentative, searching, and unfinished by definition. He’s still in the dark wood. But he wants his fellow sojourners to know something of the path, not least if they are already lost, as he once was.
In that way it is just to call his an illuminating illness. But not for the reasons you might expect.
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There are four propositions or premises that Douthat’s book calls into question. Though rarely articulated in precisely the following forms, they are taken for granted by many people today — perhaps a majority of Westerners who are either religious or affluent. Douthat wants to explode every one of them.
The first: God has a wonderful plan for your life.
This well-meant maxim is a pet theme of Douthat’s, who wrote extensively on the prosperity gospel in his 2012 book Bad Religion. One popular meme transposes the adage onto an image of Christians facing lions in the colosseum. That conjunction of Hallmark theology with historical reality gets at the idea. The presumption that my life will go well —will prosper — because I have faith, or because God is good, is a falsehood so obvious that it should require no argument to see it. All the worse when we suppose, as good meritocrats, that we deserve the good that’s come to us. Nor are those who know better, who recognize these twin beliefs as self-deception, immune to their power. We feel it even when we don’t think it. Somewhere deep within we whisper to ourselves: You earned this; God is crowning your good deeds.
Writing of the sequence of events that led to his getting bitten by a deer tick — Harvard degree, Atlantic blogger, New York Times columnist, wonderful wife, beautiful kids, a move from a cramped apartment in D.C. to a country house in small-town Connecticut — Douthat confesses that it “felt like confirmation that we were on the right path, that I had planned and worked and won the things I wanted and that I deserved them — that my ambitions and God’s purposes could stroll along together nicely, that bad things might sometimes happen to good meritocrats, but surely not to me.”
The themes of hubris and exceptionalism recur in the memoir; Douthat is unsparing in his self-exposure. A running metaphor comes from C. S. Lewis’s The Voyage of the Dawn Treader, in which a nasty child is transformed into a dragon, and his only hope of changing back into a boy is Aslan’s claws peeling — scraping, tearing, flaying — the dragon scales off his body. The metaphor works well for Douthat’s experience of chronic illness: his deepest desire is for a sort of divine desquamation, only from the inside out. But the metaphor works, too, for his approach to telling his story. The scales of hypocrisy and self-importance just keep molting. Humility, in this case, comes only by way of public humiliation. Per crucem ad lucem.
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The second proposition: Modern life is pleasant and comfortable.
Perhaps the most affecting chapter of the book is titled “The Country of Suffering.” Douthat finds himself initiated into “the secret fraternity” of the chronically ill. Long invisible before his experience with Lyme, the sick as a class of persons now stand out in sharp relief against the mass of the supposedly well. He suddenly sees clearly what so many of us labor to hide: pain. Constant, incumbering, irremediable pain. And if you expand that circle to include other forms of pain beyond the chronic, the bodily, and the diagnosed, then you realize, with Douthat, that the fraternity turns out to be more or less coextensive with the human family. In a manner of speaking, the country of suffering is just the world. It denotes, not a sad but negligible subgroup, but a universal brotherhood. We are all the wretched of the earth.
Except that we are trained to live in denial. “There was comfort there, of a sort,” Douthat writes, upon realizing that what was happening to him was not unique or exceptional but a common experience, if usually reserved for one’s later years.
But there was also a feeling of betrayal, because so little in my education had prepared me for this part of life—the part that was just endurance, just suffering, with all the normal compensations of embodiment withdrawn, a heavy ashfall blanketing the experience of food and drink and natural beauty. And precious little in the world where I still spent much of my increasingly strange life, the conjoined world of journalism and social media, seemed to offer any acknowledgment that life was actually like this for lots of people—meaning not just for the extraordinarily unlucky, the snakebit and lightning-struck, but all the people whose online and social selves were just performances, masks over some secret pain.
Few of us have any interest in living in a world without anesthesia or aspirin, beset by higher rates of starvation, child mortality, and other symptoms of premodern life. But Douthat helps us to see that there is no amount of amenities or inventions or technologies that will fix the human condition. Indeed, the great temptation is to perpetuate a collective pretense, as though even “in real life” we saw one another through an Instagram filter: airbrushing the wrinkles, tucking in the tummy, washing out the marks of anxiety, hurt, aging, and decay. Such “touch-ups,” however, are little more than masks. If suffering does nothing else, it removes the façade.
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The third proposition: Nature is a refuge and an escape from city life, a beautiful home made by God for humanity to flourish in.
This may sound like an odd fit with the rest of Douthat’s story. But the story happened at all because of a deeply felt impulse on his part to move to the country. Or at least to “the country.” That trope signaled to him what it does to many of us: a return to the past; a simpler life; a more natural existence; a space for children; a haven from congestion and crime; a habitat over which “man” has long held “dominion.”
But as Douthat later summarized his experience on Twitter: “I tried to move to the country and nature tried to kill me.”
That lesson — nature is trying to kill you — is a worthy corrective to multiple popular perspectives. One is the nostalgia of crunchy cons who love Tolkien and Wendell Berry. Not the floor of the stock exchange, but the Shire is the conservative ideal here, sometimes depicted as the fundamental counterimage to the tree-felling machines of modernity. Another is the environmentalism of the left, which sometimes falls into rhapsodies lauding the organic rhythms of benign Mother Nature. Still another is the creational theology of Christians who see nothing but God’s pronouncement of “good” over the world of his making.
Each of these views has something valuable to say. But only up to a point. And to the extent that they have either the last or the only word, they ignore, to their and our detriment, the dark side of nature. Perhaps, as we approach two years of enduring a global pandemic, the message has been received.
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The last proposition: You can trust the experts.
Apart from the deeply personal nature of Douthat’s narrative, in which we learn of his most intimate thoughts and feelings as well as those of his wife,[1] family, friends, and doctors, the central thread of The Deep Places is the experience of a mysterious illness when the establishment does not recognize its existence. Many readers will come to this book, as I did, with no knowledge of Lyme disease, much less of the controversies surrounding those who claim that it not only persists in chronic form but demands substantial protocols of treatment, including regular high doses of antibiotics. Douthat intends his memoir as a direct contribution to those debates; he hopes to persuade you, as he was unable to persuade countless medical experts, that chronic Lyme is real, debilitating, and worthy of serious scientific consideration. About that claim I have nothing to say. Freddie deBoer has written a respectful rejection of Douthat’s diagnosis. I simply take for granted the truth of Douthat’s testimony. Either way, readers will make up their own minds on that score.
The larger question that Douthat raises, though, is not about Lyme at all. It is about the authority of experts, the ambiguities of science, and the uncertainties intrinsic to medical knowledge.
No question could be more apt for our time. And perhaps the bravest feature of Douthat’s account is his willingness to reveal just how “crankish, paranoid,” and just plain weird the chronically ill — including Harvard-educated NYT columnists — are willing to become if only for some measure of relief. What Douthat would have us consider is what establishment consensus looks like through the eyes of someone failed, ignored, or mocked by that same establishment. Imagine being on fire, grabbing a firefighter, and asking for help, only to be told to lie down and sleep it off. It’s only in your head becomes just another way of telling a woman to stop being so hysterical. (Douthat’s reflections on the long-standing dynamics of mostly male doctors treating patients — disproportionately female — who are seeking relief from undiagnosed pain are nuanced and deeply felt). When the gatekeepers of normality keep slamming the door in your face, eventually you give the abnormal a try. When the center isn’t holding, you turn to the fringes. You start to experiment on your own.
Douthat’s own experiments proved a sort of training ground for pandemic debates. As 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.”
On one hand, Douthat was primed to take the virus far more seriously than some of his fellow conservatives; on the other hand, he was disposed to treat medical authorities with some suspicion, to take long-haulers seriously, to sympathize with those who tried unapproved home remedies, even to stick up for (if not to agree with) the conspiracy theorists and anti-vaxxers. He didn’t need to attempt to put a human face on such persons. He already knew their faces, had seen them in numberless waiting rooms and doctor’s offices. His own could have been — might yet be — one of them.
Commenting on the controversy over hydroxychloroquine, Douthat concludes:
It was a case study in a larger pandemic–era theme: the gulf between the confidence in institutions that the media, especially, wanted to shore up, and the much messier reality. Trust the science, people said throughout, often as an understandable response to Trump’s constant stream of bullshit, but the slogan kept running aground on the reality that official science is filtered through fallible institutions, politicized processes, and bureaucratic incentives, which throughout the crisis were amply on display.
The upshot is not epistemic anarchy, where expertise is irrelevant and authority redundant. The point, rather, is that all human knowledge is fragile, including the scientific, and reality always pricklier, and therefore less subject to our mastery, than we wish. Scientists and doctors are perhaps especially liable to the felt need, emotional as much as it is psychological, for the world to make sense: for every symptom to have an explanation, every condition a diagnosis, every question an answer, every complaint a prescription.
Furthermore, expert authority depends on the bonds of social trust, and trust will be in short supply when the grounds for trust have eroded. Treating skeptics and doubters as fools, cranks, and crazies is not the way to halt that erosion, much less to build back trust. There is finally no bright line between the enlightened and the unenlightened. The fraternity of pain is universal; the solidarity of support, total. We’re in this together. Which means that separating the sheep and the goats by degrees of implicit acquiescence to fallible and sometimes demonstrably dishonest institutions is neither prudent (as policy) nor warranted (on principle).
The reminder is timely. We too need a humbling. In moving prose and with admirable transparency, Douthat has done what only a memoir can do: persuade through personal witness. Sharing in his story, the reader starts to feel his own scales peeling off, one by one.