I’ll never forget something a friend and former pastor wrote years ago, as he was dying. Mark had been an active and robustly healthy man in his 50s before the cancer diagnosis. But his decline was swift. One of the things he was coming to realize, he said, was that he had always weathered physical illness with the assurance that he’d recover quickly, that the pain would pass, that he’d be back on his feet after a couple days.
But this time was different. This fast-moving and terminal cancer meant that each day, until the last one, would be more difficult and painful than the one before. He wasn’t ever going to “bounce back,” and the consolation of knowing that he’d soon feel better was not to be afforded him again (at least in this life).
I was in my early 30s when I read those words, and it was a bit like receiving a report from a country I’d never visited—or even thought much about. I rarely contemplated my body, because it had always done exactly what I asked of it. I’d only infrequently considered future weakness or long-term illness or death because my default setting was wellness (or, at least, if I was temporarily sick, speedy restoration of health). Only in the years since have I come to realize that it’s quite likely I’ll one day spend time in the country Mark was describing. Ross Douthat’s new book, The Deep Places: A Memoir of Illness and Discovery, gave me an armchair tour of that country.
Suffering Is Ordinary
There’s an irony at the heart of The Deep Places. On the one hand, it’s a tale of extraordinary suffering and unusual (sometimes bizarre) attempts at healing. In his years-long battle with chronic Lyme disease, Douthat—an opinion columnist at The New York Times—desperately grasps for solutions and increasingly resorts to a world of alternative treatments he would once have disdained (he baits the reader at the end of the preface: “I bent to the desk, gripped the metal tubes, and turned on the machine”).
The “deep places” of the book’s title include the radical treatments, the “things associated with cranks and charlatans,” that lie beneath the “solid floors” of medical consensus, and also deep beneath the unusual efforts of “outside-the-consensus” doctors. Douthat encounters (and sometimes employs) attempted remedies that are stranger and weirder. Quite frankly, part of the fascination of this book is watching a superbly educated and highly accomplished member of the intelligentsia descend to places he would never have guessed he’d go.
And yet what makes The Deep Places important is Douthat’s discovery that the suffering he faces is not actually so unusual after all. “There was extraordinary suffering everywhere, people dealing with pain of every variety, with conditions diagnosable and not, that had been largely invisible to me until I came into the country, cleared the filter, and experienced that misery myself” (91).
Neither Douthat’s education, nor his overlapping worlds of journalism and social media (in which healthy and happy online selves are “performed”) had prepared him to understand the depth or pervasiveness of the suffering he encountered among others. Rather, obtaining that understanding required a personal experience of the type of pain “that made your body feel like a cage around your consciousness” (90). In the course of his six-year battle with Lyme, Douthat gradually found a large community of people suffering from chronic illness and pain. More than that, he came to see that significant physical suffering is increasingly normal with age. “For the young, intense physical suffering was a lightning strike; for older people it gradually became the weather” (91). So, Douthat’s chronic pain wasn’t actually unusual—it was just premature. “I was . . . living under a storm front that had rolled in a little early” (91).
Douthat’s chronic pain wasn’t actually unusual—it was just premature.
All of this means that, as wacky and weird as are some of the methods Douthat employed and the people he encountered, his memoir is applicable not just to a few people, but to many. It describes a country to which almost all of us will one day come, because, for many of us, our eventual death will be preceded by increased frailty and enduring pain.
This book is sobering. It ends not with the feel-good news of a full healing, with Lyme in the rearview mirror, but with a mixed report, with the muted but hopeful news that Douthat’s daily physical suffering isn’t as horribly bad as it once was (185). This may be as good as it gets for many sufferers of chronic pain. The subtitle of the book is, after all, not “A Memoir of Illness and Recovery,” as we may have expected. Rather, it’s a book about Douthat’s process of discovery. It’s about living in the liminal world between questioning the consensus and descending into paranoia. It’s about understanding the history and nature of Lyme disease. It’s about discerning the relationship between bureaucracy, science, and the medical establishment. Douthat includes (among other things) a fascinating discussion of the unintended consequences of “diagnostic standardization” (39), a description of how bureaucracy shapes science and the circularity of the medical establishment’s approach (40), and an explanation for why a typical Lyme-skeptic doctor may remain skeptical (71–72).
Douthat himself attempts to chart something of a middle course in his understanding of, and battle against, Lyme. His experience of “illness and bafflement” (69) certainly causes him to question the medical establishment, to recognize its limitations and mistakes, to leave behind the CDC consensus about Lyme by taking long-term antibiotics, and to be open to even more “out-there” treatments and self-doctoring. But it doesn’t diminish his desire to be “intensely empirical and materially grounded” (114), nor does it entirely eliminate his skepticism about some of the more radical treatments (e.g., Reiki healing, bee venom, photon therapy) and conspiracy theories (e.g., Lyme as a bioweapon).
Moreover, as Douthat himself notes, his experimentation with alternative and innovative treatments never caused him to stop taking antibiotics as his main course of treatment (120). That said, Douthat did try vitamin C, capsuled salt, magnetic treatment, and a Rife machine, among other unusual remedies. And he writes this memoir with a clear purpose: to convince readers (including skeptical doctors and experts) that the problem of chronic Lyme is real and that Lyme specialists outside the medical consensus nonetheless “represent a reasonable and empirical response to an extremely knotty problem” (138). Whether his way represents a reasonable middle course or a maverick approach may depend on the eye of the beholder.
Lyme Disease in a COVID World
The book certainly takes on a particularly fascinating resonance in our current COVID world. While the scientific and medical establishments largely deny chronic Lyme disease, they take COVID very seriously. While many dissenters from the consensus deny the seriousness of COVID, it’s the dissenters who tend to take chronic Lyme very seriously (176–77).
Douthat himself had COVID, and overall abatement of his symptoms took about five months. His experience with Lyme primed him to distrust the medical establishment and public health agencies (such as the CDC and FDA) and to be more sympathetic to online, non-expert internet speculation about COVID. While recognizing that some politicians spew a constant stream of COVID-skeptical nonsense, he also wants to recognize that the slogan “trust the science” keeps “running aground on the reality that official science is filtered through fallible institutions, politicized processes, and bureaucratic incentives” (179).
Yet he certainly takes the virus itself much more seriously than do the skeptics (he was an early adopter of strict safety protocols). Perhaps it’s unreasonable to wish that, in a memoir, Douthat had laid out some principles for when, and how, and how much, to question the consensus view of experts (and when doing so becomes harmful and counterproductive). But I do wish it.
Our Own Deep Places
It’s clear that the “discovery” in the book’s subtitle concerns significant medical and public policy issues. But it certainly encompasses much more. For instance, Douthat gives extended and sometimes uncomfortably close attention to his relationship with his own body, something the Lyme clearly compels him to do. The first paragraphs of the book describe a heavy ache in his shoulder, the “pan-fry sizzle” on his hips, the “intolerable vibration” inside his ankles. We catch a glimpse of his “haggard, puffy face” and the transformation of his ample belly, so that, after losing 40 pounds, he looked “skeletal and permeable.”
Not only does Lyme cause him to attend more closely to his body, it also creates an altogether different relationship with his body. Before Lyme, he tells us, his body had almost always done what he had asked of it, without complaint. But with Lyme, it had betrayed him (16). So, this is a book about physical embodiment, and that story is told with unflinching candor.
This is a book about physical embodiment, and that story is told with unflinching candor.
But even more fundamentally, it’s about the discovery of the deep places within. It’s a reflection on how suffering changes us. Before experiencing chronic pain, Douthat thought of himself as “the guy who did things.” He felt 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” (10–11). His faith was a “pretty abstract and intellectualized thing” (95). Lyme changed at least some of that. It created moments of radical self-doubt and showed Douthat his own need to believe in God (97).
At a couple of points, Douthat borrows C. S. Lewis’s memorable image of the unpleasant boy Eustace Clarence Scrubb, who—in order to escape the many layers of dragon scales in which he’s been encased—must allow Aslan, the Christ figure, to cut down deep and tear them off. I think the “deep places” that are most important for Douthat are the inner places within himself. As with the verdict on his physical state at the end of the book, the concluding assessment of his inner person, his own “deep places,” is mixed. Douthat thinks that he’s perhaps now a bit wiser, more patient, more open-minded. He admits that he still carries “many of the same habits and vices and temptations as the me I knew before” (196). But even that way of saying it—with a pre-Lyme “me” and a chronic-Lyme “me”—suggests some significant changes. Suffering has altered him.
This memoir is an honest and insightful reflection on suffering, told in evocative and memorable prose. I’ve already recommended it to a friend struggling with chronic pain. But it certainly has much broader resonance and appeal. As an exploration of embodied life, and of the losses and gains of physical suffering, and of the strengths and limitations of the scientific and medical establishments, it speaks to all of us. And because it’s a description of a place to which many of us will come in our old age, we’ll all do well to learn from its hard-won wisdom.