Politics Foreign Affairs Culture Fellows Program

Ross Douthat’s Faith in Pain

The breadth of psychosomatic illness has yet to be charted, and we are all to some degree vulnerable to this sort of dis-ease.

The Deep Places: A Memoir of Illness & Discovery, by Ross Douthat (Convergent Books, 2021), 224 pages.

Ross Douthat is a superb writer. He is such a good writer that he is employed to think, out loud, thoughts contrary to the mood of the New York Times that employs him. In The Deep Places, a memoir of his own illness, he writes so well that you believe in chronic Lyme disease. The trick is that “believing in” chronic Lyme—believing it is caused by persistent, invisible infection refractory even to lengthy, varied, and potent courses of antibiotics—is different than believing that Douthat and others are suffering. 

The conflation of the two is, viewed uncharitably, the deliberate project of many advocates, a goal that if achieved will garner more resources, status, and attention. Viewed more compassionately, it reflects an entirely human desire to make sense of suffering. 

It is not always fair and usually unkind to review an author’s personality. All memoir risks this criticism. But with one type of memoir, meant to argue for the author’s own understanding of his suffering, this critique is inevitable. We could not be good readers for Douthat if we didn’t take his argument seriously. He says he didn’t write this book to entertain or mystify: “I don’t want readers to come away from my account thinking that chronic disease of any kind is just a mystery, a mind-body phenomenon beyond scientific ken. Which means that I want to present myself as a fundamentally reliable narrator.” And towards the end: “What they [chronic Lyme patients] are asking—what is entirely reasonable to ask in the face of so much suffering—is for doctors not to simply wash their hands of us, but to instead embrace the experimental spirit that chronic sickness seems to obviously require.”

The facts of his story seem to mirror that of many similar sufferers. He moves with his family to a farmhouse in Connecticut, the historical center of Lyme disease. This move is financially and psychologically stressful. He becomes progressively ill, with a constellation of symptoms that are visible mostly to him. Initially doctors can’t find much wrong with him on tests and send him to a psychiatrist. The psychiatrist listens to his story and suggests he has a tick-borne illness. This prompts referrals to more doctors, including specialists in chronic Lyme.

Though no definitive evidence of Lyme disease or significant tissue damage is found (they do eventually find a different organism called Bartonella on testing), his treatment escalates until he is self-dosing multiple prescription oral antibiotics along with more exotic treatments ordered online, adjusting these day by day to match the manifestations of his symptoms, while undergoing antibiotic infusions at intervals. Eventually Douthat buys a Rife machine, which reminds him of Scientology’s e-meter, and which promises to use specific electromagnetic frequencies to destroy illnesses (there are special settings for Lyme, another for coronaviruses). He does see some benefit from these treatments, describing an interesting process of acquainting himself with his body, a learning of his pains and symptoms: pain here means take this dose of that drug. Towards the end of the book, he also gets long Covid, which he can somewhat relieve by listening to an audio file on Spotify, an “anti-Coronavirus/COVID-19 frequency.” 

Douthat is such an honest writer that he cannot help but leave bread crumbs. His mother had a similar story, he says: “chemical sensitivities and debilitating inflammation that had sent our family down a lot of strange paths.” He grew up knowing about Lyme disease and married a woman who had Lyme-stricken friends, though he avers that as a teen he believed that Lyme was “serious but usually not that serious.” He had what seems like a premonitory episode six years before the fateful move, “a period of odd headaches, pain in my neck and back, that after a few inconclusive doctor’s visits had simply vanished, unexplained but attributed, shruggingly, to the stress of my new life and the commute.” Perhaps most ominously, he has a family history of a much rarer and more lethal tick-borne disease—a relative died of Powassan virus. 

One possibility—and to his credit Douthat hints at this in describing his talks with doctors—is that someone with the narrative skill to make conservative arguments palatable to the New York Times might be exceptionally skilled at making the case that his own suffering isn’t psychosomatic. Therapists have a phrase for this: “well defended.” A cynic might want to know whether Douthat continued to achieve great things through all of this. He explains that he “performed normalcy, curating the self that I exposed, editing all the darkness out,” while apparently his friends remarked that his columns remained good. At one point he writes that he is unsure how in the midst of his terrible sickness he dug out a pit six feet deep in which to install a generator, but dig it he did.

That narrative skill tugs the reader through an arc, from a sort of casual equipoise to involvement in his affliction toward belief in his diagnosis and acquaintance with the more outre theories of Lyme’s origin (such as Plum Island and biowarfare). Douthat sketches a fair and accurate picture of the history of Lyme. He notes believable reasons for believing in chronic Lyme, the boundaries of science, the trouble with bright line criteria. 

He shifts his expectations of the reader as he goes. All the way through Chapter 3, he is still mostly describing symptoms phenomenologically. When he takes the doxycycline, “the pain inside me changed.” By Chapter 5, he is using etiological language, mostly trusting that he has won his audience over. Pain when he takes antibiotics is a “Herxheimer,” the objectively unverifiable reaction that the chronic Lyme community believes represents massive die-offs of Lyme spirochetes. The Herxheimer reaction, for better or worse, might stand in for two very different ways of viewing the disease entire: intensely present to the patient but not particularly verifiable by an outsider, either stigmata that proves your illness or an example of frustratingly circular logic in which feeling worse buttresses an evidence-free treatment plan. 

If that shift in expectations has worked, if he’s successfully brought you along, you’ll be in the first camp, or at least sympathetic to the first camp. This is a good book and challenging, and chronic mysterious illness, whether due to obscure infectious causes or obscure psychological causes, or maybe Cuban beam weapons, is a signal problem of the age. 

If he hasn’t brought you along—if you believe, like me, that the breadth and depth of psychosomatic illness has yet to be charted and that grace and honesty and good humor, which Douthat has in abundance, are not a perfect shield against it, that we are all to some degree vulnerable to this sort of disease—this is still a vital book to read. Though several other prominent media figures have similar controversial and difficult-to-verify sickness, you will not read a better structured or more humane narrative than this soon. 

Peter Robinson is a physician and assistant professor of neurology at the Ohio State University.