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Leave Society
by tao lin
vintage, 368 pages, $16

The Deep Places: A Memoir of Illness and Discovery
by ross douthat
convergent, 224 pages, $26

Emma Eckstein was a bleeder: She liked to bleed. She wanted to empty herself out into the world. She was sick and dying, because that was what she desired.

This isn’t my interpretation; it’s the analysis offered by her doctor, one Sigmund Freud. Emma was one of Freud’s first patients, but she was also his student, and for a while she was the first practicing female psychoanalyst. The Ecksteins were a talented family. Emma’s brother Gustav was a left-wing ­intellectual; Trotsky would describe him as “one of the noblest figures in the international family of socialism.” Another brother, Frederick, was a Theosophist; he studied music with Anton Bruckner, and spent his own time delving into the secrets of the Knights Templar and learning jujitsu. A sister, Theresa, was a leading feminist; in 1919, she was one of just a few women in Austria’s first freely elected parliament. But Emma was different. Her world, the world of wealthy Jews in Vienna at the end of the nineteenth century, might have been the most ­intellectually fecund environment in human history, but Emma shrank away. She was constantly tired; her body hurt. ­Sometimes she had difficulty walking, or even getting up off her couch. She had terrible ­menstrual pains, and they came with great gouts of blood.

Freud’s diagnosis was hysteria: There was nothing medically wrong with her; the problem was in her mind. Patients with hysteria might spasm or freeze up; they would make bizarre stereotyped movements or find themselves incapable of getting out of bed; sometimes they would suffer intense, specific pains jumping around their bodies, for which there was no known physical cause. Still, there might be a physical solution. At the time, Freud was influenced by Wilhelm Fliess, a quack doctor who’d identified a hidden connection between the sexual organs and the cavities of the nose. In 1896, Freud handed Emma over to Fliess, who elected to remove one of the turbinate bones inside her nose. The operation seemed to be a success—but Emma wouldn’t stop bleeding. Constant hemorrhages, and an endless stream of foul-smelling discharge pouring out of her nose.

For Freud, this was just another confirmation of his theories. He wrote in a letter to Fliess:

I know only that she bled out of longing. She has always been a bleeder, when cutting herself and in similar circumstances; as a child she suffered from severe nosebleeds; during the years when she was not yet menstruating, she had headaches which were interpreted to her as malingering and which in truth had been generated by suggestion; for this reason she joyously welcomed her severe menstrual bleeding as proof that her illness was genuine. . . . She experienced this as the realization of an old wish to be loved in her illness, and in spite of the danger during the succeeding hours she felt happy as never before. . . . She became restless during the night because of an unconscious wish to entice me to go there, and since I did not come during the night, she renewed the bleedings, as an unfailing means of rearousing my affection. She bled spontaneously three times, and each bleeding lasted for four days, which must have some significance.

But despite Freud’s attempts to work through his patient’s hidden desires for him, the bleeding didn’t stop. Eventually, he called in another doctor to take a look at Emma’s nose. Probing around inside her nostrils, the doctor found something like a thread. He tugged at it, and then “before either one of us had time to think, at least half a meter of gauze had been removed from the cavity. The next moment came a flood of blood. The patient turned white, her eyes bulged, and she had no pulse.” During the first operation, Fliess had accidentally left a long strip of surgical gauze inside Emma’s skull. The flesh around it had rotted; that was the source of the stinking discharge. Freud had to leave the room when the gauze came out; he famously couldn’t stand the sight of blood. When he returned, Emma was weak, but alive. “So,” she said, looking at the queasy, shaken doctor, “this is the strong sex.”

Freud understood that he had made a catastrophic mistake. He had all his letters from Fliess burned. His own side of the ­correspondence moldered away for nearly a century, until the letters were finally rediscovered in the mid-1980s. And their publication set off a storm that still hasn’t died down.

By then, the legacy of Freud was already crumbling. The psychological professions had taken a turn toward neuroscience and brain chemistry; new drugs were opening up the prospect of actually curing sick people without having to ask any awkward questions about their mothers. And in the humanities, Freud was increasingly a target for feminist critique. Feminists were, understandably, not particularly happy with his concept of penis envy, which seems to present woman as basically a species of castrated man, formed around an essential feminine lack. But in particular, critics took aim at the theory of hysteria. By the 1970s, hysterical symptoms were being recast as acts of protest or resistance to male domination—or, as Elaine Showalter put it, a “specifically feminine protolanguage, communicating through the body messages that cannot be verbalized.” In The Newly Born Woman, a poetic work of psychoanalytic theory, the feminist philosophers Hélène Cixous and Catherine Clément hashed out a form of “hysterical engagement.” The hysteric is

the one who resists the system, the one who cannot stand that the family and society are founded on the body of women, on bodies despised, rejected, bodies that are humiliating once they have been used. And this girl—like all hysterics, deprived of the possibility of saying directly what she perceived—still had the strength to make it known. It is the nuclear example of women’s power to protest. . . . I see the hysteric saying “I want everything.”

For Cixous and Clément, the hysteric isn’t simply ill. She’s still saying something—speaking a desire in blood rather than words. But now, the message isn’t about some personal insecurity; it’s a profound statement on the subordination of women. The sickness is in the world. Cixous and ­Clément wanted to embrace hysteria rather than treat it—they were still working within the structure of ­psychoanalysis, in which an illness is always a sign, and one that isn’t always directly understood by the patient herself. But once Freud’s letters to Fliess were published, that kind of analysis started to fall into deep disrepute.

After all, Emma was a woman who knew that she was suffering from a very real physical illness—but instead of listening to her, the doctors decided she was crazy. They told her it was all in her mind. And they were wrong.

What’s more, the Eckstein case began to be associated with another controversial decision on Freud’s part. In his early work with hysterics, he had encountered something very troubling: Again and again, as he probed into his patients’ pasts, they started describing scenes of childhood sexual abuse. Initially, this formed the basis of his unfortunately named “seduction ­theory”—the idea that mental illnesses were produced by a repressed traumatic experience in childhood. Then, a few years later, he suddenly changed his mind. Now, the memories of abuse were themselves hysterical symptoms: fantasies, coded expressions of desire. For Freud and his followers, this was the moment psychoanalysis fully emerged as a mature science—but now, it seemed like something much darker. Could Freud simply not imagine that a good, liberal, bourgeois ­Viennese father might have molested his child? Was the whole of psychoanalysis just one vast, century-­long cover-up? Why was he unwilling to believe the victims?

Cixous never managed to reclaim hysteria for feminism; today, describing a woman as hysterical is widely considered far more offensive than simply calling her a bitch. Already in 1977, Jacques Lacan could ask: “Where have they gone, the hysterics of yesteryear? Those amazing women, the Anna O.s, the Emmy von N.s? What is there now to take the place of the hysterical symptoms of long ago?” What’s replaced them is a new consensus. Forms of suffering that once were dismissed as hysterical have become recognized as actual diseases: fibromyalgia, myalgic encephalomyelitis, chronic fatigue, chronic pain. We still don’t fully understand what causes these illnesses, and we’re still working out how to treat them. But now we’re much less likely to tell a woman who’s bleeding to death in front of us that, actually, it’s all in her head. We know now that when someone says she’s ill or suffering, or that she’s been hurt, our first duty is to believe her.

But the 1980s saw another major discovery of something previously hidden. Around the time Freud’s letters were revealed, it emerged that untold thousands of children had been subjected to monstrous ritual abuse—by devil-­worshippers at daycares across America, and by their own Satanic parents. At one daycare, children were made to mutilate birds; at another they drank Kool-Aid laced with human blood. One babysitting service was actually a front for something called the Brotherhood of the Ram; elsewhere, a ­developmentally delayed babysitter had forced children to participate in the ritual sacrifice of a giraffe. All of this had to be true, because hundreds of victims were themselves speaking out. Feminist activists and the religious right joined forces to fight off this evil, under a simple and powerful slogan: Believe the children. Over the course of the next few ­decades, more than twelve thousand ­cases of ritual abuse were reported. ­Hundreds of people were arrested and charged; some were convicted, plenty saw their lives destroyed in other ways. But in the end, not one of those accusations turned out to be reliable. It had all gone very ­badly wrong.

What if Freud was onto something after all? Julia Salazar is a state senator from New York, and I have quite a lot in common with her. We’re both on the socialist left and we’ve both been on Chapo Trap House; we were even born within a few months of each other. We’re also both Jewish—although there’s been some controversy on that point. At the start of her election campaign in 2018, Salazar described herself as an immigrant from Colombia, a Jew of color who had grown up in a working-class environment and had to get a job at fourteen to support her family. But as the campaign wore on, parts of this story started getting unstuck. For one, Salazar was born in the United States. In an interview, her brother said that they had not grown up working-class, but in a nice four-bedroom house in suburban Florida, and her mother insisted that though her children did have weekend jobs, she never relied on them to pay the bills. ­Salazar now describes herself as a convert to Judaism, and I’m very happy to have her. But in the past, she ­variously claimed that her father was descended from Spanish Jews forced to flee to the New World, or that her grandfather was Israeli, or that she was raised in a Jewish household—and according to her family, not a word of this is true.

I’m telling this story not because it’s significant in itself—political figures have always fudged their ­biographies—but because it provoked a fascinating response. Most commentators were split along the usual partisan lines: Socialists defended Salazar; liberals and conservatives sharpened their knives. But BuzzFeed’s Eve Fairbanks saw something of herself in the ­story. In an essay titled “Well-Off ­Millennials Are All Julia Salazar. I Wish We Weren’t,” Fairbanks describes her own affluent childhood, ­surrounded by friends who all felt the need to claim immense suffering. One girl “convinced the whole grade she had a fatal degenerative lung disease and that her parents beat her.” In fact, “the disease was made up, and she came to school early to sneak into the theater greenroom to apply costume-­makeup bruises to her neck and arms.” Others claimed to be Palestinian or Latin ­American—“not of heritage, but fully”—despite having “never left the Upper East Side as children.”

This is a strange kind of suffering. Usually, pain should be the raw material of solidarity—but here, it distinguishes you from everyone else, so you can “claim uniqueness in the form of obstacles.” Fairbanks notes the deep perversity of the American college application system, the way it encourages you to spin a tale about all the nightmares you’ve endured. She describes a friend in South Africa who grew up in genuine crushing poverty, but realized that to get a place in a U.S. doctoral program she’d have to totally debase herself, pour out all her abjection, or else she’d lose the neediness contest to a bunch of rich white Americans.

Fairbanks doesn’t exempt herself from this dynamic, either:

I got sick that year, the same year I began to have an apprehension of my privilege. I was born with an esophageal malformation that was successfully corrected with surgery at birth, but I began to tell the other kids at school that I had been born without an esophagus, or that it was made out of plastic. The fantasy became real: I began to have torso pain; I was hospitalized when I struggled to eat.

A century ago, we had a word for this kind of thing: It was hysteria. But that word doesn’t appear once in Fairbanks’s essay; it’s no longer a concept in our critical toolkit. Without it, we’re left in a difficult position. What really struck me about Fairbanks’s essay was how harsh its conclusions were. In the absence of a concept like hysteria, she has to conclude that her pain and suffering and hospitalization were really just a form of lying. All she can do is moralize: The people who present the symptoms of hardship when there’s nothing physically wrong with them should just stop doing that. “It cruelly disadvantages even further the real immigrants from Colombia.” And this is true. But the concept of hysteria actually allows you to form a much more sympathetic read on the ­situation. It says that the suffering is real, even if the plastic esophagus isn’t. And in this situation, simply telling people to stop lying is monstrous—like telling a person with anxiety to grow a pair, or a depressed person that he should just cheer up.

We are living in an age of ambient unwellness. You need only look at how many products are out there promising to make you better. ­Nootropics to enhance your cognition, supplements for your bones and your skin and every one of your organs. Microdosing to enhance your creativity; therapy, of course, for your traumas. New and better sleep regimens. Unearthly powders and goos to replace all the actual food in your diet. Everything invites you to optimize yourself. The entire self, body and mind, isn’t just the thing you are: It’s a kind of machinery, something to be fine-tuned and set to work. The dream of a fully frictionless existence, a world of highly efficient cyborgs. Because if you’re not perfectly productive, if you let up for even a moment, you must be sick: The forces of decay will swallow you whole.

The chronically ill person is a negative pole, the hidden shadow of this cyborg utopia. While the rest of us are in our manias of productivity, millions of people are imprisoned in their homes, stranded with terrible pains that have no identifiable physical cause, or exhaustion that can’t be cured by rest, or a fog that blots out the mind. Chronic fatigue and fibromyalgia are existential illnesses. The human body simply refuses to work: It ­announces itself in a way that can’t be ignored. Maybe it’s casting its own terrible veto on the sickness of the world.

But I’m not so sure that these symptoms are, as the feminists of the 1970s would have it, simply acts of protest. (They’re also certainly not exclusive to women.) The bevy of new unexplained chronic ­illnesses seems to send the same message as everything else, just in a slightly different register. You are sick. You are broken. You need to get well. And when you have a discourse that’s fanatically focused on ­believing the sufferers, affirming their own understanding of what’s happened to them, all you can do is add your voice to the chorus. You are sick. You are sick. You are sick.

Tao Lin’s novel Leave Society is about a man who wants to be well in a world that’s making him sick. When the protagonist, Li, was a teenager, his lungs repeatedly collapsed; for years afterward, he experienced regular “bolts of pain in and around his heart.” In his twenties, he was addicted to speed, benzos, MDMA, and opiates; he also suffered chronic pain in his back, “as if the chest pain hadn’t left, just migrated and evolved.” When we meet him, he’s given up the drugs (except for weed and psychedelics), and he’s finally come to realize that “his body wasn’t defective; rather, his society was damaging.”

Much of the novel consists of Li’s online research into the ways modern society is killing him. For instance, the steel staples in his lungs could be hosting pathogenic biofilms, which cause “cognitive impairment, processing abnormalities, and memory problems.” There’s the constant hum of electromagnetic radiation all around him, from phone towers and WiFi, leading to “cancer, diabetes, arthritis, inflammation, rabies, headaches, leaky blood-brain barrier, DNA and ion-channel damage.” He learns about anions, “air vitamins,” electrically charged molecules given off by plants. “He read that forests, mountains, seashores, and waterfalls had tens of thousands of anions per cubic centimeter, countrysides had a thousand, city parks five hundred, city streets fifty, air-conditioned rooms zero to twenty-five, and that below a thousand impaired cognition and slowed physical recovery.” The air he breathes is dead and empty; it’s been drained of its ability to nurture life. So is the processed food most people eat. So is the ­entire world.

Li starts obsessively noting his own mental state, whether he’s calm and happy, or upset, or disturbed. He changes his diet: lots of red meat and home fermentations and ghee. At one point, he decides to cut out starchy grains; when he eats some rice a few pages later he experiences unbearable pain. Li spends long paragraphs expanding on his counter-history of the world. Once, we lived in egalitarian “partnership societies,” worshipping the sacred feminine and living in harmony with nature. But then there was a catastrophe: the Younger Dryas impact, a devastating comet twelve thousand years ago. In the resulting chaos, “dominator society” swept out of the steppe, with its masculine monotheistic God, its love of violence and subjugation, and its plasticky, highly processed foods. This is the society Li is ­trying to leave, by ­embracing a gentler and more natural way of life—although some of his remedies are more successful than others:

One night, Li bought six capsules of cayenne pepper from a tea shop. He’d never used cayenne on a headache and was eager to try. In the library, he swallowed two capsules at a time with chamomile tea. At 5:52 p.m., minutes after ingesting all six capsules, he stood with increasingly troubling pain. He entered a bathroom, sat on a toilet, put his glasses on the floor, and held his head, moaning. He vomited reddish water.

When I first read Leave Society, I assumed that this was a very enjoyable and deeply ironic text, a subtle, brilliant critique. Li is desperate to make himself well, but everything he does pushes him deeper into the neuroses that are clearly, clearly, ­patently what’s making him sick. Outside his family, Li has no friends. Every year, he travels to Taiwan to spend longer and longer periods with his parents, and impose his healthy lifestyle on them. He orders his father to stop taking his statins and his mother to drop her thyroid medication, and gets furious when they keep taking them anyway. He’s absolutely right that our society is broken and poisonous, but he can’t see how he’s reproducing that same brokenness in his attempts to get rid of it.

But most readers don’t agree. The person who recommended the book to me described it as “militantly unironic.” The New York Times concurs: “There is no irony in Leave Society.” Li is, like all Tao Lin’s characters, a very thinly veiled version of the author himself; the story he tells is his own. I’m not sure it matters. The critique is there.

The Deep Places is a memoir of the writer Ross Douthat’s struggle with chronic Lyme disease. In 2015, Douthat decided to move his family from Washington, D.C., to New England, where he grew up. Out of the swampy city, into a boulder-strewn ­Arcadia. “Land, beautiful land.” They bought the house and started planning their beautiful new life. And then Douthat was struck by a ­mysterious and debilitating illness. Years passed. He did not get better.

Douthat is a very different kind of writer from Tao Lin. He’s a firm Catholic and a solid conservative. He is, as he puts it, the guy who does things: in other words, not the hysterical type. He likes the countryside, but he doesn’t worry too much about whether he’s breathing enough anions. Tao Lin’s great nightmare is about society, an artificial world that’s veered dangerously off the right and natural path. But the early portions of Douthat’s book read like a horror story—a good one—about nature. As in so many horror stories, we start with a happy family who move house and find something monstrous waiting for them. But it’s also about the eeriness and peril of the natural world, the pagan cruelty of the earth and its creatures. On the day Douthat and his mother go to inspect his new home, just before he decides to make an offer, he sees a family of deer darting through the estate. Bucolic. The next day, his mother phones to say that she’s seen another deer, standing outside her own house. She’d never seen a deer there before. It’s telling her, in the silent language of the animals, a terrible secret.

Later that week, when she was working in the same area, just where the deer had been standing, she almost stepped through a thin sheet of rusted metal, flush to the ground beneath a thin layer of soil. When she lifted it, there was an opening into a frighteningly deep void or cave, maybe left over from some empty fuel tank or septic ­system—an empty space in the hillside, a dark and earthy pit.

Soon after, Douthat wakes up with a swelling on his neck. A boil, his doctor tells him. Then headaches, chest pains, gagging. He can’t breathe. He thinks he’s having a heart attack. Over the weeks and months that follow, he starts living under a “weight of pain.” And as his illness p­­rogresses, Douthat’s ­landscape becomes witchier. He comes to realize that he hasn’t planted himself in ­Arcadia, but in a fickle and uncertain world, “where white shingles and ­carefully mowed backyards meet the shadow of the woods.”

The woods in New England are populated by deer ticks, and the ticks are infected with spirochetes—bacteria that cause Lyme disease. The most visible sign of a Lyme infection is a bright red rash that appears around the tick bite, sometimes followed by headache, fever, fatigue, joint pain, and partial paralysis. Symptoms usually last a few months—but sometimes, people claim to experience them for years on end. Chronic Lyme shares many symptoms with chronic fatigue and fibromyalgia, but there are two crucial differences. Firstly, there’s no mystery regarding its origins. Fibromyalgia and chronic fatigue are placeholder diagnoses; they’re a way of saying that a person is in a lot of pain, despite the fact that there’s no apparent physical problem and no obvious cause. In some cases, the disease seems to be psychogenic, linked to stress or grief; there’s a suggestion that it might be triggered by viruses, environmental toxins, or mold. Beyond that, we simply have no idea. We’re not even sure that everyone with these diagnoses is suffering from the same thing. But people with chronic Lyme know exactly what’s happened to them: The spirochetes are still breeding inside their bodies, making them ill.

The other difference is that, according to an overwhelming medical consensus, chronic Lyme does not exist.

The doctors’ reasoning is simple: People who claim to have chronic Lyme do not test positive for Lyme disease. The active spirochetes are not in their bloodstreams. Often, doctors will tell patients that they’ve misdiagnosed themselves: Actually, they’re suffering from fibromyalgia or chronic fatigue. This is, when you think about it, a strange thing to say. You think you know what’s wrong with you, but actually you don’t—and we don’t either. So maybe it’s not surprising that patients seek out alternatives. Online, there’s a whole community of sufferers sharing their forbidden knowledge; there are even chronic Lyme influencers, people who hawk theories and treatments with their selfies. Sometimes these treatments are bizarre. One of the biggest recent trends has been the use of bee venom; people will deliberately sting themselves with bees every morning to ease their symptoms. But mostly they just want antibiotics, and the doctors refuse to prescribe them. Long-term antibiotic use is dangerous. It’s been linked to cancer and heart disease—and chronic illness.

But Douthat insists that his condition is real. The descriptions of his suffering are raw and brutal, and deeply affecting. It’s not just the pain itself, but the way the pain burns all the normal comforts out of his life, “a heavy ashfall blanketing the ­experience of food and drink and natural beauty.” At one point, an old friend turns up at his lonely anchorage with beer and pizza, and though Douthat is “almost pathetically grateful,” the visit is still a burden: the agony of having to be normal, to talk and eat pizza while your body is screaming.

But perhaps even more evocative than the physical pain is the story of what happened to Douthat’s mind. At their local library, his wife sees an exhibition on chronic Lyme, “including a photo shoot of gaunt, lost-looking patients, some of them surrounded by hundreds of prescription bottles.” He decides never to let that happen to him; at first, he’s deeply wary of even some mild antibiotics. He is a rational person; he wants to prove that the sickness is not in his head. But when nothing ­eases his pain, the pill bottles on his bedside table proliferate. Antibiotics of increasing strength, plus “a spreading, multiplying army from the ­Nature’s Bounty aisle in the local pharmacy, that did not entirely inspire confidence that I was keeping my sanity intact.”

Douthat starts “chasing the Herxheimer.” A Jarisch-Herxheimer reaction is a response to a mass die-off of pathogens in the bloodstream: As the bacteria die they release toxins, which can cause fever, inflammation, and searing pain. Douthat blasts himself with antibiotics, and when he feels deeply unwell afterward he takes this as proof that the medication is successfully attacking the infection. (His response is a little different from the usual Herxheimer symptoms; for him it is “like being a marionette whose strings were suddenly jerked,” a sudden spasm of itching and rubbing. He doesn’t mention inflammation.) He gets the same response after a session with a strip-mall therapist, who tapes magnets to various parts of his body. He buys a Rife machine, an invention that promises to treat illnesses by generating sonic frequencies at the pathogen’s “mortal oscillatory rate.” He sets the machine to the frequency that’s supposed to kill the Lyme spirochete, turns it on, and immediately starts Herxing. At one point in a church, he adds his own plea to the Ave ­Maria: “Holy Mary, mother of God, intercede for me in your mercy, that I may be healed of this disease, freed of this sickness, and restored to health . . .” Right there in the pews, he starts violently twitching, as if the cell membranes of a thousand spirochetes had suddenly broken down all at once.

There’s an excellent joke in an early episode of The Simpsons. Miss Hoover, Lisa’s teacher, has been in the hospital with Lyme disease; one day, Lisa comes to school to find that she’s returned. The teacher explains:

MISS HOOVER: You see, class, my Lyme disease turned out to be psychosomatic.

RALPH: Does that mean you’re crazy?

JANEY: No, that means she was faking it.

MISS HOOVER: No, actually it was a little of both.

The point of Douthat’s book is to persuade a skeptical reader that he is neither crazy nor faking it—and I’m probably about as skeptical as they come. Still, reading his story did make me question some of my preconceptions about unexplained chronic illnesses. My view has long been that we’ve massively overcorrected: Once, doctors callously disregarded the patients they were supposed to be helping; now, we act as if sickness itself gave you a special insight into your own condition. Today, the whole language of the self is delivered in the chattering cadences of the hysteric. But in The Deep Places, Douthat shows that maybe things haven’t changed as much as I thought. It’s easy to get a certain impression of the wider social attitude to chronic illness when it isn’t happening to you—when all you have to go on is online discourse (“Your illness is valid!”) and the complete works of Freud. But time and again, Douthat comes up against a medical establishment that seems hell-bent on “ignoring, denying, and diminishing the scale of suffering taking place all around them.” They see a man in pain, and all they offer is cognitive behavioral therapy and antidepressants.

And yet, Douthat does find doctors who will give him the anti­biotics he wants, against all medical guidelines; one of them even hooks him up to an IV. (It doesn’t work.) His pill collection keeps growing. In the end, I think my attitude to Douthat’s illness is the same as my attitude to a painting of his God on the cross. I find the suffering deeply moving, and I think it’s been powerfully and beautifully represented. But there are things Douthat believes about what this all means, and I simply do not share his faith.

The chronic Lyme community, Douthat writes, is full of a “questing spirit,” an “openness to experiments and personal experience and unlikely sources of wisdom.” This is something I’ve always loved about epistemic minorities; it’s why I’m so fond of Flat Earthers and Hollow Moon theorists and every kind of crank. But there is one interpretation he flatly rejects: the idea that his illness might have some psychological cause. “What kind of stress-induced illness,” he asks, “would manifest itself at a moment of apparent triumph, a successful real-estate transaction and literal dream-come-true escape?” I think this kind of incredulity is unworthy of a thinker as subtle and ­nuanced as Douthat. Our psyches are murky, ambivalent, and often set against themselves; they can will several things at once, good and bad alike. Here, I think, Freudians and Catholics agree. The thing you most want in the world might be the site of profound anxieties, and every triumph is also terrifying. (I had a similar experience years ago, when I moved out of my parents’ house and into a new flat overlooking the Thames. I was overjoyed. For days afterward, I felt terrible pains and a deep, pulsing hollowness in my stomach; cold stabs of worry.) Turmoil in the soul is very, very powerful. It can change you in ways you would not expect.

We know, from Douthat’s own account, that at no point did he ever actually test positive for Lyme disease. We know that the pain moved erratically across his body, hour by hour, in a way that is not consistent with any known bacterial infection. We know that his symptoms changed dramatically when he was in heightened emotional states. Why is the idea of a non-physical origin so unacceptable? Why is he willing to try magnets and Rife machines, but never psychotherapy?

In his own review of the book, Freddie deBoer—a left-wing writer who’s spoken openly about his psychotic episodes—­invites Douthat to consider what “his anger at the suggestion . . . says to someone like me.” Personally, I wonder if Douthat might be another victim of the decline of hysteria: If it’s not the spirochetes, then he must be, like Miss Hoover, either crazy or faking it or both. One way or another, it’s all in his head. But the point of hysteria is that it’s never all in your head. In his letters to Fliess, Freud makes a startling ­connection:

My brand-new prehistory of hysteria is already known and was published a hundred times over, though several centuries ago. . . . The medieval theory of possession held by our ecclesiastical courts was identical with our theory of a foreign body and the splitting of consciousness.

Hysteria is a kind of demonic possession. As Cixous and Clément and the other post-Freudians understood, it’s not that the psyche itself is defective—it’s that we have been cast into a defective world. Outside forces inevitably reproduce themselves inside the mind; everyone ends up adopting some kind of hysterical position at some point in his life. As it happens, I am not the first person to offer Douthat this interpretation. Early in his illness, he runs into a friend, a ­Benedictine monk, who gives him some advice: “You should expect to get some ­demonic attacks from time to time.” This monk might have had a point.

To be clear: I am not saying that I know what caused Douthat’s illness. I’m not saying that unexplained illnesses are purely psychogenic. It’s entirely possible that next year there’ll be some medical breakthrough, and we’ll finally understand the exact physical processes that lead to chronic fatigue and fibromyalgia and, yes, chronic Lyme. But until that day, I worry that we might be passing over the notion that the values and ­structures and injustices of our society are bad for us. We validate specific pains and symptoms, and ignore the ways in which a damaged world has made being ill the only way of being a person. I wonder if we’re not performing Emma Eckstein’s disastrous operation in reverse.

Sam Kriss writes from London.

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