When, in the spring of 2019, I moved to rural Massachusetts to be with my soon-to-be fiancée, the first thing I learned to do was look for ticks. Before you went inside, you checked—arms, legs, any exposed skin. Sometimes they came in on our housemate’s dog; once, my wife plucked one from the housemate’s scalp, then stored it in the freezer in a Ziploc bag. If the housemate began to run a fever, or break out with a bull’s eye rash, the doctors could test the tick for Lyme.
Every year, half-a-million Americans contract Lyme disease. Reported cases have grown since the 1990s; originally endemic to New England (it is named for Lyme, Connecticut), Lyme has begun appearing across the Midwest and as far afield as Alaska. For most patients, Lyme is unpleasant—fever, chills, headaches, the usual—but not life threatening. A few weeks of antibiotics, and they’re back to their old selves.
For anywhere from 5 to 20 percent, however, symptoms persist for months, years, or a lifetime. The majority of physicians label this phenomenon "Post Treatment Lyme Disease Syndrome" and attribute it to immune overresponse, prior chronic illness, or psychosomatic response. But a minority, believers in "chronic Lyme," maintain that the Lyme-inducing B. burgdorferi have wriggled deep into muscle tissue, hiding in "cysts" and "biofilms" that evade antibiotics and the immune system.
It is into this peculiar pathological dispute that New York Times opinion columnist Ross Douthat fell headfirst when, in late 2015, he began to experience symptoms he came to believe were caused by chronic Lyme. Douthat’s new book, The Deep Places, is a moving, engrossing memoir of his multiyear battle with the ailment and the depths to which he went to return to health.
Douthat’s story begins with a family move to the bucolic Connecticut countryside. A tour of a well-appointed home is followed, some days later, by a red lump on his neck. An urgent-care doctor dismisses it as a boil, but further symptoms come: sudden, shifting pains, tremors, a clouding of the mind. His D.C. doctors blame it on stress and suggest psychotherapy. But when Douthat decamps to Connecticut, he meets dozens of others with similar symptoms, and physicians who assure him he has Lyme disease.
Douthat sets about to cure himself through increasingly strange measures: massive doses of antibiotics, strange herbs and tinctures, magnet therapy, and the "Rife machine," which promises to vibrate pathogens apart. He is eloquent in his defense of the reality of his disease, scrupulous in documenting his many attempts at cures, heartbreaking in the detailing of his young family’s struggles, and characteristically intelligent in his probing of the deeper significance of both his own sickness and the medical establishment’s unwillingness to recognize it.
The Deep Places is at times an effective apologetic for chronic Lyme. Douthat highlights the scientific research still in its early days and tells stories of fellow sufferers, who seem only to find relief from months and months of antibiotics that so many doctors want to deny them. The case is particularly persuasive set against the COVID-19 pandemic and the medical establishment’s revealed inadequacy.
But of course, the story is more complicated, and there are real reasons physicians are skeptical of chronic Lyme. There are the ever-changing symptoms patients report, which often, one researcher put it, lack "the objective clinical abnormalities that are well-recognized in Lyme disease." There is the fact, as writer Freddie deBoer noted in his review, that chronic Lyme patients take both feeling better and feeling worse after antibiotic doses as proof of their illness—an unfalsifiable position. There are the large, controlled studies which show that the months of antibiotics that chronic Lyme patients are subjected to mostly do not seem to yield improvement. (There are, of course, retorts to all these points, and Douthat makes them.)
It is not as though, after all, people cannot have powerful symptoms without an underlying physical problem. The chronic Lyme controversy recalls the early aughts debate about Morgellons, an alleged disease whose symptoms included crawling sensation, painful lesions, and strange fibers growing from the skin. Patients insisted they were suffering horribly, but a CDC study found the fibers were likely just from clothing, and the lesions a product of scratching, brought about by delusional parasitosis. Perhaps confirming that it was all in their heads, the most vocal Morgellons sufferers would go on to blame their illness on medical conspiracies and chemtrails.
Morgellons was almost certainly psychosomatic, spread by the internet from one sufferer to another. One worries about a similar phenomenon in the chronic Lyme forums that Douthat admits to frequenting. (Amusingly, chronic Lyme researchers have taken to arguing that Morgellons is actually… chronic Lyme.)
The purpose of the preceding is not to indict or discredit Douthat. Rather, it is to counterpoint the perfectly correct concerns he raises about what doctors regularly get wrong. It really is possible that the entire medical establishment is completely, comprehensively wrong about chronic Lyme, leaving thousands to suffer unnecessarily—they’ve done it before. And it really is possible that Douthat and others like him wasted years and endangered their lives self-medicating for an illness that does not, strictly speaking, exist.
It is obvious what Douthat believes. But his position on the chronic Lyme debate is not, at root, what makes The Deep Places worth reading. Rather, it is best as a memoir of chronic illness, an investigation of how we cope with suffering when that suffering has no name.
Douthat begins the book emphasizing his good fortune: a prestigious job, the wife and children he always wanted, a beautiful home in the country. Despite his past critique of meritocracy, he admits, he feels that there is something right about this, that his goodness, really his godliness, and his success go hand in hand.
But the thing about illness, including chronic illness, is that it can happen to anyone. Poor fortune of course correlates with medical risk, but the great and good are no less susceptible to disease and deterioration than the poor and foolish. Sickness, like death, is the great equalizer.
So when Douthat is brought low, the uncertainty of his diagnosis reflects the injustice of his leveling. The factual ambiguity of his diagnosis is a mere index of a more fundamental uncertainty: Why does a loving God let bad things happen to good people?
Douthat, of course, is a prominent believer—two of his prior books, and many of his columns, are about religion. But his public belief is often cerebral, speaking with a sociologist or theologian’s voice so as to be heard by the Times’s disproportionately irreligious audience.
The religion in The Deep Places, by contrast, is a struggle of the heart and the stomach far more than the head. Douthat puts genuine faith in the saints—and even a few departed family members—to restore his health. The book’s most affecting scene finds Douthat, his baby son in arms, crying out to God in pain on the beach near his childhood home. In response, a single sand dollar washes up, a sign—or maybe not.
While Douthat came out of his experience with a profound certainty about the cause of his symptoms—a certainty set against established wisdom—The Deep Places is most powerful when it shows Douthat at his least certain, his most abject, at once struggling with and seeking solace in God. The book’s title repeats a motif found throughout the text, of "going under" in both illness and the search for its cure. But it is also an allusion to Psalm 95, a meditation on God’s power, which demands both adoration and fear.
Why does a loving God let bad things happen to good people? The Deep Places only can gesture at answers. But it is a deeply moving portrait of a man forced to ask that question, not merely academically but with his whole mind and body. That alone recommends it.
The Deep Places: A Memoir of Illness and Discovery
by Ross Douthat
Convergent Books, 224 pp., $26
Charles Fain Lehman is a fellow at the Manhattan Institute and a contributing editor to City Journal.