The Deep Places (memoir)
By Ross Douthat
Status: Finished on 01/03/2022
Rating: 3/5
Reactions
- Ross Douthat is an extremely good writer.
- I was not convinced that Douthat had chronic Lyme disease, though he is conscious of all the reasons I am skeptical. I think it’s very possible that he does have chronic Lyme, but I also think it’s possible that his condition is psychosomatic or that he has some other disease.
- I don’t think he explains why his disease being psychosomatic would be so unlikely or why that notion is so offensive to him.
- This book is very persuasive about:
- Not being too deferential to the medical establishment;
- Be willing to put your care into your own hands and self-experiment;
- Be empathetic to people suffering from chronic disease; and
- Recognize that any one of us can become sick at any time.
- The core memoir is in the first six chapters. These chapters were very good, but the final four chapters dragged for me.
Summary
Overview
After buying their family dream home in Connecticut, Ross Douthat develops a mysterious disease. The symptoms are varied and bizarre, often involving extreme pain in different parts of his body. It is a debilitating condition that does not seem to improve with treatment. He eventually comes to believe that that he is suffering from chronic Lyme disease. This puts him into conflict with the medical establishment, who are skeptical of the existence of this condition.
Chapter 1: A Dark Wood
Before moving to Connecticut, the Douthat family lived in Washington DC. Having grown up in the northeast, both Douthat and his wife, Abby, felt nostalgic towards the setting of their childhood homes. Douthat in particular had romantic notions of how returning to Connecticut would fit within the broader narrative of their ultra-successful lives. Almost immediately upon entering Connecticut, Douthat notices a red swelling below his left ear. In the subsequent days, his life as a sick person begins. As he comes to suspect Lyme disease, his attitude towards his “dream home” darkens. His Lyme endemic surroundings seem less idyllic and more hostile.
Chapter 2: Controversy
Douthat covers the controversy surrounding the history of chronic Lyme disease. Most doctors believe that the bacteria causing Lyme disease will not survive a short-term course of antibiotics. Most people recover within a few weeks. The symptom profiles of those who claim long-term symptoms are nondescript, so doctors are skeptical that they are suffering from a common condition. More likely, chronic Lyme disease represents a large number of conditions, some physical and some psychosomatic. The clinical implication of this disagreement often comes down to the use of long-term antibiotics. Believers in chronic Lyme think the bacteria is still present and must be treated with antibiotics. The medical establishment is skeptical of the benefits of antibiotics, and is concerned about both side effects and the population risks from antibiotic resistance.
Chapter 3: The Secret of the Suburbs
Douthat’s personal commitments to being “reasonable” lead him to initially be deferential towards the medical establishment. However, as his condition fails to improve with standard treatment, he becomes overtaken with anxiety and desperation. He explores alternative treatment, including with doctors willing to prescribe long-term antibiotics. His obsession with his condition burdens his relationships, particularly with his wife. He becomes prone to emotional outbursts, often moved to tears, even in front of strangers. The public nature of his illness fosters connections with the broader world of chronic Lyme. It seems that everyone he meets either has some personal experience, often through a loved one, with the condition. He perceives a disconnect between the scientific consensus and the external world of mass suffering from long-term Lyme symptoms. Unfortunately, his intimacy with the chronic Lyme community inspires little optimism, as even those who receive alternative therapies often take many years to recover, if they ever recover at all.
Chapter 4: The Country of Suffering
Douthat reflects on the “How Bad are Things” Slatestarcodex essay, which describes both the commonality and hiddenness of suffering in our world. There are a large set of problems that us healthy people would see as unfathomable disasters if they happened to us. Statistics say that these things are actually happening to people all of the time. The fact that many of us cannot see these problems is likely a result of both the narrowness of our social bubbles and people being secretive about their own suffering. Douthat discovers that his own illness helps expose the world of suffering around him. Douthat reflects on how his faith helps him cope with his suffering. In his conception of god, good people should not expect to be sheltered from the lessons suffering has to offer. Still, he begs for god’s help.
Chapter 5: An N of 1
Given his illness, Douthat and his family decide they cannot maintain their dream home, decide to put it back on the market, and move to a more urban (DC-like) part of Connecticut. Working with a maverick doctor, Douthat begins experimenting with a huge variety of high-dose antibiotics. His doctor is careful to document the process, requiring frequent bloodwork as they experiment with introducing new medications. But Douthat takes initiative to be more aggressive. On his own, he supplements with additional antibiotics from old prescriptions, international pharmacies, and pet stores. He feels that, within an hour of taking a pill, he can usually understands what works, and can quickly move past unsuccessful experiments. He reflects on the limitations of the conservative evidence standards of the medical establishment, and celebrates Gwern-like, do-it-yourself, experimentation.
Chapter 6: Excavations
Contrary to their expectations, the Connecticut home does not sell. They repeatedly lower their price and eventually switch realtors. Finally, they accept an offer at a big loss, but then run into lots of red tape. There is a propane tank buried in the yard that they are required to remove. The messy removal efforts discover an entirely separate tank, that is corroded and disgusting. The process of tearing up the yard in an effort to salvage the property’s sale is a metaphor for Douthat tearing into layers of his illness through round-after-round of treatment. Effective cures scratch deeper and painfully remove layers of flesh along with the disease.
Note: I found Chapters 7, 8, 9, and 10 to be much less connected to the main narrative. At this stage, the house is sold and Douthat’s original illness does not have much further progression. The memoir component of the book is largely over. I found Chapters 1 through 6 much more interesting than Chapters 7 through 10. I think the book could have ended at the conclusion of Chapter 6, and if as a reader you have felt that you’ve had enough, I encourage you to stop after this passage.
And so we had one final day of closing negotiation where they pried an extra $1,000 out of us. Then it was finished. For our finances, the deal was a catastrophe. For our lives, our marriage, it was the narrowest of escapes. The new owners are hunters. I think they might actually shoot the deer.
Some part of me, the storytelling part, hoped that my symptoms would depart once the house was sold. That having divested ourselves of our prideful mistake, we would be rewarded with relief. That having accepted providence’s shove onto a different path, we would find the way suddenly smoothed. That didn’t happen. The peeling, the slow exfoliation, the excavation, continued as before. But my relationship with New England did change for the better. Once we were planted in the city again. Once we bought a new house with an enclosed backyard and sidewalks all around, the countryside became tolerable again.
On weekends, we would drive with the kids deep into the Connecticut country. Up the old roads that I remember from my youth. Looking out at the fields and forests, I no longer felt the loathing for the landscape that I had felt in the depths of my imprisonment. Some days I could almost recall the attraction I once felt to white shingled houses standing in tall grass. To red barns buried in forsythia. To the meadow of one’s own. To the romance of the land. But I was still looking at this vistas from a distance. With a bottle of pills still pressing in my hip pocket. And always I could see what lay behind them. The woods and the darkness. Cool and enveloping. And deep.
I certainly felt less engaged after this point, which will be reflected in the brevity of summaries of subsequent chapters.
Chapter 7: Where the Ladders Start
This chapter focuses on Douthat’s experimentation with unconventional therapies. Many of these do not work, but he does buy-in to the effectiveness of Rife machines. Rife machines produce low electromagnetic energy waves. There are specific frequencies for specific diseases, including Lyme disease. The Rife machine makes Douthat’s wife, Abby, very irritated. As always, Douthat is self-aware. He acknowledges that his perceived relief from the potentially-dubious Rife machine would seem to lend credit to his condition being psychological. Yet, he is convinced that his condition is not psychosomatic and seems confident that the Rife machine really works.
Chapter 8: The Island
This chapter covers conspiracy theories about the origins of Lyme disease. Some people think Lyme disease was a biological weapon originating from a laboratory on Plum Island, off the northeast corner off Long Island. This lab was close to the epicenter of the Lyme disease epidemic. Yet, this seems wrong, because the Lyme epidemic started before the establishment of that laboratory, and it does not explain why there is a separate epicenter of the disease in the Midwest. Neither Douthat or almost anyone else seems to think these views are credible.
Chapter 9: Pandemia
Douthat’s experience with Lyme disease led him to take the COVID-19 pandemic seriously from the beginning. He stockpiled early and used masks despite the early (later recanted) public health guidance advice against mask-wearing. Still, he ended up contracting the disease anyway very early in the pandemic, as did much of his family. They had a tough time with the disease, but eventually all recovered. Douthat reflects on how the pandemic and long-COVID in particular, led to greater empathy for mysterious chronic illness among medical professionals.
Chapter 10: The Permeable Body
This is a concluding, largely abstract, chapter. Our bodies are vulnerable to mysterious disease and the medical establishment does not have all of the answers. This leads to a war against an antagonistic menace from within. This risk affects all of us. The good news is that, at least those with non-terminal illness, there is hope for improvement. Douthat ends with a plea that the medical establishment take chronic illness seriously and try their best to help.