The Deep Places, Ross Douthat’s tale of living with Lyme disease, reads more like a horror story than a memoir. The burning, flaring pain of his disease is a sort of possession, sending him herky-jerky dancing through his attic. But the treatments to keep his suffering in check are even more unsettling — he relies on a secreted-away, mail-order machine that pulses electricity through his body.

It’s a book that feels a little dangerous to read, like the dusty tome that the protagonist of a ghost story picks up, learning a story of suffering that begins to escape the book and spill into the reader’s life. A small twinge as you shift position while reading might be the first sign of impending illness; you look at your arm, wondering if that freckle was always there or if it might be moving.

The release date of Douthat’s book is a few days before Halloween, but it’s not really intended for read-alouds at midnight by candlelight. His memoir is intended for the clean, well-lit rooms of doctors’ offices, for the cheerful felt-poster walls of churches pledged to the prosperity gospel, for families who hike with no need for tick checks. The book is a warning — nowhere is safe from suffering, and American culture ill prepares us for this reality.

Douthat’s chronic Lyme dances on the border of medical respectability. Though forms of the disease are recognized, his experience and attempted treatments provoke skepticism even from his own “Lyme literate” doctors. The book is not a medical handbook, and Douthat would probably be banned from YouTube and Twitter if either site policed fringe Lyme discussion by the standard they apply to COVID theories.

But when you fall out of the purview of mainstream medicine and your suffering persists, you have no alternative other than to sift through the fringes. I was driven there by my family’s losses. I have been pregnant eight times, but only two of my children have survived the first trimester. Miscarriage, like Lyme, exists on the border of ailments treated as real. If you fail to fit into a clear diagnostic category, medicine quickly shows you the door while discouraging self-directed research.

Douthat intends the book for a broader audience than Lyme patients or other people with a chronic, disputed illness. The seemingly stable are on shakier ground than they think, and the boggy deep places of the edge aren’t as alien as they appear.

At the fringes of medicine, exploration is done by anecdote. The app­roach isn’t so far from science as the FDA and the CDC might insist. In 1984, Nobel-winning gastroenterologist Barry Marshall prepared a concoction of H. pylori bacteria and drank it like a shot. He was out to prove that stomach ulcers were not simply a psychosomatic manifestation of stress. There was a physical cause, he bel­ieved, and his subsequent ulcers (confirmed by gastroscopy) were his proof. It takes a physical culprit for someone to have hope in a physical solution, not just a pat on the head and a command to “heal thyself.”

Like Marshall, Douthat and fellow sufferers are both experimenters and experiments. Despite being disclaimed by mainstream medicine, they have a strong faith in our capacity to cure. Every tube of ivermectin picked up from the veterinary store, every course of long-haul antibiotics prescribed by a “Lyme literate” doctor, every hormone panel and ultrasound paid for out of pocket is a pledge that medicine can relieve your pain. It’s just a question of pushing hard enough to find the answer that has been concealed by neglect or conspiracy.

In some ways, Douthat’s striving for a cure is a transposition of the same meritocratic story that he was living out before he fell ill. His wife, Abigail Tucker, is a New York Times–best-selling author; he was a wunderkind pundit — when he was hired as a New York Times columnist, he was the youngest person to fill that role. When his descent begins, he and his wife are preparing to “graduate” from a cramped home in Washington, D.C., to a spacious home in the Connecticut suburbs. On the morning that Douthat first notices a possible tick bite, it is overshadowed by his wife’s positive pregnancy test.

Douthat has been a public skeptic of the meritocratic mindset, suspicious of the way our modern elites’ confidence in their own striving erased any sense of noblesse oblige. But he admits the idea is too deeply rooted not to mark him, too.

The meritocratic American dream is one of transcending need or vulnerability. Money cushions scarcity and shocks, social status eases you past the lines or red tape, education and accomplishments quiet any sense that these gains might be fragile. The gig economy makes it easier to fill in any gaps, to the point where the elite might look askance at Christ’s proclamation that His Father “sendeth rain on the just and on the unjust.” Surely we are just one disruption away from resolving that bug in Creation.

But the sesame-seed-sized creature that bites Douthat is enough to shatter those beliefs. He receives a hard consolation from a Benedictine monk he encounters in an airport. Douthat asks the monk for prayer, and begins to sob as they talk. The young monk, speaking with love, warns him that the answer to his prayer may not be the one he wants to hear. “[Suffering is] a gift. It’s not something just to wish away or run from. It’s there for purgation, refinement, redirection if you’ve wandered onto the wrong path. And if you’re on the right path, doing important work — well, then you should expect to get some demonic attacks from time to time.”

Douthat grasps at this encounter as a possible turning point in his story, holding most tightly to the monk’s final words. Suffering might be one more hard thing to triumph over — the moral version of meritocratic testing. For a Harvard graduate like Douthat, the idea of being rewarded for passing one test with the opportunity to take a harder, more exclusive test can’t be unfamiliar. Instead of going from SATs to McKinsey interviews, he’s offered a different challenge: to progress from professional success to spiritual triumphs.

Written at the remove of years, Douthat’s narration of his misadventures is a mixture of fond and rueful. His voice is the most immediate when he narrates his own pain, which does not leave room for analysis or self-regard. In describing the quieter mom­ents between attacks, he speaks at more of a distance, one that he won through sacrifice.

Douthat chooses a battle that suits the shadow meritocracy of suffering: a theory of disease that suggests that pain, when deliberately chosen, can be exchanged for deliverance. It’s just a question of whether you’re tough enough to make it through the vale of tears. He navigates by the “Herxheimer reaction” — an agonizing feeling triggered by the death of microorganisms within your body. The idea that this reaction is a positive sign is a heightened version of the logic that many symptoms of disease are caused not by the pathogen but by your body fighting it. Be grateful for the fever — it’s your body getting into the fight. As the Lyme communities suggest to Douthat, “because a treatment makes you feel sicker it must be working.”

It’s a dark reflection of the Christian ideal of redemptive suffering. Douthat plunges in, chasing the pain, buoyed by the hope that his agony is happening on his terms. He feels that his strategy wins him some ground and enhances the effectiveness of more conventional treatment. But he still takes a step back from his initial hunger for Herxheimers, whose spasms leave him haunting his own family home, mixing doses of herbs and other alternative medicines in the middle of the night. “Without a way to know for sure how far to go, or when to turn back,” he writes, “the worse the better can be a dangerous philosophy.”

In my own miscarriage support groups, other mothers followed a similar, understandable logic. For women like me who had no obvious cause for our children’s deaths, hope might take the form of a blood test for a rare clotting disorder, a restrictive elimination diet, drinking a suspension of ground stone from a shrine to Our Lady. For the most part, I held my own line against these temptations to do more.

I never found a solution to my miscarriages, though I delivered a baby girl in 2020 and expect to deliver another daughter in 2022. I did nothing to earn our escape from ultrasounds where the tech falls silent and refuses to show you the screen. Our losses were not tallied up and exchanged for these days of joy. My education helped me navigate (and sometimes route around) hostile or indifferent doctors, but I could not pile up the PubMed papers I read until their weight was enough to exchange for six pounds, six ounces, of squirming infant.

Douthat has more reason to believe he plays an active role in his own escape, but his slow recovery is the fruit of both effort and grace. He finds that the relief of Herxheimers is triggered not just by medical concoctions but by petitionary prayers to his confirmation saint. Like a deep-sea diver, he rises slowly, adjusting to life in shallower water, but with each victory, he has no guarantee that he will ever rise any further. He has still never broken the surface to return to his sun-dappled, pre-Lyme life.

Instead, he settles into a harder hope — that a partial recovery might be enough for a life worth living. During his season of spiritual healing, he and his wife weigh whether to have a fourth child. When he settles into a pew to pray, he is “probably asking not just for healing but for a kind of permission and support.” The question lingering over his family is what is enough to have in hand in order to have a child.

The meritocratic story is one of careful responsibility and self-sufficiency. My own pregnancy-tracking app lists “Open a 529” as no less a part of preparing for birth as “Experience Braxton-Hicks contractions.” Douthat and his family take a leap instead. There is no guarantee that his health will fully recover, no guarantee that their finances, damaged by selling their house at a loss, will be restored.

He doesn’t give up on the possibility of healing, but he loses faith that his body, his house, and his family can be defended and made safe in the way any father might hope. Relinquishing that imagined prize — the ultimate graduation from vulnerability — is the choice to let go of an illusion.

If suffering is not guaranteed to be solvable, then our answer cannot be limited to encouraging victims to develop their own strengths and experts to develop their own cures. Douthat doesn’t want to abandon any of those tools — if he were choosy about his weapons, he would not have traveled so far into the medical fringes. But his book is a plea to see illness and pain as a broader field of combat. He suggests it is “a war in Sun Tzu’s sense — not just a science, but a difficult, interesting, experimental art.” Accompanying a loved one through the valley of the shadow of death is a plunge into uncertainty.

When all our best-designed tools and talents are exhausted, what remains is the willingness to enter into the suffering of others, without the power to ameliorate it, simply with the power to prevent it from being undergone alone.