The Wisdom To Know the Difference

Looking for serenity in Ross Douthat's "The Deep Places"

I’ve been meaning to write something about Ross Douthat’s memoir of his struggles with chronic Lyme disease ever since I read it, and I worry that the powerful impression it made upon me initially has faded some over the past several weeks. Nonetheless, the first and most important thing for me to say is also the simplest and easiest to recall: read the book. It is a beautifully-written and strikingly unguarded account of an experience an alarming percentage of Americans go through: of chronic, life-altering and incurable pain.

In Douthat’s case, the pain followed an initially-undiagnosed bout of Lyme disease. Though most of those infected respond well to antibiotics, with the disease clearing up relatively quickly, a small but meaningful fraction of those infected by the tick-borne illness remain sick at the end of the normal course of treatment. A fraction of that fraction, but still a significant number of people, never get fully well at all. Douthat is one of these, and the book chronicles his journey into chronic illness, and his quest for an effective treatment that takes him far outside the bounds of mainstream medicine.

The journey goes to deeper places, I think, than the destination, so once again I urge you to read the book rather than rely on this or any other review as a substitute for that experience. I do want to share, though, where that experience took me, because Douthat himself ends in a particular place: convinced that the medical establishment needs to take more seriously the testimony of the afflicted, and to be more open to the “experimental spirit” that he embodied in his own quest for health. Above all, though, he is proud at never having given up the fight.

That, it seems to me, is a very interesting an, in some ways, surprising place for a serious Christian to end up. Indeed, the one encounter in the book in which he receives explicitly Christian counsel—a chance meeting with a Benedictine monk in an airport—points in a very different direction, toward understanding the illness as a gift from God rather than an unmerited punishment. If accepted, it would lead him to a deeper place—and anyway, the faithful shouldn’t expect earthly rewards but rather heavier crosses to bear. As Douthat himself acknowledges, what he took from that encounter was not really what was offered; rather, he took the conviction that he must be doing important work to face such a demonic attack, and doubled down both on that work and on his efforts to overcome his disease and get well.

Now, bear in mind, I’m not a Christian—I’m Jewish, and my Judaism is, itself, a thing of shreds and patches—so I’m not making any claims to authority here or even to knowledge, really. Nor do I want to be glib here. I imagine I would be an absolutely awful patient, and an absolutely awful partner to my wife, if I were similarly afflicted. Impotent rage and despair seem as far more likely themes for me than stubborn determination, to say nothing of accepting suffering as a divine gift. Frankly, I found myself admiring Douthat’s determination. I just also found it, inevitably, bound up in a kind of faith, but a faith that fundamentally Promethean, a belief in the human ability to understand and overcome the material constraints of our world. Indeed, I became increasingly convinced that the most important purpose of Douthat’s experimentation was precisely to shore up that faith.

Freddie DeBoer wrote a warm but highly critical review of The Deep Places that pressed hard on that faith from a particular angle, one that is skeptical of the very existence of chronic Lyme disease as a “thing.” DeBoer’s skepticism is powerfully informed by his own experience with mental illness, and the damage done when someone refuses to accept that they have a disease of the mind. I take his point, but I feel no need to evince a similar skepticism of the physicality of Douthat’s condition, because I am very willing to accept that there are things that medical science doesn’t understand, and that chronic Lyme might be one of them.

Nothing follows from this, though, except compassion. Just as it does not follow that, because medical science doesn’t understand something, therefore it doesn’t exist, it also doesn’t follow that because medical science doesn’t understand something, therefore some outsider practitioner does understand it, or at least has a glimpse of the truth about it. Nor does it follow that self-experimentation is likely to yield positive results. In fact, the positive results that Douthat himself experienced from multiple different outsider treatments were frequently evanescent, with actual healthfulness only returning very slowly over a long span of time. It’s not unreasonable at all to wonder whether anything he did had any real effect—whether the treatment, if not the disease, was all in his head.

In a more generous column about Douthat’s book, Megan McArdle tells her own story about mysterious illness by way of explaining why she isn’t so skeptical of Douthat’s own account. Years ago, McArdle suddenly came down with an alarming condition that caused dizzy spells, nausea, and other symptoms that proved immune to treatment but became increasingly debilitating. Unlike Douthat, McArdle didn’t go wandering off into the para-medical wilderness, because she was inclined to believe it was all in her head. Except it wasn’t. Five years into her misery, entirely by accident, a new doctor discovered that her symptoms were a side effect of a blood pressure medication. Once she was off the medication, she got entirely well. So now she wonders how much more quickly she might have gotten better had she been less willing to accept her fate, more determined to fight for her health, as Douthat has been.

I applaud McArdle’s empathy, but I think her story serves more as a contrast than as a comparison. No practitioner operating outside of the bounds of medical science would have discovered her problem, unless it happened by accident (for example, if a holistic healer told her to stop taking all medications), much as it did in the doctor’s office. And once the discovery was made, the results were dramatic and instantaneous. If Douthat had, after five years of suffering, discovered that the problem he thought was chronic Lyme disease was actually a reaction to a medication he was taking, I imagine he wouldn't have written his book at all. If he did, it would be an extremely different one.

Again, I want to be clear. I’m not saying that knowledge is only advanced through normal scientific channels that go from grant to peer review. I’m very willing to acknowledge the host of ways in which the actual practice of science, which is a human endeavor, suffers from the pathologies of every other human endeavor. Moreover, pioneering scientists have been known to experiment upon themselves from time to time, and they do sometimes advance understanding that way. They also sometimes kill themselves. (As a pre-teen, my son enjoyed a book on the subject that laid out some examples from history in awesome and, frequently, gruesome detail.) I just don’t think that’s an accurate description of what Douthat was doing. Some of the things he tried strike me as harmless, while others strike me as downright risky—but regardless, Douthat is not a scientist. He struck out beyond normal medical bounds not because he thought he had found something no one else had thought of, but because he needed, more than anything, to try. I don’t begrudge him that at all. I’m just not clear what kind of medical establishment could reasonably endorse or even countenance that kind of thing without also countenancing outright quackery.

What they could do, though, and which Douthat also asks for, is be much better at acknowledging that he was having “a human experience.”

I put the phrase in quotes because it’s a line from Dave Chappelle’s much-discussed comedy special, “The Closer.” It’s from late in the show, when he’s telling the story of Daphne, a transgender woman comedian, with whom he formed a close bond. Recounting a long dialogue with her about her identity and its meaning, Chappelle eventually came to the point where he blurted out that he doesn't understand a thing she’s talking about. And Daphne, as he recounts it, responded: I don’t need you to understand me. I just need you to believe that I’m having a human experience. Chappelle, whether you agree with him or not and whether you think he’s making the point honestly or not, readily gives her that, because he takes that to mean: I don’t need you to affirm me, just to recognize me.

Why, though, would I bring up Dave Chappelle and transgenderism at this point? For this reason. The medical establishment’s attitude toward transgenderism has undergone a considerable sea change in the last decade or two. Aggressive treatment for gender dysphoria has gone from the margins, where many people seeking relief from deep and profound pain had to turn to practitioners outside the medical mainstream for treatment, to the center. The heart of that sea change has been to far more dramatically foreground the self-reported feelings and self-described needs of patients as a guide to treatment.

There are people who applaud that shift and people who are highly critical of it and plenty of people in between. I count myself as one of the in-between types, glad that suffering is taken seriously and that treatment is far more available, but also worried about a culture that wants turnkey answers to deep questions, and that is uncomfortable with discomfort and pain, and how that plays out in doubtful cases. I don’t actually know what Douthat’s views are on the subject of medical treatment for gender dysphoria, but he is deeply invested in treatment of chronic Lyme disease—he wrote a book about it—and it does seem to me that what Douthat is asking for with respect to people suffering from chronic Lyme disease bears some resemblance to what transgender individuals were asking for: that doctors should take their self-reported condition more seriously and be more willing to support experimental approaches even if they pose real health risks if that’s what the patient feels they need. I’m curious whether he sees the force of the comparison.

The so-called serenity prayer asks for three distinct virtues: serenity, courage and wisdom. The first two—serenity to accept the things I cannot change, and the courage to change the things I can—are hard to muster but easy to describe. The third one—the wisdom to know the difference—is the truly tough nut, precisely because what we’re talking about is wisdom as opposed to knowledge. How to make a decision whether to fight or to endure when you don’t and can’t simply know which is appropriate—that, it seems to me, is a gift of a whole other order from a virtue plainly fitted to task. If there were a simple heuristic—trust your doctor; trust your pastor; trust the little voice inside of you—then it wouldn’t really be wisdom at all.

Douthat found a great deal of courage in the course of his illness. I get the sense that, by the end, he had found some serenity as well, inasmuch as he has come to accept that “getting better” is the best he’ll do, that “wellness” in the sense of having no further after-effects of his infection may be more than he will ever achieve. That’s a serenity we all have to find eventually, as from hour to hour we ripe and ripe, and then from hour to hour we rot and rot.

I hope, and am curious to learn, what wisdom he gleaned as well.