*Sick: A Memoir*, by Porochista Khakpour

I very much enjoyed this book, which is simultaneously an account of having Lyme disease (and not knowing for a long time), a tale of multiple substance abuses, a look into the mindset of somebody not at all like me, a second-generation Iranian-American memoir, and (unintended) the strongest case for social conservatism I have read in some time.  Here is one excerpt, another application of the intersectionality concept:

It is no coincidence then that doctors and patients and the entire Lyme community report — anecdotally, of course, as there is still a frustrating scarcity of good data on anything Lyme-related — that women suffer the most from Lyme.  They tend to advance into chronic and late-stage forms of the illness most because often it’s checked for last, as doctors often treat them as psychiatric cases first.  the nebulous symptoms plus the fracturing of articulacy and cognitive fog can cause any Lyme patient to simply appear mentally ill and mentally ill only.  This is why we hear that young women — again anecdotally — are dying of Lyme the fastest.  This is also why we hear that chronic illness is a woman’s burden.  Women simply aren’t allowed to be physically sick until they are mentally sick, too, and then it is by some miracle or accident that the two can be separated for proper diagnosis.  In the end, every Lyme patient has some psychiatric diagnosis, too, if anything because of the hell it takes getting to a diagnosis.

And this bit:

I am a sick girl.  I know sickness.  I live with it.  In some ways, I keep myself sick.

You can order the book here.


Lyme disease 10 times more common than thought
300,000 not 30,000

Miss Hoover: You see, class, my Lyme disease turned out to be psychosomatic.
Ralph: Does that mean you’re crazy?
Janie: It means she was faking it.
Miss Hoover: No, actually, it was a little of both. Sometimes, when a disease is in all the magazines and on all the news shows, it’s only natural that you think you have it.

'and then it is by some miracle or accident that the two can be separated for proper diagnosis'

Or maybe just visit a German doctor, where testing for borreliosis is pretty routine, especially if someone says they spend a fair amount of time outside in a natural setting - like walking their dog.

Or, of course, if they have the typical rash - with women being treated exactly the same as men, in my experience.

“Women simply aren’t allowed to be physically sick until they are mentally sick, too.”

Any interest I might have had in a book on this interesting (to me; my mother was bitten several times without contracting the disease while going full “Harrowsmith” in the 70s) topic evaporated upon reading the sentence quoted above.

That was my thought too. I would love to learn more about the planet so many of these "put-upon" women in our society come from and make every effort to not go there.

Yes. No woman in my family got this memo, that's for sure.

Certainly there are individual women where family pressures or an overactive sense of personal responsibility compel them to keep going when they should be in bed resting, but there are lots of men like that too. I don't see this as a particularly gendered problem.

Yes, but the reasons the person has pressure to compel them to keep going will almost always be gendered. This can explain a lot.

+1. The claim you quoted is so patently absurd that the author is probably not a liar who deliberately says something false, but rather a bullshitter who simply does not care whether what she says is true or false, as long as it sounds good. A stroll through any hospital will suffice to confirm that plenty of women are "allowed" to be physically sick without any requirement that they should be mentally sick, too.

The fact that Tyler quotes the passage favorably arguably tells one something about the limitations of his speed-reading techniques.

You're clearly not giving Tyler's comment the Straussian reading it deserves...

My reading of your reading of Tyler's comment is that you're implying that he is implying that the woman is batshit crazy, but he's too polite or too scared to say so. Or something like that. Maybe you're right. Personally I don't think the passages Tyler quoted are worthy of being treated with such Straussian sophistication (if that is what it is), but I guess that's what makes Tyler a genuine gentleman.

"(T)he fracturing of articulacy": a consequence more of Lyme disease or of intersectionality?

Some pernicious contemporary combination of the two?

What pharmaceutic regimen or physical therapy might help dispel the "cognitive fogs" of which we are being warned?

What are the AMA and the CDC doing to combat (or: to institutionalize) diagnosticians' "cognitive fogs"?

There’s a disease apocalypse! Women and children hardest hit!

She shouldn't take it personally. Anyone who has a difficult to diagnose disease with cognitive or emotional effects is treated the same way. Best to have something obvious and mechanical that can be identified and fixed.

>She shouldn't take it personally.

I beg to differ. If she didn't take it personally, she wouldn't have a book, and Tyler would not have cited it, and you would have spent the entirety of your life not knowing that Lyme disease is sexist.

... “is sexist.“

Excuse me, get with the times: it’s “can be discursively framed as intersectional.”

"another application of the intersectionality concept", i.e. finding offense where one can.

Frankly, based on the excerpt above, I don't see at all how the book could be "the strongest case for social conservatism I have read in some time . . ." Based on the excerpt, it would seem to be quite the opposite, i.e. a case against.

I took it in the same way as saying “San Francisco is the strongest case for social conservatism that one could make.” Although maybe Berkeley works better.

A snapshot of a sick society bitterly divided.

This book reminds me of a book about Proust, which attempts to prove Proust wrote literally about his life, and deliberately kept himself ill and speculated with vast amounts of money (millions of dollars in today's money) in the stock market, in order so he could write more authentically. Imagine that! Art imitating life imitating art.

Bonus trivia: a book that attempts to show artists are like scientists and their fiction should be treated seriously is "Proust was a neuroscientist" by a scientific researcher and liberal arts fan, Jonah Lehrer (2007). She makes a pretty good case in profiling various writers, that they were writing about real scientific phenomena (Proust gets mentioned for discovering memory is malleable, and the more you think about something the more it changes, and changes you, which science finds is true).

The book that shows Proust was art imitating life imitating art is: "Proust and his banker,: in search of time squandered" by Gian Balsamo. TC mentioned it about a year ago. I finished about half of it, it got kind of boring after a while, not unlike I think Proust himself (never read him). Proust speculated like a maniac, lost almost all his millions, then, in a stroke of luck, finished with incredible gains just before he died an untimely death (he was into 'patent medicines' and lived indoors too much, not healthy).

Proud doesn't get boring after a while, it is quite the opposite. It is for many (all?) readers very difficult to begin, very boring at first, and the more you read, the more interesting and the less boring it becomes.

Bonus bonus trivia: (a) Jonah Lerner is a he, not a she. (Yes, I know one is not supposed to notice or care about the difference any longer.) (b) memory may be malleable, but mine insists that it remembers that our man Jonah plagiarized other authors, fabricated quotes, etc etc, and what do you know, it turns out my memory was right: https://www.nytimes.com/2016/07/12/books/a-fraud-jonah-lehrer-says-his-remorse-is-real.html

Reading the excerpt, I was waiting for the inevitable conclusion that it is all Trump’s fault. I kept on searching and was not disappointed; this is from a Guardian article on the author:

In the Trump administration, the “mess” has got an awful lot worse, as healthcare becomes more and more limited and increasingly labyrinthine to access; Khakpour, like so many sick Americans and their relatives, spends days chasing doctors, medications and results. “We know what they’re doing, right?” she says, of the attack on the nation’s health. “It serves a very small, elite, Aryan nation subset of the population. But I think more and more Americans are realising that they’re being excluded and excluded and excluded.”

Based on this evidence, I would stick to the original diagnosis of mental illness.

"And it all started on 1/20/2017! Somehow!

God knows none of this dates back to before Trump took the Oath!"

But Khapkour is of Iranian origin, the archetype of Aryan (except if she is from some non-Aryan small ethnic minority in Iran, but I have found no indication of that). She should realize that thanks to Trump, she is more and more included and included and included.

I'm amazed she's found so many American-born doctors to be disappointed by.

Being primitive and superstitious about such matters, I haven't seen him in years but my own doctor was an Iranian with lovely Old World manners.

Healthcare did get worse under Trump. Harder to get and more expensive too. Not saying its all his fault but he does deserve to be called out on things he promised.

Amazing how credulous TC is about "chronic Lyme", which non-quacks agree doesn't exist.


There is no evidence that the syndrome of chronic fatigue, ‘brain fog’ etc has anything to do with B. Burgdorferi. Big European randomized trials have shown that these patients do not benefit from antibiotics.

Whatever they have is real, but to go on pretending that it’s Lyme disease despite all evidence to the contrary is not helpful.

There is, however Post-Lyme Syndrome, which doctors do agree exist. A lot of the times, the things people who think they have chronic Lyme are describing fits Post-Lyme Syndrome, where basically the disease was caught too late and even when there is no more active infection, the damage has been done. Maybe you'll recover from it over time and maybe you won't. It's a sucky thing to have to live with and I guess it's understandable people with it would find themselves grasping at straws.

Largely agreed, but I'd add a couple points. Without question, post-Lyme is real, and sucks. However, many of the people insisting they have "chronic Lyme" have never been properly diagnosed with Lyme in the first place -- or they've instead been improperly diagnosed by unscrupulous "Lyme gurus" who prey on the suffering and the desperate (people with post-Lyme, some other illness, or psychosomatic issues) by giving tests with high false-positive rates or, in some cases, simply making up results. Additionally, many "chronic Lyme" sufferers persist in taking high doses of antibiotics for *years*, in many cases without any real evidence of having ever been infected, and in all cases without any evidence it helps (along with lots of evidence it's harmful). In general, I've found the popular press on Khakpour's book alarming -- for the most part they credulously adopt her framing and fail to articulate the actual science.

Whether you call it "post-Lyme" or "chronic Lyme," it exists. Obviously, my evidence is anecdotal, but I know someone who got Lyme before they even knew it existed. He lived with it for the rest of his life, and the effect on him was obvious. One may argue the possible treatments or etiology, but Lyme can have lifelong effects.

As for Lyme being the last thing doctors look for when a patient appears, it makes perfect sense in most situations, because Lyme and other tick-borne diseases are not common in most of the country or the world. That is changing as the disease spreads, and doctors are learning to test for it early.

"This is why we hear that young women — again anecdotally — are dying of Lyme the fastest."

Ah, the scientific method.

This study indicates that the annual death toll from Lyme's disease (ca. 2001) was bouncing around 23 cases per year.


Lyme disease was listed as an underlying or multiple cause of death on 114 death records during 1999–2003. Upon review, only 1 record was consistent with clinical manifestations of Lyme disease. This analysis indicates that Lyme disease is rare as a cause of death in the United States.

Same place.

There has been quite a lot of research trying to find evidence that doctors don't listen to women, don't take them seriously, don't treat their illnesses. The studies have all tended to come to the opposite conclusion: women complain more, miss work more, and receive more medical treatment than men. But scientific study always yields to political correctness in Tylerland.

Someone will mention "Straussian readings," but Leo Strauss didn't waste his time reading nonsensical junk, so a Straussian reading of something this inane is by nature not Straussian.

I thought the Straussian reading was about why we're more hesitant to deem certain men who suffer "fracturing of articulacy and cognitive fog" mentally ill.

It seems like some commenters should read the post a little more carefully.

I agree. A key word is "unintended".

Are you thinking that the book, and author argue so poorly, or so illogically, that Tyler finds the argument persuasive for the opposite side, namely social conservatism? That seems at odds with his claim to have enjoyed the book and the illumination provided by its viewpoint.

Maybe I am mistaken, but yes, I think that's exactly what Tyler means by "and (unintended) the strongest case for social conservatism I have read in some time".

Then, I see that this is at odds with the tone of the rest of the message, but I mean, the passages that Tyler quotes, and the other passages of the book quoted in comments, are as bad as it gets it the world of contemporary leftist prose. They are full of clichés (the Aryans, for God's sake!), of ridiculously false statements, asserted with a moaning tone. The book really seems to me one of the worst ever discussed on this blog. I can't imagine that Tyler really liked it in the first degree, and recommend it seriously.

From the New Yorker piece referencing this book that I glanced at awhile back, it sounded like a woman who believes she's suffering from chronic Lyme, would resent a diagnosis of chronic fatigue syndrome. Interestingly, chronic fatigue syndrome itself was once the diagnosis that its sufferers felt, in tears, was met with scepticism and lack of support. I have heard women on the neighborhood forum mention chronic Lyme ("seeking best doctor with chronic Lyme experience"), but it is now eclipsed by something called Hashimoto disease.

Twenty years ago, lupus was in the air as the difficult-to-diagnose affliction among women. You don't hear about lupus so much anymore. Perhaps they can treat it now? Or they got a more accurate test for it?

Judging from the series of memoirs of which this is the latest, the medical profession has retreated to a mind/body distinction.

*Of course I know that lupus and all these things are real, please don't misunderstand - it's just interesting to me that their frequency in women's conversation varies over time.

I'm going to assume, with his unquenchable thirst for reading, that TC is familiar with the CDC's reports from the last couple years that tickborne illnesses are rising, and there are terrible new strains that lead pretty quickly to chronic death, without regard to intersectionality.*

*Not for the world meaning to disparage the important work being done in the field of intersectionality.

ut it is now eclipsed by something called Hashimoto disease.
Twenty years ago, lupus was in the air as the difficult-to-diagnose affliction among women. You don't hear about lupus so much anymore. Perhaps they can treat it now? Or they got a more accurate test for it

Hashimoto's is a discrete problem with the thyroid which you can detect with ultrasound. Not sure what sort of treatment there is for it or what problems it causes, but there are cases they just monitor because the practical problems are scant.

I had a lupus sufferer in my family. When she was looking into it 25 years ago, her doctor tells her its a waste to pursue the matter, "It's difficult to diagnose and almost impossible to treat". She got another doctor who sent her to a rheumatologist who had her on an extensive medication regimen. Don't know if all the pills did her a blessed bit of good.

I assume Cowen's reference to "social conservatism" is distinguishing social conservatism from economic conservatism. One can be a social conservative and not an economic conservative, and vice versa. Indeed, that is often the case. Of course, many if not most of today's young people are not socially conservative but they are economically conservative. Is the glass half full or half empty? But what exactly is a conservative? In his famous essay, Hayek explained why he is not a conservative: https://www.press.uchicago.edu/books/excerpt/2011/hayek_constitution.html The traditional "conservative" emphasizes order and stability and fondness for authority. One can pick most any quote from the essay, but here's one I like: "Unlike liberalism with its fundamental belief in the long-range power of ideas, conservatism is bound by the stock of ideas inherited at a given time. And since it does not really believe in the power of argument, its last resort is generally a claim to superior wisdom, based on some self-arrogated superior quality." Anyone who hasn't read Hayek's essay can't distinguish between conservative and liberal, much less between social conservative and economic conservative.

"Economic conservative" (an other variants, like "fiscal conservatism") is what everybody except the americans call "economic liberalism".

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