In American Breakdown, Jennifer Lunden regards her nearly three decades of living with multiple chronic illnesses as a terrible side effect of life in 21st-century America. Before the discovery of long covid, she began a quest to understand her own ailments (myalgic encephalomyelitis/chronic fatigue syndrome and multiple chemical sensitivities), which were possibly triggered by a bout with mononucleosis.

Early in her convalescence, Lunden read about diarist Alice James, who suffered from a similar mysterious illness (neurasthenia) during the Industrial Revolution:

 

“In Alice, I met my Victorian counterpart, my kindred spirit. And somehow, reading about her — bright, witty, proud, and stuck — I began coming unstuck.

“Why was Alice sick? Why was I?

“From my bed, and with the aid of interlibrary loan and a helpful librarian, I set out on a journey to find some answers. I spent years researching American history, nineteenth-century and contemporary toxicology, biology, medical history, economics, environmental history, sociology, chaos theory, and more, and by the time I finished, things were a whole lot clearer.”

In the process, Lunden noted how modern medicine adopted the metaphor of the body as a machine. This concept worked well for infectious viruses like polio that could be isolated and inoculated against, but not for chronic, multi-system illnesses. When faced with the difficulty of diagnosing and treating such cases, many physicians even now dismiss them, especially when women are the patients. She writes:

“Imagine how different things would be if instead of blaming the patient, doctors had to point to the real source of the problem. Medicine doesn’t have all the answers; research is an ongoing process. But when a doctor tells a patient her mysterious symptoms are the result of mental illness, that doctor is presuming an exhaustive knowledge of all disease.”

Rather than viewing individuals as mere cogs in a machine, Lunden looks for connection. While attending a local support group in Maine for people with multiple chemical sensitivities, she is struck by one woman’s assessment: “We think we’re the sick ones, but maybe our bodies are smart. Maybe our bodies are warning us about a real danger. I mean, the formaldehyde in those cupboards is a neurotoxin. Should anyone really be inhaling it?”

I first encountered a draft of Lunden’s book in 2016 at the Bread Loaf Writers Conference, when we were in a nonfiction workshop together. As someone who suffers with rheumatoid arthritis, possibly triggered by an undiagnosed case of chronic Lyme disease, I found the premise of her work astonishing. Like many of the patients she writes about, I’d been through a frustrating period of taking supplements and trying new diets. When I received an advance reader copy of American Breakdown, I worried my expectations that her work would go beyond mere self-help might leave me disappointed. Yet what I found in its pages far exceeded my imagination.

As a licensed clinical social worker and therapist, Lunden disrupts the American capitalist paradigm by participating as both patient and practitioner in innovative healthcare that emphasizes extensive patient narratives and uses sliding scales for payment. According to her experience and research, “Working with patients as whole people — through their stories — is critical to healing.”

The book structure meanders in a pleasant way and includes over 70 pages of notes documenting sources for its 17 chapters. Readers are invited to follow Lunden and her 19th-century counterpart, James, through their years of illness. Along the way, the author lays out myriad paths to explore, including the use of arsenic in Victorian wallpaper; the formation of the Environmental Protection Agency and its failure to protect its own employees from poisoning; the effects of pharmaceutical companies’ courting of doctors and advertising directly to consumers; and even a look at brain science and breakthroughs in medicine related to genetics.

Although progress moves slowly in American healthcare, there are signs of hope. And in her appendix, Lunden includes suggestions for how to “ignite change.” Fans of Rebecca Solnit and Susan Orlean will find much to love in this thought-provoking exploration of the body as a delicate web.

Wendy Besel Hahn is the nonfiction editor for Furious Gravity, an anthology of 50 women writers in the Washington, DC, area. Her work appears or is forthcoming in the Washington Post, Scary Mommy, Hippocampus, Sojourners, and elsewhere. She lives and writes in Denver, Colorado.

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