It’s hard to be sick in America. I don’t mean sick with a cold or flu, ailments that knock you out for a few days. I mean the sick that hangs around for weeks that become months that become years. The sick that other people can’t see, that experts aren’t always sure how to treat, that you live with for so long you forget what it feels like not to be sick anymore. Maybe you live with it forever.

This kind of invisible, chronic sickness is the focus of Jennifer Lunden’s book, American Breakdown: Our Ailing Nation, My Body’s Revolt, and the Nineteenth Century Woman Who Brought Me Back to Life. In it, Lunden tells the stories of two women, one of which is, of course, her own. Lunden struggles for decades with myalgic encephalomyelitis—a condition more commonly known as chronic fatigue syndrome (referred to as ME/CFS for the rest of this piece)—and multiple chemical sensitivity (MCS). These conditions leave her at times unable to work, leave her bed, or even speak. “It’s hard for people to understand this if they’ve always been hale and hearty, but when you have little to no energy, everything costs,” Lunden writes. “Reading a challenging book costs energy. Holding it costs. Sitting upright costs. At my lowest, even talking cost: one sentence cost.” 

The second woman whose story gets told is Alice James, sister of renowned nineteenth century writer Henry James. Like Lunden, Alice spends her life sick in ways that puzzle doctors, and her diagnosed condition, neurasthenia, has a lot in common with ME/CFS. This causes Lunden to feel a deep connection to Alice, as she sees pieces of her own health journey reflected in Alice’s.

And speaking of having your struggles reflected in the stories of others, if you are also sick and you come to Lunden’s book looking to be seen, you’ll feel seen. It’s in there.

But if you come to American Breakdown as one of the healthy ones, thinking you’ll learn about sickness from a distance, I’ve got news for you: Lunden’s deeply researched, ambitious memoir isn’t just about her. By blending rich and raw narrative with medical, environmental, and political history, she tells a story about all of us, and its message is simple: No matter how healthy you feel today, we all live in danger of becoming sick.  

By including Alice’s story with her own, Lunden’s hefty, more than 360-page book gains more than just emotional connection. Alice allows Lunden to highlight how much hasn’t changed for chronic illness patients in more than a century of medical advances. Beyond the societal dismissal of and limited treatment options for both of their chronic conditions, their two time periods also carry a whole lot of sexism in the medical system. When Alice was alive, Lunden writes, doctors often blamed too much education and “emotional expressiveness for causing these illnesses in their female patients, believing that engaging the mind and emotions caused women to divert energy away from where it was needed most: their reproductive organs.” Meanwhile, Lunden finds a paper written in 1994(!) that blamed endometriosis on “modern women’s conflict over her role in society.”

But Lunden is ultimately proposing there’s something else their stories share.

Alice lived during the Gilded Age, a name Mark Twain assigned the period between the end of the Civil War and start of the twentieth century. It was a time of great advancement and change—we got everything from Edison’s lightbulb to the New York Stock Exchange—but “all the opulence of the period was but a thin layer of gold covering a world of grime and strife,” Lunden writes. “The cityscapes were gray with soot from the smoke pouring out of the chimneys of coal-burning factories and from the smokestacks of trains and steamships bearing goods for the multiplying masses surging to the cities. The smoke was so thick in some cities that streetlights blazed even in the day to light the way through the pall. The rich were very rich; the poor were very poor. And everything seemed to move very, very fast.”

If you’re not already making a connection to today, I’ll let Lunden do it for you: “Alice James lived in America’s first Gilded Age,” she writes, “now we’re in another.”

There are consequences to living in a fast-moving world that hides its ugliness under a cheap layer of gold shimmer. For example, deadly wallpaper. During Alice’s lifetime, Lunden writes, manufacturers added arsenic to wallpaper after discovering it helped make vibrant colors like green and yellow. (Arsenic was, in fact, added to a lot of items during this time.) So began a decades-long debate of scientists and medical professionals saying that arsenic wasn’t safe and of manufacturers saying it was, of manufactures telling consumers they’d removed the arsenic from their wallpaper when they hadn’t, and of manufactures successfully lobbying the government not to pass regulations over whether or not they put arsenic in their wallpapers—all of which resulted in countless people getting sick.

We may not have arsenic in our wallpapers today, but Lunden argues that this larger cycle continues to play out. Every day we are inundated with new chemicals found in our shampoos, our cleaning products, our “‘beachside breeze’ scented garbage bags, and even lemon-scented duct tape,” Lunden writes, “and consumers don’t know what these products contain or whether they’re harmful to our health.” But we do know, as Lunden notes, that a 2018 study found the number of people reporting chemical sensitives over the past ten years increased by more than 200 percent and diagnoses of MCS, one of Lunden’s conditions, increased by 300 percent. Our corporations remain, by and large, infinitely more interested in making money than ensuring they’re producing safe products. And as for our government’s commitment to keeping us safe? Consider this: In 1982, Lunden says, the EPA changed its “acceptable” risk of cancer from one in a million people to one in ten thousand people. Which, to be clear, means chemicals now enter our homes with EPA approval that are one hundred times more likely to give us cancer.

When Lunden finishes outlining all the ways the products and people today increasingly make us sick—and trust me, I’ve just scratched the surface of her examples—she makes time to call out the problems with our medical and insurance systems, as well as the American ideology that views productivity and health as synonymous with a human’s morality and worth, explaining how all of this makes our collective health crisis worse. She also drops this eye-catching stat: A 2016 study found that the annual number of patient deaths in U.S. hospitals due to medical errors may be as high as 250,000, making it the third leading cause of death in the nation. (She does also note that some academics question the methodology of this and similar studies, but all agree that “the number of errors is not small at all.”)

Throughout all of this, Lunden never drops the narrative threads of herself and Alice. In doing so, the book can’t become a faceless examination of what research says is happening to our bodies. It’s a devasting look at how society failed two very specific women. And how the longer this continues, the more likely it is to fail all of us.  

So why are we not in the streets, screaming that it’s time to change? Or maybe hiding under the covers of our beds, trying, in vain, to hide from all the dangers? Why do we stand for this? How can we live like this?

Lunden knows the answer: “The first thing most people are inclined to do, often unconsciously, when faced with someone who has a disability or a chronic or life-threatening illness is differentiate themselves,” Lunden writes. “I’m not like her. It could never happen to me. … That person must have done something wrong. Probably she wasn’t going to the gym, or she was eating Hostess Twinkies all the time, or she had too many negative thoughts. I’m not like that, so it won’t happen to me.”

I confess that, as someone who has lived for five years with chronic nerve pain, I hate people who think this way. But I don’t blame them, either.

We have to trust that our lotions and soaps and shampoos and Kleenexes won’t be the ones the EPA lets through that ends up causing cancer, and that the doctor won’t make the mistake when we’re on the operating table. Or that our hair product won’t be linked to infertility and hair loss. That it won’t be our roads that get paved with radioactive waste. That our COVID won’t become long COVID. That Canada’s contaminated air won’t find its way into our neighborhoods and lungs. We have to believe we have some control, that our good diets, good vibes, and good choices can protect us from a lifetime of being sick.

Otherwise, we’d be left with this unbearable truth: Every day you don’t get sick is a day that you were lucky.

Maybe tomorrow, you’ll be lucky again. Some people, of course, are systemically set up to be lucky. But every day, someone’s luck changes, even if yesterday they ran five miles and ate organic chicken with Brussels sprouts. So why couldn’t it happen to you?

The final section of American Breakdown focuses on solutions to problems the book outlines. It’s here that Lunden describes a potentially major breakthrough for chronic pain sufferers in the form of brain retraining, which can help calm the brains—and with them, the bodies—of people who’ve been in a prolonged state of fight or flight due to stress, trauma, or pain. (This only works, though, after the underlying causes of that stress, trauma, or pain are addressed.) Using this method, Lunden cures her ME/CFS and MCS entirely, twenty-seven years after she first got sick. She also reminds readers that the original Gilded Age was followed by the Progressive Era, one where hard-working activists tackled everything from environmental and social causes to fighting government corruption. She implores readers to bring about another such moment, to consider what we, as individuals, can do today to make the world a healthier place.

Lunden’s more positive outlook in this final section, I admit, made less of an impact on me than the indignant, sometimes desperate tone that fueled the earlier sections of the book—the ones where she was sick. Plus, she ends with an epilogue that makes clear our solutions don’t always work.

Still, I didn’t finish American Breakdown without hope. I just find it in those earlier pages, the ones focused on our problems. I find it in the knowledge that, after reading Lunden’s book, more people will understand the ways the systems that are supposed to keep us safe are letting us down. I find it in the question silently fueling the book: If you knew you were going to get sick, too, what kind of changes, what kind of world would you demand?

It’s time to start demanding it.