Review | How American health care has been failing women for centuries

Intriguingly, “American Breakdown” begins not with Lunden’s own story, but rather with the 19th-century woman of the book’s subtitle, diarist Alice James. Sister of her more famous brothers, writer Henry and psychologist William, Alice serves as a fitting historical and literary reference point for the chronically ill and variously diagnosed, including Lunden. As Lunden puts it, “A network of entwined lives, theories, and treatment advances runs from Alice and William in the late nineteenth century” to her arrival at her doctor’s office in the late 20th century. Though memoir plays a crucial role in Lunden’s story, “American Breakdown” is ultimately not a memoir. The interwoven relationship between two women facing illness and treatment across centuries becomes the frame for an ambitious and deeply researched examination and contextualization of medicine and health care in the United States. The “breakdown” mentioned in the book’s title refers not to James or Lunden but to America, a nation that Lunden argues has been ailing for a long time. In the telling, “American Breakdown” expands from a depiction of the ills of health care into a sweeping critique of late-stage capitalism.

The accumulation of corporate failings outlined in the book — and their effects on our health and health care — is compelling. Lunden provides, among other insights, a detailed and absorbing tale of the ill effects of chemicals in our lives. We live with the legacy of lead-based paint and arsenic in wallpaper. Beyond that, she writes, “today, we have carpet laced with benzene and particleboard furniture off-gassing formaldehyde,” both known carcinogens. And in the workplace, the demands for corporate output and profits keep Americans on the job for long hours. By 1900, the lightbulb allowed for round-the-clock work, and work became the measure of an individual’s value. Leisure was redefined as laziness. Even now, according to reporting based on data from the Organization for Economic Co-operation and Development, Lunden writes, full-time workers in the United States “are guaranteed just ten holidays, a paltry sum when compared to the combined holidays and vacations adding up to thirty-six to thirty-seven days a year for workers in France, Spain, and the United Kingdom.” According to the U.S. Travel Association, “American workers passed up 212 million paid vacation days in 2017 — a $62.2 billion bonanza to the companies that employ them.”

Though the United States remains an economic powerhouse, health-care provisions for its workers fail to match those around the world. “Of the over fifty wealthy industrialized countries,” Lunden writes, “the United States is the only one without universal healthcare, and we spend twice as much on healthcare per person.” Moreover, we spend more money on health care but don’t get healthier, “ranking dead last in healthcare outcomes, equity, access, and administrative efficiency.”

Along with the book’s rigorous cultural critique, Lunden draws from on her own experience with CFS, including the range of treatments she has tried with varying success. Diet, hyperbaric oxygen, functional medicine that “takes a holistic approach to the complexity and interconnectedness of biological systems,” and GoFundMe (because of her medical costs) all play important roles in her recovery and the book’s scrutiny of health-care systems and practices. She describes a type of brain re-training as especially effective for her that seemed reminiscent of physical therapy for balance that I have done to treat vertigo. The interplay between the author’s efforts with her own ailments and the chronicling of our nation’s shortcomings delivers the cumulative power of this book.

As the book unfolds, Lunden takes an increasingly strong social justice stance not only on equitable access to health care but also on environmental and economic justice. Whether revealing the sordid history of arsenic, illuminating the conflicts embedded in the system of health insurance for profit or positing the dangers of treating corporations as if they were people, she argues for a redefinition of the American Dream. An appendix provides suggestions for social change beginning with a call “for the separation of corporation and state.”

The story Lunden tells does not end with the final page of her book. Though she has found some relief from CFS, she describes a relapse in the epilogue, noting, “here I am, so much better but still recovering.” She maintains optimism, clinging to the idea that an individual human being is what James called “a certain value as an indestructible quantity.” As for America, Lunden offers a way forward. She believes that humans have survived because we “are fundamentally cooperative.” In “American Breakdown,” she tells the tale of our ailing nation to demonstrate the pressing need for us to care for each other collectively. In this version of the story, health and happiness that we sustain together becomes the new definition of prosperity and the American Dream.

Anna Leahy is the author of “Tumor” and directs the MFA in creative writing program at Chapman University.

Our Ailing Nation, My Body’s Revolt, and the Nineteenth-Century Woman Who Brought Me Back to Life