In October 2023, it will have been twenty years since I was diagnosed with burn out. My doctor placed me on medical leave for at least six months and told me I was only allowed to do two things: rest and go to therapy.

It felt as if my life had fallen apart. In fact, my life had been falling apart (or maybe, it never really came together) for a long time, but it wasn’t until my body had had enough that I realized what state I was in.

In Swedish, my diagnosis is called “utmattningssyndrom,” which translates as “fatigue syndrome.” My case was so severe that for those first six months, I had no problem following the doctor’s orders. I was incapable of doing anything but rest and go to therapy. I didn’t have the strength to work, I didn’t have the strength to think, and I didn’t have the strength to exercise. In fact, exercise made things worse. I was out of breath and ready to collapse after walking less than a mile.

After those first six months, I was still in bad shape, but I agreed to start easing my way back into work. Working for an NGO run by a friend of mine, during the first few months, I was at the office one day a week for two hours, and was wiped out. Slowly but surely, I increased my hours and days until I was back to full time.

On the surface, that might seem as if I was fully recovered. But with burn out, you are never completely restored. Relapse lures behind every corner. For some, medication is the solution. For me, it is Cognitive Behavioral Therapy (CBT), the techniques of which I practice every day.

In her memoir American Breakdown. Our Ailing Nation, My Body’s Revolt, and the Nineteenth-Century Woman Who Brought Me Back to Life (Harper Wave, 2023), Jennifer Lunden chronicles her life living with Myalgic encephalomyelitis or Chronic Fatigue Syndrome (ME/CFS), possibly triggered by a mono infection. A young woman on the cusp of adulthood and a life of her own, Lunden began suffering from an inexplicable exhaustion beyond description. It was as if her body took on a will of its own, a will that went against what Lunden herself wanted.

Seeking help, Lunden turned to medicine and social services, but found that she was unable to locate the help she needed. The turning point in her quest to understanding what was happening to her was the discovery of the diary of Alice James (1848–1892), sister of novelist Henry James, who suffered from a mysterious illness that defied diagnosis. Here was a woman who spoke across the century that separated them, revealing to Lunden that the situation she was in was greater than herself with a much longer history than she had anticipated.

Together with Alice, Lunden jumped down the rabbit hole where medical history and gender history intersect, resurfacing to lay bare the twisted capitalist and gender-biased logic that underpins American health care and social security, as well as the insidiousness of corporate greed and consumerism and how the use of chemicals and preservatives are allowed to harm us and our environment. At the root, Lunden reveals the long history behind these phenomena, tracing it back to the philosophy of René Descartes (1596–1650).

As shocking as it might seem that what ails and kills Americans today can be traced as far back as the seventeenth century, American Breakdown, in fact, only traces the historical roots halfway. The dualism found in Descarte’s work is not his own invention, but him expounding on the dualism inherent in Christianity since the very beginning when the founding Fathers and Mothers of the Church in the second and third centuries CE turned to Plotinus (204–270) and his fellow Neoplatonists for an explanation of the cosmos that enabled them to separate their beliefs from the mother religion of Judaism. This dualism became increasingly pronounced in Protestantism, which, in turn, infused it into the building blocks of capitalism.

In medicine, the historical roots trace back even further. Until the nineteenth century, we relied on the Four Humors of Galen (129–199), which he in turn developed based on the teachings of Hippocrates (460–370 BCE). Over time, the Four Humors–blood, phlegm, black bile, and yellow bile–became gendered. Blood and yellow bile were hot humors and therefore masculine, while phlegm and black bile were cool and therefore feminine.

We tell ourselves that we have abandoned such primitive methods, when in fact they are still alive and well, e.g. in personality type tests, such as the Myers-Briggs Type Indicators (MBTI), and in medicine, where men and women are treated differently depending on their gender and, consequently, their temperaments. In everyday practice, this results in men being more likely to be taken seriously than women when they see a doctor.

Though American Breakdown searches for the answers to ME/CFS, I found parallels to my own experience living with burn out. As American Breakdown also points out, I believe that conditions such as ME/CFS, burnout, and, most recently, long-COVID are the results of the same societal and environmental triggers. There are indications that the scientific community is starting to make the same connections, and I am excited to see what results they will eventually reach.

American Breakdown is an exposé that lays bare how we are conditioned to accept as normal what is hurting us. The historical background to our current state of crisis serves to demonstrate how ingrained into society these attitudes are, but also, that they are man made, and as such, American Breakdown shows us that what is done can also be undone.

In the words of my friend, the Australian, I shall return.