Our Malady: Lessons in Liberty from a Hospital Diary by Timothy Snyder is just under 200 pages. While it’s not long, it covers topics we all face daily whether we know it or not—our health and freedom. A Yale professor, historian, and writer, Snyder was not well at the end of 2019. He made multiple visits to Emergency Departments in various hospitals in the U.S. and Europe. 

This treatise is both memoir and thoughtful discussion about the intersection of medicine, health, and politics. First, Snyder introduces the term malady. It’s not a part of most people’s general vocabulary but the definition is simple. It’s either a disease of the body or a general disordered condition, especially of a society or group. 

So, you can have a disease like appendicitis (as Snyder did) and also live in a society with a malfunctioning and disadvantageous health care system. Add to that the way politics is embroiled in health care and thus encroaches on our freedom to be physically well. Stir the topics together and you’ve got the basic premise of this book.

Personal memoir

Snyder’s own tale of medical woes is a scary one. Because he’s traveling for other reasons, he bounces from hospital to hospital. In the U.S., his doctors are overworked and have approximately two minutes to meet and treat him. While some of his health issues are properly diagnosed and treated, not everything is addressed. So, the resulting complications become life-threatening.

Snyder compares this experience to his previous ones in European hospitals and doctor’s offices. In countries where medicine isn’t a for-profit endeavor, the care is remarkably different than where it’s about profit. Doctors spend time discussing not just your current concern but your life in general. They show genuine concern. Mothers spend more time in the hospital after giving birth. They have support while they learn to nurse their babes, among other things.

During his extended recovery, Snyder confronts his own mortality. And then he starts thinking about why the United States does medicine the way it does. 

Health care in the U.S. versus freedom

Because of his illness, Snyder realizes that health and freedom are intertwined. If we have our health, we are free to do many more things. We feel secure in our lives and the world around us. In Snyder’s mind, tying politics to health care increases pain, suffering, and death. Requiring that profits sustain the system only help the few at the top, while hurting the rest of us. Instead, he says, gaining security and health should be the goal. But that’s not how our system works. And it’s only getting worse as time passes.

Written as the COVID-19 pandemic ramped up, Our Malady also discusses the overall failures to manage it effectively. Thinking about freedom as a country facing 1,000 deaths a day, with continual outbreaks and quarantines seems obvious. Our health care system and our society center on individualism not on collective solidarity, as Snyder sees it. And this is doing us a disservice, both as citizens and as a country.

Drawing connections to history

Snyder’s historical speciality is Central and Eastern Europe and the Holocaust. So, when he includes illustrations from history they’re chilling. For example, when the Nazi regime forced Jews into ghettos, they also cut off their access to health care. And then the malady increased as propaganda told Germans and tourists that Jews spread disease. 

Overall, the twentieth century is full of frightening examples where regimes treat health as a privilege instead of a right. It’s typical of the authoritarian mindset, and the antithesis of actual health, security, and well-being. Snyder posits that this puts pain (for many) and wealth (for a few) before health. And politicians or businesses who guard their own purse before their fellow citizens aren’t offering freedom. They’re offering tyranny.

My conclusions

I’ve highlighted many passages in my advance copy ebook. I wish I could share more of them with you, but it’s not possible until the book is final and published. Snyder takes complex concepts and blends them with examples. That makes it easier to follow and absorb. But his words are strong. He’s not afraid to put himself out there and make clear that this path is dangerous. Like his previous books, Our Malady is a cautionary tale.

I recommend this to anyone whose primary political campaign issue is health care. It’s mine. And now I have more ways to argue my points with people who see things differently. I’m grateful Snyder gathered his thoughts while his body was healing, so that hopefully we can use them to heal the U.S. healthcare malady.


Thanks to NetGalley, Crown Publishing, and the author the opportunity to read a digital advanced reader’s copy in exchange for this honest review. Publication date is September 8, 2020.