‘Everything is Tuberculosis’ author John Green on writing, anxiety, and illness

“Not a book I would choose to read under normal circumstances,” one reviewer said of Everything is Tuberculosis, the latest non-fiction book by author, educator, and internet personality John Green.

Likewise, Green — best known for the young adult novels Looking for Alaska (2005) and The Fault in Our Stars (2012), as well as for co-founding the educational YouTube channel Crash Course with his brother, Hank — would not have written this book if it weren’t for the extraordinary situation in which we find ourselves.  

Today, most Westerners associate tuberculosis (TB) with the distant past or the novels of Charles Dickens. But TB is neither the stuff of history nor fiction. In 2023, Green writes, over one million people died of the illness worldwide — more than “malaria, typhoid, and war combined.” Briefly rivaled by COVID-19, it remains the deadliest infectious disease on Earth even though it’s perfectly curable and has been since the 1950s.

Everything is Tuberculosis not only offers a concise history of TB but also a scathing condemnation of wealthy nations’ unwillingness to help fight the disease outside their borders — an attitude that is unlikely to change as Europe and the United States move closer towards austerity and protectionism. If the number of TB-related deaths is difficult to fathom, the fact that every one of those deaths was preventable makes it even harder.

In light of this startling fact, it should come as no surprise that Green’s private self currently bears little resemblance to the nerdy, goofy, and cheerful character he plays while hosting episodes of Crash Course. “I try to be optimistic,” he tells Big Think, “but the truth is I live my life very close to despair.”

In the following interview, the author opens up about the impact that writing about — and living closely to — death and disease has had on his work, mental health, and faith in humanity.

Big Think: In the introduction to Everything is Tuberculosis, you mention that you started writing the book to understand how an illness could shape so much of human history. But what made you interested in all this in the first place?

Green: The first thing that made me want to write about TB was meeting Henry Reider, a young TB patient in Sierra Leone, at a government hospital. Seeing the circumstances he was living in and the challenges he was facing trying to survive, I thought, “What did that say about us? About the world we have built? About the world we might build instead?”

That was the initial inspiration, but in some of the early books I read about tuberculosis, like Phantom Plague by Vidya Krishnan, I also started to see how the disease is an expression of global injustice, revealing how human-made structures reinforce inequality across the world.

Big Think: Are you a hypochondriac at all? If so, does that make writing about illness more difficult?

Green: I’m somewhat hypochondriacal, and I definitely have a lot of health anxiety, but I don’t think writing about disease affects me one way or the other. When I’m writing, it’s almost like I’m not my regular self. I feel like the part of me that has health anxiety is not the part of me that writes the stories.

Big Think: In public appearances, you’ve made no secret about your lifelong struggles with anxiety. Do you find that writing helps or hurts? In a way, one can imagine the process — which involves a lot of thinking and overthinking — can prevent you from being in and fully enjoying the present moment.

Green: I identify with that, although I’ve never thought about it that way. Sometimes, writing can involve overthinking, and overthinking can be a source of distress. But at the same time, writing has guardrails that help keep me grounded. I’m using language, the same 26 letters, to straighten out my thinking so that it does not feel as curved and abstract and scary. It turns it into something I can comprehend.

Mr. Rogers, the great children’s television presenter, used to say that anything mentionable is manageable. I agree: Writing about something, mentioning it, it makes it more manageable for me.

Big Think: Is writing ever emotionally exhausting for you?

Green: It can be hard to walk outside of fiction. When I have a good writing day and then go outside, it always feels like, “What the heck is happening?” It almost feels like a drug. It feels so intense and overwhelming. The emotions I experience when writing, even though they might not be the ones I normally experience in my day-to-day life, are still so real.

Once, while I was writing with my friend Maureen Johnson, I started to cry, and she said to me, “You know, you don’t have to feel what they’re feeling.” And I said, “But I do. Maybe you don’t, which is great for you, and I wish it could be the same for me, but right now I have to feel what they’re feeling.” And honestly, I like that I can feel what they feel. There’s something terrible and difficult about it, but also something wonderful.

Big Think: It’s a double-edged sword, then?

Green: Writing is a weird job because it’s like play-acting. It’s sort of a child’s game. But at the same time, especially if you’re writing for an audience, you’re not totally engaged in the game. You’re trying to get someone else to engage in that play with you, but the person isn’t there, and they won’t be there for years, probably. I love it.

Big Think: But some days are easier than others, right?

Green: Right. I love it the way that you love something you hate.

When you do creative work, you’re never not working because you’re always thinking about work. I’m currently working on a story, and I think about it when I go to sleep and when I wake up. I’m even thinking about it while we’re having this conversation.

It can be annoying for friends and family, but at the same time, I like having something to think and daydream about to distract me from the horrors that abound in every direction. If I didn’t have that, I’d be worse off.

Big Think: Since we are talking about illness and mental health, your brother has spent the past few years battling cancer. How do you deal with that horrible reality as a friend, a family member, a writer?

Green: The first thing I’d say is that you feel like you want to solve it or come to some resolution, but you don’t have to do that.

I had a close friend die of cancer a few years ago. When she was sick, I remember judging myself for the responses I was having and feeling like I was making it about me instead of her. But it was also about me in that I was also facing a lot of uncertainty and experiencing this grave sense of unfairness.

Trying to solve things is human, but the truth is that the world is unfair and random and capricious. We’re all just trying to live in it. It’s not wrong to feel despair, but we have to remember that to be alive is to be in hope.

Big Think: Illness can be a frightful, saddening, upsetting topic to write about, especially in the case of TB, which continues to cause so much avoidable suffering. As a writer, how do you explore such a topic without letting it eat away at you?

Green: It’s hard because I try to be optimistic, but the truth is I live my life very close to despair. I fight against it because, for me, it’s not an abstract, existential question. It’s a matter of survival. I want to be here with my family, in the world, for as long as I can be. I have to battle with despair because the consequences of not doing so are unacceptable.

To write about a topic like TB is difficult because you see just how unfair it is. We don’t have the technology to prevent my brother from getting cancer, but we do have the technology to prevent people from dying of TB. We can treat and cure the disease, and the fact that we fail to do so is a huge stain on humanity.

If I respond to that with despair, though, I’m in some ways disempowering myself and disempowering humanity because we can make change for the better.

I keep a note in my wallet that says, “The year you graduated from high school, 12 million children died under the age of five. Last year, fewer than 5 million died.” I keep it because I have to remind myself that positive change is possible. When we work together, we can make the world safer for children, make it so more people survive to adulthood, make it so mothers are more likely to survive childbirth or people are less likely to die of tuberculosis.

I feel despair right now because we’re not making those decisions. We’re not heading in that direction. The U.S. pulling out and away from foreign aid is devastating — and it’s not just the U.S. The E.U., the U.K., and other rich countries are saying they will do less to make the world an equitable and just place. It is difficult for me at this moment to feel anything other than anger.

Big Think: Speaking of political developments, experts have warned that the Trump administration’s gutting of health organizations and medical research is not just pausing scientific breakthroughs but actively undoing progress. Longitudinal studies that have suddenly lost funding cannot be continued, meaning potential cures or treatments may never see the light of day. Was any of this on your mind in the time leading up to the release of Everything is Tuberculosis?

Green: I was a bit naive. I believed it would be more like the first time around, where the administration’s decisions certainly caused harm, but there wasn’t a complete dismantling of our response to infectious diseases. This time, there is a complete dismantling of our ability to continue making progress, and a significant amount of that progress is being reversed.

Again, this is not just a problem in the United States. It is just presenting itself most acutely in the U.S., and it’s devastating to see my government walk away from many of its long-term commitments to improving health. We’ve always had a very inequitable healthcare system in the U.S., much more inequitable than the healthcare systems in Europe. But we’re making it even worse, and that’s hard to watch.

I think of the history of tuberculosis as this long staircase. For thousands of years, we were on the first step and didn’t know anything about the disease. Hippocrates told his students not to bother treating it because it would make them look like bad healers. Then, slowly, we walked up the staircase. We learned what causes the disease. We developed certain treatments for it. We created a vaccine that wasn’t very good, but at least there was one. We kept walking up the staircase and finally got to a point where we could be running up. Instead, we’ve fallen down.

It’s not the first time in history we’ve fallen down, but fallen we have. I know what it means for the lives of the hundreds and thousands of people who’ve seen their treatment interrupted and know that most of those people will now die.

Big Think: If there was a silver lining to all this, what would it be?

Green: There’s always an empathy gap between us and other people, and that empathy gap is what causes humans to be monstrous to each other. I don’t believe humans are monsters because they want to be or because they’re evil. I think they don’t always understand that another person’s life is as valuable and complex and rich as their own or that of their friends and family members.

We forget that all human lives have equal value in the day-to-day grind of being alive. And so if we can close those empathy gaps, we become less monstrous and much more compassionate and generous and capable of tremendous sacrifice and kindness toward each other.

Humans are monstrous, but we are also wondrous and can be incredibly kind to each other. We love each other deeply and go back to our hometowns to be with our friends in their time of need. We are both and have to believe we’re both because if we believe we’re only monsters, we become monsters. If we believe we’re only wonders, we’ll forget about the cruelty we can enact on each other.