If you’ve followed the career of Lena Dunham and read some of her most poignant writing for this magazine, you’re likely aware that she’s not afraid to bare her personal struggles—with relationships, with health, with extra-long nails. An ability to combine profound reflection on the body with insight on the grit and humor of everyday life is one of the hallmarks of her nonfiction writing. “My nurse,” she wrote in an essay about her hysterectomy for Vogue, “is a model-gorgeous woman, sardonic and odd, like the sidekick on a TV show who producers pretend is less stunning by slapping spectacles on her.”

This spring, 10 years after the release of her best-selling memoir Not That Kind of Girl, she will publish her second book, Famesick, a nonfiction work about how health troubles have intersected with her life in the spotlight.

“I felt a little bit like the detective in the movie who has the newspaper clippings and the red strings,” she tells me of the process of writing the book, which involved going back into her emails and diaries, “trying to put it together and understand exactly what had happened and how it had happened and why it had happened.”

Of course, the book is not just a medical mystery; it’s also a study of ambition, the desire to please—especially as a young woman—and what happens when those impulses run up against physical limits. Dunham first found success at just 23 years old, when her debut feature, Tiny Furniture, was released in 2010; Girls would follow in 2012. At the same time, her health struggles (coupled with substance-abuse issues) were compounding.

It was hard to hit pause on all her obligations and desires, she says: Writing for film and television was her “version of going to the Olympics—it doesn’t matter if you have a cold, it’s the Olympics.” The breakthrough finally came when, as she puts it, “the override function stopped, and I was no longer able to do the suppression that was required to participate in daily life.”

The year 2018, she says now, was “the year that did not exist,” as though she had stepped “through the looking glass” into an alternate reality. “You start to feel like, I’m no longer in the land of the living, and will I ever get to go back there?” (Not coincidentally, the image on her new book’s cover—a photo by Anna Gaskell that Dunham has loved for years—is a reference to Alice in Wonderland.)