At the end of last year, Netflix released Too Much – a sickly, indie-sleaze romcom about an American transplant who falls for a troubled British muso. It was created by Lena Dunham and her musician husband Luis Felber, and apparently loosely based on the couple’s backstory. It felt, to many critics, like second-screen fare, decidedly Lena Dunham-lite. Was this really the same person who had given us the spiky, self-absorbed world of Girls, the millennial Sex and the City complete with brutal situationships, toxic besties and, er, one of the main characters accidentally smoking crack?

Famesick sheds almost all the Richard Curtis-isms to find that old, controversy-courting Dunham alive and – if not exactly well – then learning to cope with it. Her second memoir (Not That Kind of Girl was published in 2014) charts the chronic illness and seemingly unending stress that came to define her 20s and 30s after she had snagged her own HBO series aged just 24. The afflictions described across its 400 pages include – though are not limited to – OCD, colitis, the connective tissue disorder Ehlers-Danlos syndrome, endometriosis, early menopause, PTSD and addiction to both opioids and benzodiazepines. At one point, Dunham accidentally sets herself on fire; at another, she panics about how Vogue will cover up the impetigo on her face, “a waterfall of golden blisters, turning a sickly green as they dried”. The book is scattergun and sometimes lacking in self awareness (who cares that Dunham had to give her designer booties up, like contraband, when she entered rehab?). It’s also undeniably frank and exhaustive: a lifetime of therapy condensed into something you could conceivably rip through in a weekend.

Dunham’s health doesn’t initially dominate, but – like a chronic illness itself – it slowly and quietly becomes the focus. She describes it all in unvarnished but terrifying fashion, from the digestive tract she had treated “like a clogged drain I was snaking” – surviving on energy drinks and diet supplements on the set of Girls – to her use of, and later dependence on, Klonopin, “on and off, for years, like a lover I wasn’t particularly attached to, could take or leave”. There’s a horrifying retelling of an episode in which Dunham punctures her eardrum with a cotton bud that would go on to inspire a plotline on Girls. As Famesick continues, the injury feels almost trivial when compared to Dunham’s constant gynaecological issues, or the run-in with a doctor that brings back long-buried, “sickly waves” of memories of being sexually abused by a babysitter. The darkness increasingly creeps into the celebrity world she continues to inhabit, as with the Met Gala that Dunham attended in 2018 while on release from rehab, “wan and haunted … champagne I couldn’t drink circulating like a joke I wasn’t in on”.

Many inappropriate men walk in and out of Dunham’s life, like bit-part players in a TV show. The two that stand out are her former longterm partner, musician Jack Antonoff, and her Girls co-star Adam Driver, neither of whom come out of Famesick particularly well. Antonoff lavishes her with tchotchkes and promises of marriage and children, before – as Dunham tells it – slowly tiring of her medical issues and drug dependency. Driver, meanwhile, appears as an allegedly unpredictable, often angry man who may not have been doing much acting in Girls: “I remember doing a fight scene with Adam … when I opened my mouth, all that came out was a stammer – until finally, Adam screamed, ‘FUCKING SAY SOMETHING’ and hurled a chair at the wall next to me. ‘WAKE THE FUCK UP,’ he told me. ‘I’M SICK OF WATCHING YOU JUST STARE.’” Once the show had wrapped, the pair never spoke again.

The girls of Girls are described in loving but hazier terms, apart from Jemima Kirke – “part Lolita, part Keith Richards” – who is faithfully drawn in a way that maybe only a childhood friend could be. The female friendship that really propels her through the making of the show, it turns out, is one with its producer Jenni Konner, who morphs from best friend to acquaintance and back to stranger as the book nears its end. There is so much going on here that it feels like there’s scarcely space for Dunham to adequately explain the episode that saw her and Konner put out a statement in 2017 defending Girls writer Murray Miller against sexual assault allegations (denied by Miller) made by actor Aurora Perrineau. But, where she does address it, her sense of shame and the feeling she may have harakiri-ed her career is clear: “I did not decide to kill myself,” she writes, “but I did think it was time to die.” Similarly, she apologises to anyone alarmed by her description in Not That Kind of Girl of touching her sibling’s genitals as a child, although she does think that some saw it as an opportunity to take her down. She writes about dealing with the resulting online furore in the midst of a trip to the Netherlands to promote the book: “Had you told me I’d still be getting those comments 11 years later, I would have downed the rest of the bottle of pills and chosen that plane as my final resting place”.

It feels fair to say that Dunham doesn’t always make it easy to feel sorry for her, though. There are moments big and small where her decision-making seems questionable – continually moving house, passing up career opportunities when she desperately needed them, deciding to carry a blind, ailing dog around in a tote on a TV set. Elsewhere, weighty names are dropped – from Oprah to Nora Ephron – in a way that sucks the oxygen out of the other words on the page (see also: needless cameos for a pre-fame Safdie brothers and “TayTay” – Taylor Swift – featuring in a long, long list of acknowledgements).

And yet, there’s an honesty and a fluency to her prose that makes her hard to dismiss. Illness, she writes, “wasn’t just a town I was passing through, but a city that I was going to pay taxes in”; when Girls first took off, it was “a miracle to me that I managed to speak cogently about the work, when I had to tell my feet to walk”. On parenthood, and a failed round of IVF, she is at her most truthful: “The irony is that knowing I cannot have a child – my ability to accept that and move on – may be the only reason I deserve to be anyone’s parent at all. I think I finally have something to teach somebody.”

Towards the end of Famesick, Dunham meets Felber, and the London era that inspired Too Much begins. Met Gala invites fall away and friends’ weddings populate her calendar instead. It’s easy to see now why she wrote that series, and retreated into something less jagged than the reality of her own past decade. But it’s clear –in Famesick as in Girls – that Dunham is able to write about the painful parts of life in a way that feels both intimate and universal. Perhaps the real horror of this book (dedicated to, among others, Sharon Tate, Whitney Houston, Caroline Flack and Liam Payne) isn’t so much that celebrity can make you sick. Rather, it’s that no amount of fame or money can keep you safe once it does.