Nathan Hill’s second novel Wellness received numerous praises upon its release in 2023. The novel focuses on the marriage of Jack and Elizabeth, who come of age in the bohemian art scene of mid-1990s Chicago. Two decades after Jack and Elizabeth put down roots in that city, they wrestle with their deadening union as they approach middle age. The novel explores the impact of childhood upon one’s adulthood, while satirizing fast-paced American society, ever-changing technology, and the 21st-century expectation of constant improvement without an end goal.

Hill studied creative writing at the University of Iowa and earned a master of fine arts (MFA) in creative writing at UMass Amherst. He credits his work as a journalist for the Cedar Rapids Gazette as integral to honing his skills as a writer. Wellness follows Hill’s successful debut The Nix (2016), which won the Los Angeles Times Art Seidenbaum Award for First Fiction. Wellness was a New York Times bestseller and was selected by Oprah Winfrey for her book club. NPR, Amazon, and Audible also chose Wellness as a book of the year.

This guide refers to the first edition published by Knopf in 2023.

Plot Summary

Elizabeth Augustine and Jack Baker meet and fall in love in Chicago in the mid-1990s. Jack, who is originally from Kansas, is a photography student at the Art Institute of Chicago; Elizabeth, who comes from a wealthy east coast family, is a student at DePaul. They remain in Chicago after graduation, marry, and have one son, Toby. The plot alternates between their perspectives, covering various moments in their shared and separate past and in the novel’s present (the year 2014).

After noticing one another in separate apartment buildings across an alley, they meet in person at a bar where Jack is photographing a band; when he leaves, he invites Elizabeth to go with him. As they get to know each other, they discover they’ve both experienced isolation and a lack of belonging their entire lives. Determined to live bohemian lifestyles, they become part of a group of like-minded, anti-establishment friends and vow never to sell out.

Decades later, alternating chapters reveal their worries and fears about their marriage. The couple purchases a unit in a building being refurbished for condominium use. The developer, a college friend named Benjamin Quince, informs them the construction is delayed due to protestors who object to the idea that some of the condo units will be low-income housing. Benjamin is certain the protests can be quashed, so Jack and Elizabeth meet to submit to him their design ideas. Jack is dismayed by many of Elizabeth’s requested features, finding them out of character and fearful that this is a sign she is unhappy.

Elizabeth becomes friendly with Brandie, a mother at their son’s school. Brandie organizes play groups that Elizabeth prods Toby to attend, despite his reluctance. Toby has always been a challenge to parent. Elizabeth, a psychologist, works at Wellness, a company disguised as a medical facility that researches the placebo effect. Wellness is especially interested in debunking products advertising weight loss. Its latest project is a pill with no active ingredients to measure the placebo effect in romantic relationships. When Elizabeth learns that Brandie’s marriage is troubled due to Brandie’s husband’s infidelity, Elizabeth gives her the pill, certain that keeping Brandie as an ally will prove useful to ensuring her son remains at the private school where Brandie serves as a board member.

Jack, meanwhile, attempts to reconnect with Elizabeth, wanting the kind of emotional intimacy they used to share. His attempts at avant-garde photography are a failure. Having drinks with Kate and Kyle, a couple Elizabeth has met through Toby’s school, Jack feels awkward and unconfident. Kate and Kyle have an open marriage, which they insist could help Jack and Elizabeth. After their meet-up, Jack agrees to attend one of their sex parties so he and Elizabeth can observe and determine if an open relationship is indeed for them.

At the party, Kyle and Kate separate Elizabeth and Jack, getting them to reflect on their marriage and speculate about the cause of their disconnection. After Kyle and Kate go into the party to participate, Elizabeth steps outside for some air. She is confronted by protestors—members of Community Corps, an organization promoting a mixture of traditional Christianity and positive thinking. Brandie is among the protestors. After the protest, Brandie confronts Elizabeth, who retaliates by revealing the truth of the placebo pill. Brandie gets back at Elizabeth by upping Community Corps’ protests against the development.

As Jack and Elizabeth grow further apart, sleeping in separate bedrooms, the novel delves into key moments from their childhoods. Elizabeth, the only child of an old-money family, was rarely in the same school long enough to make friends: Her father moved Elizabeth and her mother from state to state for his political career. A demanding narcissist, he insisted Elizabeth be perfect and frequently threw tantrums. Elizabeth grew ashamed of her ancestors’ legacy, especially as much of their wealth had been garnered by unethical means.

Jack’s self-absorbed mother resented having him; the quiet and reserved Jack constantly attempted to appease her and didn’t fit in at school. Jack’s only bright spot was his older sister, Evelyn, a painter whom his parents doted on. Evelyn instilled in Jack a love of art; her influence led him to attend the Art Institute of Chicago. After Evelyn died in an accident, both Jack’s parents blamed Jack. Jack left home for Chicago at 18 and had no further contact with his parents until his father sent him a Facebook friend request in 2008.

Over the next six years, Jack keeps his personal life hidden, but engages in daily arguments about his father’s conspiracy theories. Eventually, Jack’s father apologizes for blaming Jack for Evelyn’s death and informs Jack that he has terminal cancer. Jack’s father passes away, and he returns to Kansas for the first time. There he attends the funeral and speaks candidly with his mother about Evelyn’s death. She refuses to concede and Jack leaves without reconciliation.

While Jack is in Kansas, Elizabeth meets with her former mentor, Dr. Sanborne, the psychologist who began Wellness. She asks him for marital advice, fearful that her entire marriage is a placebo and that Jack is not her soulmate. Dr. Sanborne emphasizes that people are constantly changing—the Jack she fell in love with is now a different person.

Upon returning to Chicago, Jack tells Elizabeth he wishes to separate. Wellness has been driven out of business after Brandie exposed its treatments as placebos. Elizabeth has an epiphany that she has lived her life focused on the future rather than the present, believing that that is where she will find true happiness. She immediately wants to speak with Jack, so she heads to the condo building. There, Benjamin tells her that the construction is off as all of the investors have pulled out. Believing that the only way to reclaim Jack and Elizabeth’s invested nest egg is insurance fraud, Benjamin has set the building on fire. Elizabeth finds Jack standing outside, watching it burn.