When Lena Dunham first met her future husband, she told him two things: “I was sick, and people did not like me. If he could be comfortable with those two immutable truths, then we could be together.”

These are two of the central themes that the writer, actor, and director explores in her new memoir, Famesick. An account of making the hit HBO series Girls, the book also considers the time that Dunham spent in rehab and hospitals shortly after wrapping the show’s final season. Notoriety and illness are the through lines in Dunham’s life, and in Famesick they are the perils that often accompanied her rewards. “Getting sick is not that different than getting more famous,” she writes. “It has a maddening circularity, and it’s also very hard to explain, even to the people closest to you. When you’re sick, one medication causes side effects that must be treated by another, more drastic drug.”

Lena Dunham is the Nora Ephron of the millennial generation: vulnerable, brash, and brassy. She’s a grand romantic living in a world of post-sincerity. Her first film, Tiny Furniture, mined the foibles and travails of being a young girl in search of love and experience. Her era-defining Girls expanded on the frustrations of millennial women trying to find love in a world of deadbeat men and to find stable work in an economy that was increasingly rigged against them. A grungier, trashier, bawdier version of Ephron’s rom-coms, Girls captured life in a New York City with more financial and economic and emotional pressures.

Famesick is Dunham’s latest effort to mine her early adult experiences for knowledge and humor, to look bracingly at her friendships, her loves, and her work and see what life lessons can be gleaned from them. If Dunham’s gift has always been to tenderly expose the underbelly of loneliness, of growing up and growing apart, Famesick is about what happens when you get older—when you stop being the youthful provocateur and become instead the grande dame for a generation struggling with midlife crises.

Each chapter of Famesick is named for an episode of Girls. The first, “I Get Ideas,” tells the story of Dunham’s early attempts at filmmaking shortly before she landed the HBO deal. After feverishly writing the script for Tiny Furniture, we are told, Dunham slammed it down in front of her mother, Laurie Simmons, a sculptor who’s an accomplished artist in her own right, and claimed it was a gift: something for the two of them to do together. The film proved to be a blurring of the lines between family members and colleagues, friends and coworkers, fiction and reality. Examining the painful dynamics of a young woman’s attempts to distinguish herself from parents with strong personalities, Tiny Furniture ended up featuring Dunham’s brother as well as a retinue of actors who were also her friends in real life, such as Jemima Kirke.

Praised for its razor-sharp wit and raw desperation, Tiny Furniture helped launch Dunham’s career. Soon she was meeting various producers in Hollywood to sell a TV series. Paired with the producer Jenni Konner, who quickly became her best friend, and the charismatic director Judd Apatow, Dunham found her transition from indie filmmaking to show-running an HBO series to be surprisingly smooth, at least at first: “I remember the boundless creativity that television seemed to allow…. If you wrote an abstract painting or a Bundt cake or a sports car into an episode, it would appear, like everything Harold drew with his magical purple crayon.”

When it premiered in 2012, Girls was an immediate success. The story of four recent college graduates living in Greenpoint, Brooklyn, partying in nearby Bushwick, and attempting to live out their aspirational Sex and the City fantasies, the show satirized as much as lionized its millennial protagonists. Girls was often criticized for its blunt depictions of sex and its often very white, very upper-middle-class perspective on New York City. The four women struggle to remain friends as they deal with the ups and downs of young adulthood—getting jobs, falling in and out of love, moving from one apartment to the next, and eventually being forced to grow up.

By the end of the series’ first season, Dunham was the talk of the town. Attending movie premieres, flying back and forth between the coasts, and doing photo shoots for the cover of Vogue, she was embraced as one of the great representatives of her up-and-coming generation. Unfortunately, Dunham soon discovered that the seeming magic of the industry also had a “corrosive” effect. Her friendship and creative partnership with Konner, while “cozy” and tight-knit, sometimes came with unexpected turbulence. Konner “especially loved me when I was on my game,” Dunham writes acerbically. At times, her colleague was “everything [she] needed—a best friend, a mother, a mentor all rolled into one.” At other times, she was mostly a boss: Konner told Dunham at one point that the network wanted her character to gain weight, under the assumption that women who are too skinny aren’t funny. As the pressures mounted, their relationship turned icy; while family and friends had helped her make Tiny Furniture, Dunham realized that the people involved in making Girls with her were ultimately neither.

This pattern of conflating her professional and personal life also crept into her other relationships. Apart from Konner, Dunham’s primary confidant during the period she was working on Girls was her boyfriend, the singer-songwriter Jack Antonoff. A power couple of sorts, the two lived with a “sense of doom” that things would not last. As readers of Famesick, we already know they won’t. Dunham started dealing with the complications from endometriosis and Ehlers-Danlos syndrome, which sometimes stalled production on Girls toward the end of its six-year run. Soon enough, Dunham’s illness and Antonoff’s touring schedule wound up pushing them apart. “He spent a lot of time telling me about the kind of person I was, and it wasn’t the good kind,” Dunham writes. Antonoff began spending more time away from her, even as Dunham got sicker and sicker. When he was home, Dunham writes, Antonoff was often “locked in the back room with the teen pop star” (a person who goes unnamed in the book but is widely believed to be the singer-songwriter Lorde), “whose needs seemed as massive and complex as my own, and who called me ‘Aunt Lena’ when I hobbled into the kitchen with my walker to grab another bottle of green tea.” By now it was clear that Dunham’s body—like her life—was not what it once was.

As her workaholic tendencies gave way to the stubborn demands of illness and the toll of bad relationships, Dunham’s family took her in, ready to buy heating pads and brew hot tea. Her parents, in particular, became her tether to the real world: Lena’s father, the artist Carroll Dunham, often served as a force of sharp reason. “Don’t you get it?” he once asked her. “You’ve won. You’re only twenty-eight, and you’ve been called a racist, a fat whore, an ignorant rich girl, and a child molester. What else is left?” When Antonoff missed a surgery that Dunham had scheduled—he showed up at the hospital several hours late and blamed it on the traffic—her father noted: “Surgery is like a train, not a tour bus. You either make it, or you don’t.” Dunham’s mother offered her own witticisms and rapport but also struggled with the cost of her daughter’s fame. The family was unable to maintain any sense of normalcy and frequently clashed over Dunham’s public persona. “When an image of my father’s work was highlighted in an article as clear evidence of the kind of left-wing perverts who produce a sex-obsessed narcissist,” Dunham writes, “it stopped being charming and started to undo every narrative thread that had kept us intact.”