Mandi's depictions of growing up female in small town and rural Appalachia help fill a gap in Appalachian literature, just as her first-person account of addiction and recovery in millennial Appalachia increases our understanding of the causes and costs of the opioid epidemic. . . . The Nature of Pain is also our story. It is the story of a people and a place, of grievous theft and of ongoing reclaiming.

--Pauletta Hansel, As the Crow Flies

Mandi Fugate Sheffel delivers a rare and propulsive narrative about one of the most unsung heroes among us: a young Appalachian who leans on her community to heal. It's a moving story of unspeakable pain and a region done wrong. Sheffel's memoir is a balm for our turbulent times, a call to action and to leadership--and to hope.

--Beth Macy, author of Dopesick and Raising Lazarus

A story of friendship and family in a larger narrative of loss, addiction, and recovery. As we read, we come to love Mandi and her cousin Eric, and root hard for them to be able to hold onto what is worth keeping in their family and move beyond what is hardest. The book complicates any notion you might have about the place and people she writes about, written with a refreshing and raw voice that is sincere and empathetic. In The Nature of Pain, Sheffel shoots straight. She avoids sentimentality and never seeks permission, offering readers a new sort of story, different from the one that you thought you already knew.

--Meredith McCarroll, coeditor of the American Book Award-winning Appalachian Reckoning: A Region Responds to Hillbilly Elegy

The best, most humane memoir to emerge from the opioid crisis. Few other books have understood Appalachian culture as deeply and articulated it with such complexity. There is no sensationalism here, only the hard truths of addiction and the moving story of a profound bond. This is a story you will never forget.

--Silas House, author of Lark Ascending

Strikingly vivid and quite powerful--unlike anything I've read before. The Nature of Pain provides a firsthand education in contemporary Appalachian culture, prescription drug misuse, and what healing looks like following traumatic losses. It is a success story of recovery that plumbs the depths of the soul for the origins of addiction. Sheffel's strengths are her vulnerability on the page, her honesty, and those moments when she describes the beauty and value inherent in her complicated loved ones--and her complicated self.

--Shawna Kay Rodenberg, author of Kin: A Memoir

Mandi Fugate Sheffel is a truth teller. With extraordinary courage and insight, she shares her journey from addiction to redemption--a deeply human story that manages to be both vibrantly Appalachian and truly universal. I loved every word.

--Jennifer Haigh, New York Times bestselling author of Rabbit Moon

Longlisted for the James Patterson Book Prize

Publisher: University Press of Kentucky

Pub date: 2025-10-07

Length: 192 pages