We can, or think we can, understand the causes of disease in cellular and chemical terms, so we should be able to avoid it by following the rules laid down by medical science: avoiding tobacco, exercising, undergoing routine medical screening, and eating only foods currently considered healthy. Anyone who fails to do so is inviting an early death. Or to put it another way, every death can now be understood as suicide.I received an Advanced Reading Copy of Barbara Ehrenreich's Natural Causes, and based on its subtitle (An Epidemic of Wellness, the Certainty of Dying, and Killing Ourselves to Live Longer), I thought it was going to center on the moral ambiguity of end-of-life care – keeping people alive at all costs, without regard to the quality of that life – but that's not really what this is (although that is covered, too). Primarily, it's about the way that we in the West are living at this specific point in history – giving our bodies over to a medical profession that isn't as altruistic or science-based as we assume, mistakenly believing that a “self” is a discrete and important unit whose death is final and tragic, frittering away our lives in forestalling the death that is inevitable and as natural as life itself – and while Ehrenreich is persuasive in these points, backing up every assertion with quotes and research, she ends this book in a place to which I don't think everyone will follow; I'm still mulling over whether I (perhaps an ideal reader for this material) am ultimately persuaded to follow her there, but I certainly enjoyed the journey. And the usual caveat: I do understand that I shouldn't quote from an ARC, that these passages may not appear in this exact way in the final edit, but especially with this material, I wanted to let the author make her argument in her own words (I hope that the irony is apparent in the opening quote I used; I appreciate that's the additional danger of excerpting out of context.)
Barbara Ehrenreich is a feminist and an activist, a big-picture journalist who dissects trends through the lens of their historical moment, and I don't believe that most of us think this way: we accept the ways things are around us as the inevitable result of “progress” towards some idealised present, and especially as that relates to health and science. We look at improvements in hygiene, nutrition, vaccines and antibiotics, nod approvingly at increasing life expectancy statistics, and assume that through science and medicine, these stats will continue to rise: can't Millenials expect to live comfortably to a hundred or more? Aren't tech billionaires working on the keys to immortality? But Ehrenreich says that there's nothing inevitable – let alone ideal – about where we are today medically, dismissing even the annual physical as little more than a ritual equivalent to “primitive” shamanism, complete with costumes, strict roles, and deference to occult knowledge. As a feminist, she decries the twentieth century's medicalisation of childbirth as paternalistic and demeaning for women, and more or less makes the point that today's insistence on annual mammograms and pap smears will someday be seen in the same light – as pointless at best, as proof of an ego- and profit-driven industry at worst. (As a breast cancer “survivor” [she hates that word], Ehrenreich has little good to say about the whole “cancer industry”, as can be seen in her award-winning article, Welcome to Cancerland .) As for herself, Ehrenreich has reached an age where she is no longer willing to participate in these rituals.
Having dismissed the state of modern medicine, Ehrenreich examines the rise of the personal pursuit of fitness as a marker of status (rich people can afford spas and gym membership, poor people eat poor food and are more likely to be prescribed the opiates that are killing them) and then proceeds to skewer the complementary wellness industry, deriding in particular the celebrity gurus. Ehrenreich mocks “the scientifically discredited Dr. Oz”, charges that Gwenyth Paltrow and her website Goop sells “self-absorption as the ultimate luxury product”; that Paltrow's wellness techniques “are not exactly evidence-based”, and even states that Jamie Oliver's efforts to modify school lunches without “bothering to study local eating habits before challenging them” was “a mortifying failure” in both the UK and the US. The latest trend, as Ehrenreich writes, is the holistic approach to the “mindbody”, and while plenty of self-help authors and motivational speakers are getting rich off the concept, the idea is not only illogical (if a person can control both her body and her mind from the outside to bring them into harmony, just what is doing that controlling?), but contrary to science:
Rejecting the traditional – and continuing – themes of harmony and wholeness, (Elie Metchnikoff) posited a biology of conflict within the body and carried on by the body's own cells as they compete for space and food and oxygen. We may influence the outcome of these conflicts – through our personal habits and perhaps eventually through medical technologies that will persuade immune cells to act more in more responsible ways – but we cannot control it. And we certainly cannot forestall its inevitable outcome, which is death.Before she became a journalist, Ehrenreich earned a PhD in Immunology, so when she starts writing about body systems and cells, and especially when she writes about microphages, I necessarily defer to her expertise. According to the research, these microphages seem to have agency – they roam the body, “deciding” what work to do in order to support the immune system – and while they have a vital role in combatting disease, they also appear to trigger and encourage cancers and other inflammatory diseases (everything from autoimmune disorders to heart disease and Alzheimer's are apparently now known to be inflammatory diseases, promoted by our own microphages). So while we might be trying mightily to postpone our own deaths from the outside through diet, exercise, and medical interventions, at the cellular level, our bodies are independently determining our end dates:
Just as programmed cell death, apoptosis, cleanly eliminated damaged cells from the body, so do the diseases of aging clear up the clutter of biologically useless older people – only not quite so cleanly. And this perspective may be particularly attractive at a time, like now, when the dominant discourse on aging focuses on the deleterious economic effects of largely aging populations. If we didn't have inflammatory diseases to get the job done, we might have to turn to euthanasia.To this point, I understood the philosophy of what Ehrenreich was writing about; the basic futility of denying ourselves the things we like in order to delay the inevitable. But the final thrust of the book takes a weird turn as Ehrenreich, always a big picture thinker, explains the historical markers that led to where we are now, and why it's so wrong. She writes that in the beginning we humans recognised the animism of everything around us, but that an “austere, reformed version of monotheism set the stage for the rise of modern reductionist science”. And when our supposedly increasingly rational minds then killed off our only God as well, we were preparing for the rise of the “self” as the most important unit of life (the concept of “the self” was only “invented” relatively recently by Descartes, et al), which made us begin to think of our individual deaths (for the first time?) as tragedies to be fended off. Here Ehrenreich quotes the writings of Jackson Lears:
The reductionist science that condemns the natural world to death is not “science” per se but a singular, historically contingent version of it – a version that depends on the notion that nature is a passive mechanism, the operations of which are observable, predictable, and subject to the law-like rules that govern inert matter.Because microphages and other cells appear to make decisions (and as Ehrenreich adds, so too do the subatomic particles of quantum physics), she concludes that we are wrong to dismiss the natural world as merely “inert matter”. She shares the recent studies of terminal patients who have been given psychotropic drugs, and after “tripping” and recognising their place in the true animate universe, they were no longer afraid to die. I have read Ehrenreich's Living With a Wild God, and in it she describes how as an atheist and a rational-minded scientist, she was led to believe that nothing survives death – she certainly doesn't believe in a soul – but she has had a series of visions in which, out of nowhere, was revealed to her the pulse of life behind the curtain of reality (like “a burning bush” in her words), and the following (which I don't think would make complete sense to anyone who hasn't read Living With a Wild God) seems to be Ehrenreich's main thesis:
It is one thing to die into a dead world and, metaphorically speaking, leave one's bones to bleach on a desert lit only by a dying star. It is another thing to die into the actual world, which seethes with life, with agency other than our own, and at the very least, with endless possibility. For those of us, which is probably most of us, who – with or without drugs or religion – have caught glimpses of this animate universe, death is not a terrifying leap into the abyss, but more like an embrace of ongoing life.And I don't know if, coming suddenly at the very end of this book as it does, this thesis can said to have been supported by what precedes it. It would seem that Ehrenreich's main points are that modern medicine can ultimately do very little to prevent our body's own efforts to kill us; which is a natural process anyway, and will return the stuff of our bodies to the living cosmos. I wonder if the takeaway most readers will get is that you should smoke and drink, eat that burger, skip the annual physical, because you're going to die anyway, and it doesn't matter because death isn't the end. And looking at those two proposed summaries, I don't know if there's truly a difference between them. As I began with, I enjoyed the journey of this read, but am left ambivalent in the end.
