From the celebrated author of Nickel and Dimed, Barbara Ehrenreich explores how we are killing ourselves to live longer, not better. A razor-sharp polemic which offers an entirely new understanding of our bodies, ourselves, and our place in the universe, Natural Causes describes how we over-prepare and worry way too much about what is inevitable. One by one, Ehrenreich topples the shibboleths … topples the shibboleths that guide our attempts to live a long, healthy life — from the importance of preventive medical screenings to the concepts of wellness and mindfulness, from dietary fads to fitness culture.
But Natural Causes goes deeper — into the fundamental unreliability of our bodies and even our “mind-bodies,” to use the fashionable term. Starting with the mysterious and seldom-acknowledged tendency of our own immune cells to promote deadly cancers, Ehrenreich looks into the cellular basis of aging, and shows how little control we actually have over it. We tend to believe we have agency over our bodies, our minds, and even over the manner of our deaths. But the latest science shows that the microscopic subunits of our bodies make their own “decisions,” and not always in our favor.
We may buy expensive anti-aging products or cosmetic surgery, get preventive screenings and eat more kale, or throw ourselves into meditation and spirituality. But all these things offer only the illusion of control. How to live well, even joyously, while accepting our mortality — that is the vitally important philosophical challenge of this book.
Drawing on varied sources, from personal experience and sociological trends to pop culture and current scientific literature, Natural Causes examines the ways in which we obsess over death, our bodies, and our health. Both funny and caustic, Ehrenreich then tackles the seemingly unsolvable problem of how we might better prepare ourselves for the end — while still reveling in the lives that remain to us.
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We can depend on Barbara Ehrenreich on to write incisive, well-argued and trenchant commentary and criticism of American culture. She is especially noteworthy for bringing to us the larger view connecting cultural, political and sociological trends to economic realities, just as she showed us in her book Nickle and Dimed: On (Not) Getting By in America. In this most recent book, Natural Causes: An Epidemic of Wellness, the Certainty of Dying, and Killing Ourselves to Live Longer, she challenges our ongoing efforts to resist death at all costs, even if it means quality of life has to suffer.
The first section of the book addresses medical care as an industry. As we age, we are subjected to increasing levels of humiliation and shame due to the medical paradigm that living longer is the greatest goal. But at what cost? I am reminded of my friend Jerry who decided against more chemo when he was being treated for cancer. The doctors made it clear that they might be able to get him six more months of life if he underwent further chemo treatments. He decided that six months of throwing up wasn’t for him. He said no to chemo because his quality of life was more important to him than extending his life.
Ehrenreich makes it clear that, “Not only do I reject the torment of a medicalized death, but I refuse to accept a medicalized life, and my determination only deepens with age.”
She makes the economic connection here, too, as in this quote: “What could be more ridiculous than an inner-city hospital that offers a hyperbaric chamber but cannot bestir itself to get out in the neighborhood and test for lead poisoning?” Obviously, serving those who can pay for a hyperbaric chamber is more important than PREVENTING a health disaster in the general population.
Ehrenreich then takes on the cultural notion we seem to be suffering under now – that death is avoidable and that if we just beat our bodies into submission, we can stay alive. This section will make a lot of us devoted to “healthy living” really uncomfortable, especially those regular denizens of the spa, the gym, the “this” diet and the “that” diet, and the shops that sell “alternative” health care products. And if we don’t eat right and exercise enough, then we guilt-trip ourselves for any health problems we might have acquired, even age-related problems. That’s because we suffer the false notion that the body is capable of living a lot longer than we ever knew, if not living forever. In fact, she writes about the view of some Silicon Valley denizens who see poor health and death as technical problems to be solved technically.
There is a long section in this book in which the reader learns about cellular biology and how the body’s cells can sometimes betray us – or more accurately, betray our idea of how those cells are supposed to behave. Ehrenreich has a PhD in cell biology so we get into the biology weeds here. I happen to have been lucky enough to learn about this kind of thing before reading her book so I already knew the meaning of words like “macrophage” and “telomere,” and I could understand her commentary. I enjoyed reading about her struggle to understand her own experience of cancer, how the macrophages were not behaving in a “friendly” way, and coming to the rather radical conclusion that these cellular parts may have a mind of their own and will do as they wish.
This brings us to the final section of the book which is the most philosophical and, for me, the best section of the book. She takes on the existential meaning of death to a species that is all about “self” these days, from “self-improvement” to taking “selfies.” How do we come to terms with the disappearance of a personal self, aka death?
Ultimately, Ehrenreich gets to that place in her last chapter that Buddhist monks seek, that is, “Killing the Self, Rejoicing in a Living World.” She does it through a far different method than what I’m accustomed to because I am far more familiar with Buddhist philosophy than I am with the nitty gritty of cell biology. In fact my only criticism of this book is that Ehrenreich seems quite unfamiliar with eastern culture and philosophy. She traces the meaning of “self” back to the ancient Greeks and she quotes more modern existentialists struggling with the concept of death. However, there’s almost nothing about an ancient tradition in China that provides a considerable amount of insight into the notions of self, the meaning of life, and the meaning and acceptance of death. Meditation and mindfulness existed as practices long before they were taken up as half-assed fads in the west. Too bad Ehrenreich isn’t familiar with the real deal.
This was interesting – at first. Then it felt like a column extended into a rant and started feeling repetitive and disagreeable… I take some of her points – we are a culture obsessed with the idea of a right to health and that is being taken to ridiculous extremes in many ways. BUT I’m not convinced by many of her arguments about false positives or discomfort traded for prevention (e.g., mammograms – which are, frankly, a minor discomfort traded for detection and in many instances elimination of early-stage breast cancer, especially when compared to the trauma of treatment and survival rates of later stage cancer). I do agree that we each have a right to make that call – as long as the treatment at issue affects our individual bodies and not, for example, herd immunity with vaccines or similar broader-impact treatments that touch others who did not agree to our choices. It’s a thought-provoking book, even if I didn’t agree with all the thoughts. Her writing style is easy enough to engage with, if at times slightly inflammatory for my taste.
Thanks to NetGalley for my review copy.