Natural Causes Not Ehrenreich's Best


By Barbara Ehrenreich

Grand Central Publishers, 257 pages



There is a scene in the movie A Ghost Story in which an earnest young man expounds upon human vanity and the meaningless of humanity within the cosmos. Nothing will endure, he notes, not great art, individual achievement, reputation, or the solar system itself. We all die and at some point the sun will flame out, the galaxy will implode, and all trace of our existence will disappear. Around him women attend to babies, food is prepared, beverages are consumed, and life goes on. A few bemusedly nod—not because the messenger is wrong, but because what can anyone do with that information? A cynic might view Barbara Ehrenreich's Natural Causes in the same light. Alas, she invites such a reading.


There are few non-fiction writers whom I admire more than Barbara Ehrenreich but I must ask what we are supposed to do with what she tells us in Natural Causes. It's a depressing book, and perhaps also be a dangerous one. Ehrenreich, 76, reflects upon aging and death from the perspective "that I am old enough to die … [and] old enough not to incur any more suffering, annoyance, or boredom in the pursuit of a longer life." Ehrenreich has sworn off such things as annual physicals, pap smears, mammograms, cancer screenings, and bone density tests—most of which, she avers, are irrelevant because they either reveal false readings or irreversible fates. She is exceedingly critical of wellness movements, including the gym culture of which she is a devotee by choice, though she does not believe it will yield a longer or healthier life. If you think she's ruthless on that subject, you're not going to like what she has to say about yoga, running, diet fads, supplements, mindfulness, or mind-body dualism—most of which she sees as utter hokum. Long-time Ehrenreich readers will recognize her takedowns as medicalized versions of her autopsy of positive thinking in Bright-Sided (2009).


Her very chapter titles tell you what Ehrenreich thinks of the medical profession and disease-prevention and life-prolonging alternatives: "Rituals of Humiliation," "The Veneer of Science," "Crushing the Body," "The Madness of Mindfulness," "Death in a Social Context." Ehrenreich is in full muckraker dudgeons in these sections and occasionally lapses into ad hominem attacks or slips into anecdotal evidence. She notes, for example, that running guru Jim Fixx died at 52, author John Knowles—who wrote books on living past 80—also perished at 52, that a vegan diet didn't help Steve Jobs, and that women's fitness center mogul Linda Roberts died of lung cancer though she ate healthily and never smoked. By contrast, Jeanne Louise Calmet lived to 122 after having done lots of things contrary to medical advice. Sure, but these are outliers and all of them would have been marvels a hundred years ago when the average age at death was 49.


The heart (if I might) of Ehrenreich's book comes when her voice shifts from rant to science. She has a Ph.D. in chemistry and can discourse with great intellectual heft on matters such as stochastic noise, lipids, beta-amyloid plaques, neutrophils, macrophages, and inflammaging. In these sections—the bulk of which occur in chapters titled "Cellular Treason" and "Tiny Minds"—she offers a "dystopian view of the body," and that's putting it mildly. The same immunity mechanisms that help fight disease will, in some circumstances and in general as we age, switch from helpful to harmful. Don't look for balms; Ehrenreich clinically observes, "The survival of an older person is of no evolutionary consequence…. [The] diseases of aging clear the clutter of useless older people." Nor is human free will unique. Ehrenreich walks us through studies that show that atoms and cells demonstrate decision-making properties that coordinate human demise.


Only toward the end of her book does Ehrenreich gravitate toward anything remotely cheerful. It's not religion; she sees far more evidence for black holes than for a soul or a deity. Her prescription is to live as joyfully as one can, surrender to the inevitable, and obliterate the self—the last of these her take on the Buddhist concept of ego death. Your life, memory, and works will disappear but the things that made life worthwhile—sunsets and nature, for instance—will continue for a long time. In the final moments, the self can be suppressed through hospice, painkillers, psychedelic drugs, and (in some places) doctor-assisted suicide. 


So, again, what do we do with such messages? I haven't the foggiest idea; death, like birth, is a mystery in which we are unwilling participants. I worry, though, that Ehrenreich refracts too much through her own intellect. Most people don't have a Ph.D. in chemistry and cannot make equally informed decisions about their care. Moreover, much of what she condemns suggests that we need better medical care, not less, and greater oversight in determining best practices from ineffective ones. In the same vein, we certainly need stronger regulations to curtail false claims, hucksterism, and the peddling of latter-day snake oil and electric belts. And I really must caution against a cursory reading of this book, lest one conclude there is no need for medical screening. I know women who are alive because of mammograms; Ehrenreich is one of them. In the end, though, there's no getting around the fact that Natural Causes is such a downer that one could come away with the message of: eat, drink, and be merry for tomorrow we will die. Unless you're poor—then it's life sucks and then you die, a thesis Ehrenreich advances. Maybe all we can do is go on with the party, come what will.


Rob Weir


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