Cover image for Natural causes : an epidemic of wellness, the certainty of dying, and killing ourselves to live longer
Title:
Natural causes : an epidemic of wellness, the certainty of dying, and killing ourselves to live longer
ISBN:
9781455535910
Edition:
1st ed.
Physical Description:
xv, 234 pages ; 22 cm
Summary:
Offers insight into healthcare practices, identifying the cellular sources of aging and illness and revealing that aggressive treatments provide an illusion of control and survivability at the cost of life quality.
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Available:*

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Summary

Summary

A New York Times bestseller!
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 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.


Author Notes

Barbara Ehrenreich is the author of "Blood Rites"; "The Worst Years of Our Lives"; "Fear of Falling", which was nominated for a National Book Critics Circle Award, & eight other books. A frequent contributor to Time, Harper's, Esquire, The New Republic, Mirabella, The Nation, The New York Magazine, she lives near Key West, Florida.

(Publisher Fact Sheets) Political activist and writer Barbara Ehrenreich was born in Butte, Montana on August 26, 1941. She studied physics at Reed College and graduated in 1963. She received a Ph.D. in Cell Biology from Rockefeller University in 1968. Rather than pursuing a career in science, however, she decided to focus on social change.

Ehrenreich has written columns and contributed articles to publications including Time Magazine, The Progressive, The New York Times, Mother Jones, The Atlantic Monthly, Ms, The New Republic, Harper's Magazine, and The Nation. She taught essay writing at the Graduate School of Journalism at the University of California, Berkeley in 1998 and 2000.

Ehrenreich has written many books, with 2001's Nickel and Dimed: On (Not) Getting by in America and 2005's Bait and Switch, The (Futile) Pursuit of the American Dream both becoming New York Times bestsellers. Nickel and Dimed examines working-class poverty, while Bait and Switch discusses white-collar unemployment. Her next bestseller was in 2014 with Living With a Wild God: A Nonbeliever's Search for the Truth about Everything.

In 1998 Ehrenreich was named Humanist of the Year by the American Humanist Association, and she received the Nation Institute/Puffin Foundation Prize for Creative Citizenship in 2004.

(Bowker Author Biography)


Reviews 6

Publisher's Weekly Review

Claiming to be "old enough to die," feminist scholar Ehrenreich (Living with a Wild God) takes on the task of investigating America's peculiar approach to aging, health, and wellness. She comes down hard on what she describes as "medicalized life": the unending series of doctor's visits, fads in wellness, and preventative-care screenings that can dominate the life of an aging person. Ehrenreich's core philosophy holds that aging people have the right to determine their quality of life and may choose to forgo painful and generally ineffective treatments. She presents evidence that such tests as annual physicals and Pap smears have little effect in prolonging life; investigates wellness trends, including mindfulness meditation; and questions the doctrine of a harmonious "mindbody" and its supposed natural tendency to prolong life. Contra the latter, she demonstrates persuasively that the body itself can play a role in nurturing cancer and advancing aging. Ehrenreich remains skeptical and scientifically rigorous throughout her inquiry, a combination she attributes to her time in the women's health movement and her doctorate in cellular immunology. That this knowledgable book arrives in the context of an urgent American healthcare crisis, when many people can't access or afford healthcare, may irritate some readers. Still, Ehrenreich's sharp intelligence and graceful prose make this book largely pleasurable reading. Agent: Kristine Dahl, Curtis Brown. (Apr.) © Copyright PWxyz, LLC. All rights reserved.


Booklist Review

Americans are obsessed with their bodies. Too thin? Too fat? Does that mole look weird? Bombarded with advertisements for bodily functions that once were rarely discussed outside the physician's office, Americans have become consumers of vast amounts of medical information that engenders a false sense of competency, turning us into fierce advocates for commandeering our bodies and controlling our destiny. But is such a thing possible? Award-winning and best-selling writer and dedicated activist Ehrenreich (Living with a Wild God, 2014) looks at both sides of this conundrum, from the lifestyle adjustments promoted by a burgeoning wellness industry to the immutable facts of biology at the cellular level that propels the human body to either combat or embrace the aging process. Ehrenreich, who holds a PhD in cellular immunology, offers a healthy dose of reformist philosophy combined with her trademark investigative journalism. In assessing our quest for a longer, healthier life, Ehrenreich provides a contemplative vision of an active, engaged health care that goes far beyond the physical restraints of the body and into the realm of metaphysical possibilities.--Haggas, Carol Copyright 2018 Booklist


New York Review of Books Review

America is experiencing an outbreak of distrust. We doubt government, the media and climate change. In a 2016 Gallup poll, three-fifths of respondents characterized members of Congress as dishonest and unethical. Two-fifths felt the same way about journalists. In a Pew Research Center survey from the same year, about a fifth of interviewees said they didn't trust climate scientists to give them "full and accurate" information about climate change. Imagine what the pollsters are finding in 2018, after more than a year of tweets by our media-bashing, climate-change-denying bully pulpiteer. As of 2016, though, doctors still got some respect. They retained the esteem of 65 percent of the people who were polled. Nurses clocked in at 84 percent, making them among the most credible professionals in the nation. Enter Barbara Ehrenreich, a writer we ought to be able to rely on. In her masterwork, "Nickel and Dimed" (2001), she embedded herself in the unskilled labor market, serving as a waitress, cleaning-service maid and Walmart employee. A muckraking classic, "Nickel and Dimed" exposed in unignorable detail the tolls of poverty on the working poor in America, land of scant and grudging social relief. In her latest book, "Natural Causes," Ehrenreich takes on the medical establishment, along with some less respectable institutions. As the Victorian-length subtitle suggests - "An Epidemic of Wellness, the Certainty of Dying, and Killing Ourselves to Live Longer" - "Natural Causes" is a work of sweeping social critique. Ehrenreich's stated target is the fantasy that we can cheat the ravages of age and death. Fair enough. She directs a goodly portion of her wrath at the American candy store of quackeries: the "mindfulness" industry; Silicon Valley-style "biohacks" meant to engineer immortality; integrative holistic health; the mania for fitness (even though the author admits to being something of a gym rat herself). "Natural Causes" asks us to accept that our bodies defy our control. Ehrenreich bases her case on a new paradigm in scientific thought which argues that, contrary to popular belief, the body is not a unified army able to repel dangerous invaders, but "at best a confederation of parts ... that may seek to advance their own agendas." Moreover, the immune system may be our enemy, not our friend. In her youth, Ehrenreich earned a Ph.D. in cell biology. Her subject was macrophages, big, hungry cells on the front lines of the defense. ("Macro" means big; "phage" means to devour.) "To me as a lowly graduate student," she writes, "they were heroes, always rushing out fearlessly to defend the body against microbes or other threats." Disillusionment occurred about a decade ago, when she read an article in Scientific American reporting that macrophages, previously thought to gobble up cancerous tumors, sometimes feed them instead, then send them off to wreak their merry havoc. Rather than massing for an assault, these macrophages, she writes, "are cheerleaders on the side of death." This is "cellular treason," she says, and acknowledging the body's betrayal means letting go of the fantasy that order can be imposed on chaos. Ehrenreich moves swiftly, to my mind too swiftly, from the metaphor of intrabody conflict to critiques of religion, psychology, philosophy and our cheerful American worldview. She has come to lay waste to utopian fallacies, she says, and replace them with dystopian realities. She contests almost everything that promises harmony between mind and body, self and world, God and universe. Remarkably, she begins her crusade with antiquity, specifically monotheism, which installed a single god to rein in an unruly pantheon. She skips ahead to the Enlightenment and the emergence of the notion of a unified self, and from there to 20th-century science, which regarded nature as a thing to be dissected and tamed, rather than as a multitude of rebellious forces animated by something like will. The book concludes with an admonition to die well. We must undo the clutch of the ego and free ourselves of tortuous end-oflife interventions, finding comfort instead in the richness of the universe that will survive us. "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," she writes elegiacally. "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." You can't begrudge Ehrenreich her effort to assuage our and her own fears about mortality, even if her historical chapters sometimes read like freshman surveys. But "Natural Causes" has another message, and it's decidedly questionable. Now that Ehrenreich has come to terms with her own decline (she's 76), she says, she has grown deeply skeptical of modern medicine. In the first chapter, Ehrenreich, a breast cancer survivor, confides that she has given up on cancer checkups, mammograms and Pap smears. She has never gotten around to having a colonoscopy. "This was not based on any suicidal impulse," she assures us. At first, she worried that she was just a slacker. Later, though, she realized that she had been put off by too many doctors pushing too many procedures and panaceas: tests for sleep apnea, medication for the thinning of the bones, dental X-rays. Moreover, as a woman, she had experienced a great deal of medical condescension. When a pregnant Ehrenreich, who already had her Ph.D., asked her obstetrician how much her cervix had dilated, he turned to the nurse and asked: "Where did a nice girl like this learn to talk like that?" A pediatrician prescribed one of her children unnecessary antibiotics to assuage the "nervous mother." Medicine is puffed up with its own importance and obsessed with profit, she says, and she, for one, does not intend to spend her remaining days enacting its "ritual of domination and submission," "in windowless waiting rooms and under the cold scrutiny of machines." It's true that end-of-life treatment has contributed to the ballooning cost of American health care (though some have questioned whether it's as big a drain as it's often made out to be). And medicine, like any other profession, has its charlatans and jerks, and is certainly being perverted by the bean counters. We would all feel better if hospitals weren't so cheerless. But Ehrenreich should know better than to dress up her dislike of doctors as a reasoned excuse to avoid them. To be sure, she cautions, none of what she says "should be construed as an attack on the notion of scientific medicine." But actions outweigh words, and her example could lead some readers astray. Doctors do more good than harm. So do nurses. They'd do even more good if more people had access to them. The more than 27 million Americans without health insurance would surely be glad to have the checkups and colonoscopies that Ehrenreich has chosen to forgo. Let us age with grace, but let us not spread the plague of distrust by tarnishing a group of men and women who do what they can for those they can reach, and under increasingly difficult conditions. So here's my advice, for what it's worth. Don't take this book too seriously. It could be harmful to your health. ? JUDITH SHULEVITZ is the author of "The Sabbath World: Glimpses of a Different Order of Time."


Guardian Review

A great iconoclast has written a polemic about ageing that sends up New Age platitudes and is full of scepticism of the wellness industry Ten years ago, Barbara Ehrenreich read an article in Scientific American that shook her to the core. Its argument was that the body’s immune system, far from protecting us, can enable the growth and spread of tumours, “which is like saying that the fire department is indeed staffed by arsonists”. In the 1960s, Ehrenreich had worked on immune cells as a PhD student, specifically on those known as “macrophages”, and had come to think of them as friends – frontline defenders against microbial invaders. Now that they stood exposed as traitors, one of her basic beliefs was shattered. If our body can attack itself, why bother trying to look after it? What’s the point in striving to stay healthy, when longevity is beyond our control? “Old age isn’t a battle,” she says, quoting Philip Roth, “old age is a massacre.” In the past few years, she has given up on screenings and scans. Not that she is lazy or suicidal. But at 76, she considers herself old enough to die. All the self-help books aimed at her age group tell her otherwise; they talk of “active ageing”, “productive ageing”, “anti-ageing”, even “reverse-ageing”, with a long life promised to anyone who makes an effort, regardless of factors such as genetics or poverty. But to her, ageing is “an accumulation of disabilities”, which no amount of physical activity or rigorous self-denial can prevent. If she has symptoms, she’ll have them investigated. But when a doctor tells her there could be an undetected problem of some kind, she won’t play along. Experience has taught Ehrenreich that standard health checks are at best invasive and at worst a scam Experience has taught her that standard health checks are at best invasive and at worst a scam. Overdiagnosis has become an epidemic. Bone density scans, dental x-rays, mammograms, colonoscopies, CT scans: she questions them all. Preventive medical care, in the US at least, has become a lucrative industry. Many doctors profit financially from the tests and procedures they recommend. And celebrity-driven campaigns for more screening increase the demand. People are being made sick in the pursuit of wellness. An estimated 70-80% of thyroid cancer surgeries performed on American, Italian and French women in the first decade of this century are now judged to have been unnecessary, she claims. And then there are all the elderly who “end up tethered by cables and tubes to an ICU bed”, their life needlessly prolonged and demeaned. There’s an argument that health checks have value as rituals, that beeping machines in sterile rooms provide the kind of reassurance to modern western consumers that shamanistic drumming and animal horns do in more “primitive” cultures. Ehrenreich quotes from a 1950s spoof anthropology paper, Body Rituals Among the Nacirema (“American” spelled backwards), in which supplicants lie on hard beds within temples, while magic wands are inserted in their mouths and needles jabbed in their flesh. Modern medicine invokes science in its defence. But whereas science is “evidence-based”, medicine tends to be “eminence-based”, with patients in thrall to the doctor’s superior prestige. It’s no coincidence, Ehrenreich thinks, that most American medical schools still insist on the dissection of cadavers. That’s how living patients are expected to be – as passive and silent as corpses. Ehrenreich’s scepticism about the medical profession is informed by her feminism and dates back to a moment in late pregnancy when she asked the male obstetrician who had just removed his speculum from her vagina whether her cervix was beginning to dilate: “Where did a nice girl like this learn to talk like that?” he said to the nurse standing nearby. That kind of misogyny may be on the wane but it hasn’t gone away. Women are still needlessly forced into humiliating positions by men in white coats. Gynaecological examinations “enact a ritual of domination and submission”, with the patient made to undress and be open to penetration, much as in the criminal justice system, “with its compulsive strip searches”. Deprived of agency in her encounters with the medical profession, Ehrenreich found an alternative by taking up physical exercise, which offers greater promise of control. Initially mortified by the feebleness of her body, she developed a scary competitiveness and graduated from a women-only gym to a unisex version, where at her zenith she would outdo young men and “draw spectators for my leg presses at 270 pounds and lunges while holding a 20-pound weight in each hand”. She still works out, but no longer sees gym-going as a means of empowerment. Large businesses once notorious for exposing their workers to unhealthy conditions now promote corporate wellness programmes. But the benefits are dubious (their coercive nature may even be a source of workplace stress) and the idea that if you’re less than fit you’re less than human is pernicious. Ehrenreich has fun at the expense of health sages and fitness gurus, with their mantras about the “wisdom of the body”. It would be unfair to describe her as gleeful when she lists some noted casualties – among them Apple co-founder Steve Jobs (who died at 56), US social activist Jerry Rubin (56), The Complete Book of Running author Jim Fixx (52) and the author of the book Younger Next Year: Live Strong, Fit and Sexy – Until You’re 80 and Beyond, Henry S Lodge (58). Still, she can’t resist wryly concluding: “If this trend were to continue, everyone who participated in the fitness culture – as well as everyone who sat it out – will at some point be dead.” That we’ll all be dead, sooner or later, is no longer indisputable. Death-deniers are a growing body; the richer the individual (invariably a man), the more hubristic their claim to immortality, whether it’s Russian billionaire Dmitry Itskov with his plans to surpass Methuselah by living to 10,000 or Larry Ellison, co-founder of Oracle, who finds mortality “incomprehensible” (“Death makes me very angry”). The diseases of old age used to be seen not just as inevitable but as kindly, even altruistic. Now they’re regarded as cruel, abnormal and, according to one expert (the author of Younger Next Year), “an outrage”. “Every cell is on your side,” goes the holistic slogan, but Ehrenreich disproves it. Against the utopian presumption that our cells work in harmony, “like citizens of a benign dictatorship” or a smoothly running machine, she presents the body as a site of constant conflict and deadly combat, with cells pitted against each other as well as against external invaders. Those seeming good guys, the macrophages, turn out to be cheerleaders for death, encouraging cancer cells to do their worst. Philosophically, she concedes, it’s hard to imagine immune cells being accomplices in destruction; some scientists still dispute it and she owns up to “simplifying to an extent that would annoy many cellular immunologists”. But she makes the case persuasively, with 20 pages of notes and citations to back her up. Ehrenreich is more persuasive when on the attack than when it comes to offering solutions More controversially, she sees cells acting as though with a mind of their own – not following instructions but doing as they please. “Cellular decision-making” is the term for it, though you could also call it “free will”. Not that cells possess consciousness, but they are capable of acting in ways that are neither predetermined nor random, with an outcome of inflammation and disease. It’s a pessimistic scenario but at the end of the book Ehrenreich offers a glimmer of light. For such agency to exist at a microscopic level in our bodies points to a universe swarming with activity – and to mysteries beyond our ken. To recognise that, and see oneself humbly as a transient cell in a larger animistic order of being, makes the prospect of death easier to accept. Or so Ehrenreich concludes. After her earlier sendup of New Age platitudes, this quasi-Buddhist celebration of non-selfhood sounds less than convincing. As does her recommendation of psilocybin (the active ingredient in magic mushrooms) as a way to abolish the self and approach death with equanimity: by taking a trip on a psychedelic drug, you’ll appreciate the beauty of the universe and go more gently into that good night. Really? Might you not be keener to stick around? And more resentful of the world going on without you? Like most polemicists, Ehrenreich is more persuasive when on the attack than when it comes to offering solutions. There is a lot in her book to take issue with: the impatient dismissal of mindfulness, for instance, and the paranoid interpretation of the anti-smoking lobby as “a war against the working class”. Even her essential premise is flawed: yes, death can come even to those who have worked hard at staying healthy, but that’s a given and doesn’t mean it’s not worth the effort. And then there’s her animus against gyms, as the locus of a pampered, narcissistic, middle-class elite, when she continues to attend one. Still, she is one of our great iconoclasts, lucid, thought-provoking and instructive, never more so than here. That PhD in cellular immunology, left behind while she went on to write books and run campaigns, has proved useful after all. - Blake Morrison.


Kirkus Review

Ehrenreich (Living with a Wild God: A Nonbeliever's Search for the Truth about Everything, 2014, etc.) returns with research and rumination on the complexity of our human bodies and the misconceptions of our minds.The author has a doctorate in cellular immunology, and throughout the text, she employs the erudition that earned her degree, the social consciousness that has long informed her writing, and the compassion that endears her to her many fans. Ehrenreich leads us through the recent biomedical research that shows us, among other things, that our immune systems can turn on us, actually easing (rather that preventing) the spread of cancer cells. Elsewhere, she writes about the puzzles of menstruation (why do human women bleed far more than other creatures?), autoimmune diseases, and the pervasive belief that we can control our lives. "We are not," she writes, "the sole authors of our destinies or of anything else." The author also explores the social and cultural aspects of health and aging: She notes how wealthier, healthier people look upon the poorwho are more likely to smoke and eat poorlywith moral disdain. She goes after the medical establishment for what she believes are superfluous, redundant tests and procedures, and she assails the self-help industry for our currently dominant, and often unhelpful, ideas of selfhood and wellness. Ehrenreich sees the body-mind connection as incredibly complex and discusses the odd notion that cells often do what they want rather than what they're "supposed" to do. The author will certainly not endear herself to the pious among us; her discussions of the origins and evolution of religious ideas are hardly orthodox. Mostly, she urges that we recognize that death is natural, that we enjoy our lives while we can, and that we disabuse ourselves of any self-serving notions of post-mortem permanence or even influence.A powerful text that floods the mind with illuminationand with agonizing questions. Copyright Kirkus Reviews, used with permission.


Library Journal Review

With her trademark take-no-prisoners prose, Ehrenreich (Nickel and Dimed) argues that a desperation to control our fates leads us to cling to ritualized medical procedures, dietary fads, and gym exercises that generate corporate profits but do nothing to change our destiny. Ehrenreich criticizes the classist arrogance of framing sickness as a moral failing, when health largely hinges on uncontrollable vagaries of our genes and cells (not to mention poverty). The author combines two themes: the first is the fiery treatise against medicalization and the "cult of wellness," while the second is a mishmash of theories of the human body at war with itself and notions of an "animate universe." With a PhD in cellular immunology, the author's credentials in science and medicine are unimpeachable, and her ability to make the her subjects accessible is unsurpassed. In this book, she drifts into a dystopian and idiosyncratic scientism, softening the potency of the text's first half. VERDICT A welcome reminder to relax in the face of our own mortality, this is fast-paced, hard-nosed discourse. Sure to appeal to dissidents from the cult of wellness.-Michael Rodriguez, Univ. of Connecticut, Storrs © Copyright 2018. Library Journals LLC, a wholly owned subsidiary of Media Source, Inc. No redistribution permitted.