You won’t look at death the same way again.
Natural Causes: An Epidemic of Wellness, the Certainty of Dying, and Killing Ourselves to Live Longer by Barbara Ehrenreich is an odd and oddly satisfying read.
Mistakenly judging the book by its cover (and title), I expected her usual contrarian, deconstructionist and well-researched approach (loved Bright Sided) focused on the medical, health and mindfulness industries. And there’s some of that, a quick and cutting look at how little we know about health and health care (and why she no longer goes to the doctor for routine exams) but it quickly gets delightfully weird and metaphysical.
Ehrenreich is a truly talented writer with a background in science and a dark sense of humor. She starts the book by building a case that maps the limits of medical- and self-knowledge.
“The body…is not a smooth-running machine in which each part obediently performs its tasks for the benefit for the common good. It is at best a confederation of parts—cells, tissues, even thought patterns—that may seek to advance their own agendas whether or not they are destructive of the whole. What, after all, is cancer, other than a cellular rebellion against the entire organism? Even such seemingly benign conditions as pregnancy are turning out to be driven by competition and conflict on a very small scale.”
With that in mind, exercising for health and longer life starts to look suspect. She imagines a gym and how “…a mid-twentieth-century psychiatrist would no doubt find reasons to suspect a variety of mental disorders—masochism, narcissism, obsessive-compulsive disorder, and homoerotic tendencies (which were views as pathological until the 1970s)—any of which could indicate the need for professional interventions.”
And the forced optimism of “mindfulness” is the next to fall. She points to “…a mammoth federally sponsored “meta-analysis” of existing studies, published in 2014, which found that meditation programs can help treat stress-related symptoms, but that they are no more effective in doing so than other interventions, such as muscle relaxation, medication or psychotherapy ...So maybe meditation does have a calming, “centering”effect, but so does an hour of concentration on a math problem or a glass of wine with friends.”
All of the research and evidence belie the mistaken belief that we have far more agency over our lives and health outcomes and mortality than we actually do. “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 considered healthy. Anyone who fails to do so is inviting an early death. Or to put in another, every death can now be understood as suicide.”
But of course, the data don’t bear this out, so we’re really just laboring under the misperception of control.
“If there is a lesson here it has to do with humility. For all our vaunted intelligence and “complexity,”we are not the sole authors of our destinies or of anything else. You may exercise diligently, eat a medically fashionable diet, and still die of a sting from an irritated bee. You may be a slim, toned paragon of wellness, and still a macrophage within your body may decide to throw in its lot with an incipient tumor.”
It’s at this gloomy but accurate point that the book veers from good and expected to completely unexpected and wildly interesting. Basically, she thinks we have been thinking about death all wrong. This, for me, was one of the most powerful lines in the book:
“You can think of death bitterly or with resignation, as a tragic instruction of your life, and take every possible measure to postpone it. Or, more realistically, you can think of life and an interruption of an eternity of personal nonexistence, and seize it as a brief opportunity to observe and interact with the living, ever surprising world around us.”
She bases this realignment on the notion that the world “lives” in a very different way than humans, creatures blessed (or cursed) with self-awareness and, therefore, with the conception of our own mortality, and following faulty and incomplete blue-prints (diet, exercise, medical interventions) to preserve our lives.
“So much, then, for the hours—and years—you may have devoted to fitness. The muscles that have been so carefully sculpted and toned stiffen when calcium from the dead body leaks into them, causing rigor mortis, and loosening only when decomposition sets in. The organs we nurtured with supplements and superfoods abandon their appointed functions. The brain we have tamed with mindfulness exercises goes awry within minutes after the heart stops beating.”
And from there, it’s but a short stretch to a metaphysical reversal of our current scientific approach that sees humans as above nature:
“The scientific argument, in other words, is that the attribution of agency to the natural world was a mistake, although a useful one in an evolutionary sense. I am suggesting, to the contrary, that it was the notion of nature as a passive, ultimately inert mechanism that was the mistake, and perhaps the biggest one that humans ever made.”
From that recognition, death takes on a new meaning and our fear of it could, possibly, begin to wane.
“It is one thing to die into a dead world and, metaphorically speaking, leave one’s bones to bleach on 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 religions—have caught glimpses of this animate universe, death is not a terrifying leap into the abyss, but more like an embrace of ongoing life.”
This book is not for everyone. It’s not a self-help book to live a longer, healthier, more mindful life. And it’s not a (much-needed) takedown of the health careand self-help industry. Instead, it’s a carefully constructed philosophic and scientific inquiry into how we can find joy in an apathetic and often hostile world of diseases and accidents and physical and mental degradation and decline ending always in death.
It’s a powerful read and highly recommended.