Natural Causes: Life, Death and the Illusion of Control
By Barbara Ehrenreich | Granta| $39.99 | 249 pages
Some time ago I made up my own private axiom. As axioms go, it wasn’t brilliant, but it somehow caught on. It came out of my experience of the ever-complicated business of keeping healthy and the growing realisation that whatever I did to protect one ageing bodily tissue could very well compromise another. A friend of mine reduced my axiom to three letters, the ETO, standing for the eyebrow-toenail opposition, a commendably shortened version of “What’s good for your eyebrows is bad for your toenails.” Another good friend didn’t accept that I’d made it up, but took it to be a time-honoured Yiddish saying. Perhaps it was, dug from the fatalistic depths of my consciousness.
Whatever its provenance, the big surprise is that it has scientific backing. Indeed, it’s the subject of Natural Causes, Barbara Ehrenreich’s twentieth book.
For those for whom Ehrenreich is not yet a household name, let me introduce her. She began as a biochemist, with a doctoral thesis from one of the top American science labs, but was diverted from that promising career when her university was implicated in supplying chemicals to the military for use in the Vietnam war. In short, she became an activist, and soon made her name as a writer on socio-political themes. She is perhaps best known for Nickled and Dimed: Undercover in Low Wage America, her book-length demonstration that the minimum wage was next to impossible to live on in Clinton-era America. But earlier books, like The American Health Empire: Power, Profits and Politics and Complaints and Disorders: The Sexual Politics of Sickness, drew on her scientific understanding.
With Natural Causes, she’s back in this territory, exposing the myths of today’s “wellness” industry with her usual forensic thoroughness, all the while reminding us that the very fact of being human means dealing with the certainty of death. Even if life expectancy for recent first-world generations has surpassed that of our parents and grandparents, our lengthened lives rely on an inordinate amount of intervention, expenditure and effort. As the demographic bulge of ageing baby boomers looms, government, corporations and middle-class individuals alike have breathed oxygen into the imperative of healthy living, each for reasons of their own. But how healthy living is defined and who is ultimately responsible for it is still unresolved. And for all the concern, all the dietary precautions and fads, all the weights we lift and the kilometres we run, death remains inevitable. What’s more, in a sobering reversal of the assumed natural order of things, it’s beginning to look like the lives of forthcoming generations could turn out shorter than ours have been.
Having survived breast cancer in her fifties, septuagenarian Ehrenreich has spent years forestalling the inevitable by regular sessions at a gym. Two years her senior, I’ve enhanced my mobility with two hip replacements and extended my life by avoiding red meat and alcohol and years of walking and bike-riding. But being faced with relentless, often conflicting advice about the benefits of the many touted practices, supplements, diets and foods has left me wondering how much of what’s left of my life I want to spend on extending it, even assuming I could afford it. Added to this is the growing uncertainty about any of their claims, and a growing appreciation of how little, healthwise, any of us do control.
It’s this persistent, arguably pernicious illusion of control that Ehrenreich has firmly in her sights. A particular target is the contemporary stress on “mindfulness” or “mind–body” wholeness, the widespread belief that health is achieved through a kind of equilibrium or harmony between the mind and the body, a holistic system in which the mind may listen to the body but need never relinquish ultimate control. As ideas go it has merit, but only perhaps as metaphor, to be jettisoned now as the once prevailing “body as machine” has been.
Why this iconoclasm? It all comes out of Ehrenreich’s reading about macrophages, those amazingly efficient little soldiers of our immune systems. These are the proteins that attack invading microorganisms, those viruses and bacilli that make us ill and can even lead to death. Macrophages, in other words, are vital for our survival. But ten years before writing this book Ehrenreich came across an article in Scientific American reporting on studies linking macrophages with cancer. “This changes everything,” she told herself after reading it (the emphasis is hers).
Further investigation followed, suggesting a totally new paradigm. Our bodies at the cellular level are not the perfectly balanced, holistic systems the mindfulness gurus tell us, but are continually poised on the brink of civil war. The same macrophages that defend us against the ravages of infectious diseases are implicated in the spread of cancer and other autoimmune diseases, from multiple sclerosis to osteoporosis and its antithesis, arthritis. Soldiers they are, but “the warriors may get greedy and turn against their people, demanding ever more food and other resources.”
All of this is expounded in fascinating detail in what might be called Ehrenreich’s keystone chapter, “The War Between Conflict and Harmony,” without which the book’s entire edifice could fall. And much to our credit it was an Australian, later to become Sir Frank Macfarlane Burnet, who advanced our understanding by acknowledging the nebulously metaphoric basis of immunology, the most accurate metaphor on offer being that militaristic one. As Ehrenreich writes:
We could say, in retrospect, that Burnet was torn between two paradigms: One, the holistic, utopian one, saw the body or organism as a well-ordered mechanism, evolutionarily ordained to be exactly as it is. In the other emerging paradigm, which could be called dystopian, the organism is a site of constant conflict — as between cancer cells and normal cells or between the immune system and other tissues in the body. The conflict may result in some sort of compromise in which, for example, the disease settles into a chronic condition. Or it may end, sooner rather than later, in the death of the organism.
Apart from what this has meant for treating diseases, the recognition that what may be the cure for one disorder may only make us vulnerable to another does much to dismantle the wellness metaphor, which has been seized on by governments and employers to deal with the disruptive economics posed by ageing populations, and by individuals on the merry-go-round of attempting to postpone an inevitable death. This new understanding of how our cells work raises urgent questions about how best to live one’s life. Exercise, diet, medical monitoring and intervention — all these become increasingly necessary as we age. But a greater appreciation of the ETO should lead us towards a more philosophical approach. If we’re going to die, either from invading microbes or their antibodies gone crazy, we may as order our priorities and spend what time we have doing whatever it is that makes life on this earth worthwhile to us. Within reason, of course, always hedging our bets.
How Ehrenreich manages to pack such a thoroughgoing analysis into 235 pages is a tribute to both her erudition and concision. Natural Causes can be a tough read, but it is a compelling one, and for all of us trying our damnedest to stay alive, a path towards liberation. ●