“For all our vaunted intelligence and ‘complexity’, we are not the sole authors of our destinies or anything else.”
Natural Causes: Life, Death and the Illusion of Control, by Barbara Ehrenreich, is a sometimes provocative but genuinely questioning exploration of modern western attitudes to health, fitness and ageing. The author is a doctor although not of medicine, holding a PhD in cellular immunology. She writes from a personal but also knowledgeable perspective.
Starting with the increase in routine healthcare testing and screening now expected of supposedly sensible citizens, she explains why she has opted out of those she has a choice in taking (living in America some tests are required for medical insurance). She has decided that, having reached an age where she considers death could be deemed acceptable, she prefers to enjoy her life and not spend what time remains anticipating its end.
The book in no way rejects the worth of advances in modern medicine but rather questions the intense preoccupation so many have with attempting to control their health. She points out the lack of correlation between many diet and fitness fads and increased longevity. She notes that medical interventions can also produce harmful side effects, at times triggering conditions they aim to prevent becoming deadly.
Written with a dry wit she opens by looking at a number of screening tests carried out on women which are unpleasant, invasive and of dubious worth. The trust placed in doctors has granted them a power over other’s bodies that makes questioning what they do appear an act of foolishness, the patient marked down as uncooperative.
“Physicians have an excuse for flouting the normal rules of privacy”
Back in 1971 patients started asking why certain demarcations were necessary and examining themselves
“many doctors were outraged with me arguing that in lay hands a speculum was unlikely to be sterile, to which feminist writer Ellen Frankfort replied cuttingly that yes, of course, anything that enters the vagina should first be boiled for at least ten minutes.”
As well as questioning the usefulness of tests the author discusses over-treatment and the marketing of alternative medicines. She then moves on to the exponential growth in the use of gyms and other such facilities in the late twentieth century.
“a fashionable segment of the society had taken up a new project – themselves”
She writes that what resulted was women being masculinised, men feminised and all increasingly objectified. Unfit behaviour signified lower-class status, as did certain food choices. In fitness culture there was a separation
“in which mind struggles for control over the lazy, recalcitrant body”
Such attitudes spread into the workplace where incentives were offered to employees presented as workplace perks. Weight and size became a measure of ability.
“But there’s a darker, more menacing side to the preoccupation with fitness, and this is the widespread suspicion that if you can’t control your own body you’re not fit, in any sense, to control anyone else”
The increasingly vocal and judgemental public looked at healthcare costs and taxation, deciding that blame could be apportioned to those needing treatment.
“the less-than-fit person is a suitable source not only of revulsion but resentment”
The mega-wealthy and self proclaimed smart elites, particularly those in Silicon Valley, started looking for ways to achieve immortality, asking in all seriousness
“why should you ever die?”
The author points out, in case any reader needs reminding, that death happens anyway and often from the causes the various personal projects have worked so hard to avoid – cancer, heart failure, autoimmune diseases. However it is looked after, the human body continues to function in unpredictable ways.
The focus of the writing moves on to mindfulness where the brain, as a muscle, is given repeated work-outs to affect change. The mind is also affected by its bombardment of negative attitudes towards those who do not look or act as proponents of health and fitness expect.
“Still we persist in subjecting anyone who dies at a seemingly untimely age to a kind of bio-moral autopsy: Did she smoke? Drink excessively? Eat too much fat and not enough fiber? Can she, in other words, be blamed for her own death?”
This is particularly noticeable in commentary on the lifestyles of those living in poverty whilst rarely looking at the reasons for their choices.
“Concern for the poor usually comes tinged with criticism.”
Having explored the efforts influential segments of society put into caring for their bodies, the author then turns attention to why they continue to die anyway. She explains how cells grow and change, how certain cells work to clean up but can mutate.
“Deadly combat among cells is part of how the body, and especially the human body, conducts its normal business”
Towards the end she steps back from this preoccupation with self quoting Stephen Hawking.
“We are the product of quantum fluctuations in the very early universe”
A human being is a building block of matter, existing for a time and with some perhaps contributing to the natural order in some unremarkable, minuscule way. Before and after, the universe continues.
Throughout the narrative sources are cited for readers wishing to dig deeper into the claims made. I felt at times that accuracy was simplified for the sake of readability but this remains an interesting subject presented in a mostly cogent, always accessible way. It is not a polemic against any of the topics covered but rather an invitation to question why we accept certain widely held views, ceding to demands made. It advocates for choice, to live and enjoy life before those recalcitrant cells call time, as they inevitably will.
My copy of this book was provided gratis by the publisher, Granta.