Barbara Ehrenreich cuts an unusual figure in American culture. A prominent radical who never became a liberal, a celebrity, or a reactionary, who built a successful career around socialist-feminist writing and activism, she embodies an opportunity that was lost when the New Left went down to defeat. Since the mid-1970s she has devoted her work to an unsparing examination of what she viewed as the self-involvement of her professional, middle-class peers: from their narcissism and superiority in Fear of Falling and Nickel and Dimed to their misplaced faith in positive thinking in Bright-Sided. Again and again, she has offered a critique of the world they were making and leaving behind them. She is, in other words, both a boomer and the opposite.
At first glance, her new book, Natural Causes, is a polemic against wellness culture and the institutions that sustain it. What makes the argument unusual is its embrace of that great humbler, the end of life. “You can think of death bitterly or with resignation ... and take every possible measure to postpone it,” she offers at the beginning of the book. “Or, more realistically, you can think of life as 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.” With a winning shrug, she declares herself “old enough to die” and have her obituary simply list “natural causes.”
Ehrenreich contemplates with some satisfaction not just the approach of her own death but also the passing of her generation. As the boomers have aged, denial of death, she argues, has moved to the center of American culture, and a vast industrial ecosystem has bloomed to capitalize on it. Across twelve chapters, Ehrenreich surveys the health care system, the culture of old age, the world of “mindfulness,” and the interior workings of the body itself, and finds a fixation on controlling the body, encouraged by cynical and self-interested professionals in the name of “wellness.” Without opposing reasonable, routine maintenance, Ehrenreich observes that the care of the self has become a coercive and exploitative obligation: a string of endless medical tests, drugs, wellness practices, and exercise fads that threaten to become the point of life rather than its sustenance. Someone, obviously, is profiting from all this.
While innumerable think pieces have impugned millennials’ culture of “self-care”—and argued that the generation born in the 1980s and ’90s is fragile, consumerist, and distracted—Ehrenreich redirects such criticisms toward an older crowd. Her book sets out to refute the idea that it’s possible to control the course and shape of one’s own biological or emotional life, and dissects the desire to do so. “Agency is not concentrated in humans or their gods or favorite animals,” she writes. “It is dispersed throughout the universe, right down to the smallest imaginable scale.” We are not, that is, in charge of ourselves. (...)
Natural Causes opens with her decision to reject a series of medical interventions. Ehrenreich is in her seventies and has survived breast cancer but, “in the last few years,” she writes, she has “given up on the many medical measures—cancer screenings, annual exams, Pap smears, for example—expected of a responsible person with health insurance.” She describes making this choice after a series of troubling experiences: First, her primary care doctor talked her into a bone scan, then diagnosed her with osteopenia—thinning of the bones—“a condition that might have been alarming if I hadn’t found out that it is shared by nearly all women over the age of thirty-five.” Bone scans, though, have been heavily promoted by the manufacturer of the osteopenia drug, which itself turns out to cause bone thinning. Next, she got a false positive on a mammogram and decided never to get another.
Even though she showed no signs of sleep apnea, her dentist wanted her to get a test for it, “after which I could buy the treatment from her: a terrifying skull-shaped mask that would supposedly prevent sleep apnea and definitely extinguish any last possibility of sexual activity.” The risk of sudden death in her sleep, she decides, is tolerable. She turns down colonoscopies, certain that she’ll die of something else before colon cancer kills her anyway. She fires her doctor after he suspends his ordinary practice and offers “concierge care” instead—pricey, constant access and a heightened testing regime.
Ehrenreich, who has a Ph.D. in cell biology, isn’t opposed to scientific medicine. But she is alert to the power dynamics that characterize a patient-doctor relationship and the ways those dynamics can influence patients’ decisions: Some will seek or accept treatments that won’t help with their condition, simply because so much power is invested in the doctor. Ehrenreich quotes at length from a 1956 article titled “Body Rituals of the Nacirema” (“American” backwards), which describes an American hospital through an ethnographer’s eye:
A bit wryly, Ehrenreich points out that she’s not the anti-empirical one in this debate. Doctors have been quite resistant to so-called “evidence-based medicine”—the disbursement of treatment according to quantitative evidence rather than medical discretion. And, accustomed to the present system, many patients now worry that anything less than constant testing and maximal intervention would leave them at risk: “An internist in Burlington, North Carolina, reports that when he told a 72-year-old patient that she did not need many of the tests she was expecting in her annual physical, she wrote a letter to the local paper about him as an example of ‘socialized medicine.’ ” Doctors and hospitals use these expectations to drive up demand and prices, and patients, afraid and intimidated, submit.
The way Americans assent to such treatments fits more broadly into a culture of arduous self-improvement regimens. Here, Ehrenreich speaks as an inveterate gym rat, a participant in the astonishing rise of the workout since the 1970s. She sees the ascent of exercise culture in part as a continuation of women’s reclamation of their bodies in the 1970s, and in part as an example of the retreat from public concerns and move toward individualism that many of her peers made around the same time. “I may not be able to do much about grievous injustice in the world, at least not by myself or in very short order, but I can decide to increase the weight on the leg press machine by twenty pounds and achieve that within a few weeks,” she writes. “The gym, which once looked so alien and forbidding to me, became one of the few sites where I could reliably exert control.” What was a consolation, however, quickly evolved into a prize. Working out became a status symbol, a form of conspicuous consumption for a professional middle class bereft of purpose; and it became a disciplinary device, part of a culture that inflicts “steep penalties for being overweight.”
Once associated with play, exercise is now closer to a form of labor: measured, timed, and financially incentivized by employers and insurers. Like any kind of alienated labor, it assumes and intensifies the division between mind and body—indeed, it involves a kind of violence by the mind against the body. Ehrenreich is tired of being told to “crush your workout,” of being urged to develop “explosive strength” through a “warrior” routine. She cites the copy from an advertisement for a home fitness machine: “A moment of silence please, for my body has no idea what I’m about to put it through.” Exercise, for some reason, has become a struggle to the death. As Oscar Pistorius—the amputee and Olympic runner convicted of murder in 2015—has tattooed on his back, “I beat my body and make it my slave / I bring it under my complete subjection.”
While workout culture requires the strict ordering of the body, mindfulness culture has emerged to subject the brain to similarly stringent routines. Mindfulness gurus often begin from the assumption that our mental capacities have been warped and attenuated by the distractions of our age. We need re-centering. Mindfulness teaches that it is possible through discipline and practice to gain a sense of tranquility and focus. Such spiritual discipline, often taking the form of a faux-Buddhist meditation program, can of course be managed through an app on your phone, or, with increasing frequency, might be offered by your employer. Google, for example, keeps on staff a “chief motivator,” who specializes in “fitness for the mind,” while Adobe’s “Project Breathe” program allocates 15 minutes per day for employees to “recharge their batteries.” This fantastical hybrid of exertion and mysticism promises that with enough effort , you too can bend your mind back into shape.
“Whichever prevails in the mind-body duality, the hope, the goal—the cherished assumption,” Ehrenreich summarizes, “is that by working together, the mind and the body can act as a perfectly self-regulating machine.” In this vision, the self is a clockwork mechanism, ideally adapted by natural selection to its circumstances and needing upkeep only in the form of juice cleanses, meditation, CrossFit, and so on. Monitor your data forever and hope to live forever. Like workout culture, wellness is a form of conspicuous consumption. It is only the wealthy who have the resources to maintain the illusion of an integral and bounded self, capable of responsible self-care and thus worthy of social status. The same logic says that those who smoke (read: poor), or don’t eat right (poor again), or don’t exercise enough (also poor) have personally failed and somehow deserve their health problems and low life expectancy.
Of course, the body cannot really be mastered this way. For Ehrenreich, in fact, the body is not even a single thing, but rather a continuous, contradictory process. Immunology—her academic specialty—hinges on an essentially military metaphor of distinction between self and nonself: The immune system protects the homeland by destroying invaders. What, then, are we to make of routine episodes of intrabody conflict? There are obvious cases, such as cancer and autoimmune disorders. But Ehrenreich points out that even something as ordinary as menstruation appears to be the product of the adaptive struggle over resources between mother and fetus, an “arms race ... between the human endometrium and the human embryo/placental combination.” The body, like the body politic pictured on the frontispiece of Hobbes’s Leviathan, only gives the appearance of unity: It’s made of a “collection of tiny selves.” And for that matter, there’s not really a king to impose order. (...)
But Ehrenreich’s universe hums with life and activity. It’s warm, not cold. She wants to join it in her final years, not leave it behind by cloistering herself in the clinic, the gym, or the spa. For the elderly today, “the price of survival is endless toil” to keep fit, along with incessant trips to the doctor and avoiding all good food, right up till death. She’s not interested. She still works out, though less intensely than before, and she stretches every day—some of it even “might qualify as yoga.” “Other than that, I pretty much eat what I want and indulge my vices, from butter to wine. Life is too short to forgo these pleasures, and would be far too long without them.”
At first glance, her new book, Natural Causes, is a polemic against wellness culture and the institutions that sustain it. What makes the argument unusual is its embrace of that great humbler, the end of life. “You can think of death bitterly or with resignation ... and take every possible measure to postpone it,” she offers at the beginning of the book. “Or, more realistically, you can think of life as 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.” With a winning shrug, she declares herself “old enough to die” and have her obituary simply list “natural causes.”
Ehrenreich contemplates with some satisfaction not just the approach of her own death but also the passing of her generation. As the boomers have aged, denial of death, she argues, has moved to the center of American culture, and a vast industrial ecosystem has bloomed to capitalize on it. Across twelve chapters, Ehrenreich surveys the health care system, the culture of old age, the world of “mindfulness,” and the interior workings of the body itself, and finds a fixation on controlling the body, encouraged by cynical and self-interested professionals in the name of “wellness.” Without opposing reasonable, routine maintenance, Ehrenreich observes that the care of the self has become a coercive and exploitative obligation: a string of endless medical tests, drugs, wellness practices, and exercise fads that threaten to become the point of life rather than its sustenance. Someone, obviously, is profiting from all this.While innumerable think pieces have impugned millennials’ culture of “self-care”—and argued that the generation born in the 1980s and ’90s is fragile, consumerist, and distracted—Ehrenreich redirects such criticisms toward an older crowd. Her book sets out to refute the idea that it’s possible to control the course and shape of one’s own biological or emotional life, and dissects the desire to do so. “Agency is not concentrated in humans or their gods or favorite animals,” she writes. “It is dispersed throughout the universe, right down to the smallest imaginable scale.” We are not, that is, in charge of ourselves. (...)
Natural Causes opens with her decision to reject a series of medical interventions. Ehrenreich is in her seventies and has survived breast cancer but, “in the last few years,” she writes, she has “given up on the many medical measures—cancer screenings, annual exams, Pap smears, for example—expected of a responsible person with health insurance.” She describes making this choice after a series of troubling experiences: First, her primary care doctor talked her into a bone scan, then diagnosed her with osteopenia—thinning of the bones—“a condition that might have been alarming if I hadn’t found out that it is shared by nearly all women over the age of thirty-five.” Bone scans, though, have been heavily promoted by the manufacturer of the osteopenia drug, which itself turns out to cause bone thinning. Next, she got a false positive on a mammogram and decided never to get another.
Even though she showed no signs of sleep apnea, her dentist wanted her to get a test for it, “after which I could buy the treatment from her: a terrifying skull-shaped mask that would supposedly prevent sleep apnea and definitely extinguish any last possibility of sexual activity.” The risk of sudden death in her sleep, she decides, is tolerable. She turns down colonoscopies, certain that she’ll die of something else before colon cancer kills her anyway. She fires her doctor after he suspends his ordinary practice and offers “concierge care” instead—pricey, constant access and a heightened testing regime.
Ehrenreich, who has a Ph.D. in cell biology, isn’t opposed to scientific medicine. But she is alert to the power dynamics that characterize a patient-doctor relationship and the ways those dynamics can influence patients’ decisions: Some will seek or accept treatments that won’t help with their condition, simply because so much power is invested in the doctor. Ehrenreich quotes at length from a 1956 article titled “Body Rituals of the Nacirema” (“American” backwards), which describes an American hospital through an ethnographer’s eye:
Few supplicants [patients] in the temple are well enough to do anything but lie on their hard beds. The daily ceremonies, like the rites of the holy-mouth-men [dentists], involve discomfort and torture. With ritual precision, the vestals awaken their miserable charges each dawn and roll them about on their beds of pain while performing ablutions, in the formal movements of which the maidens are highly trained. At other times they insert magic wands in the supplicant’s mouth or force him to eat substances which are supposed to be healing. From time to time the medicine men come to their clients and jab magically treated needles into their flesh.Stripped of the authority of Western medicine, the treatments the article describes sound like cruel rituals. “The fact that these temple ceremonies may not cure, and may even kill the neophyte,” the article goes on, “in no way decreases the people’s faith in the medicine men.”
A bit wryly, Ehrenreich points out that she’s not the anti-empirical one in this debate. Doctors have been quite resistant to so-called “evidence-based medicine”—the disbursement of treatment according to quantitative evidence rather than medical discretion. And, accustomed to the present system, many patients now worry that anything less than constant testing and maximal intervention would leave them at risk: “An internist in Burlington, North Carolina, reports that when he told a 72-year-old patient that she did not need many of the tests she was expecting in her annual physical, she wrote a letter to the local paper about him as an example of ‘socialized medicine.’ ” Doctors and hospitals use these expectations to drive up demand and prices, and patients, afraid and intimidated, submit.
The way Americans assent to such treatments fits more broadly into a culture of arduous self-improvement regimens. Here, Ehrenreich speaks as an inveterate gym rat, a participant in the astonishing rise of the workout since the 1970s. She sees the ascent of exercise culture in part as a continuation of women’s reclamation of their bodies in the 1970s, and in part as an example of the retreat from public concerns and move toward individualism that many of her peers made around the same time. “I may not be able to do much about grievous injustice in the world, at least not by myself or in very short order, but I can decide to increase the weight on the leg press machine by twenty pounds and achieve that within a few weeks,” she writes. “The gym, which once looked so alien and forbidding to me, became one of the few sites where I could reliably exert control.” What was a consolation, however, quickly evolved into a prize. Working out became a status symbol, a form of conspicuous consumption for a professional middle class bereft of purpose; and it became a disciplinary device, part of a culture that inflicts “steep penalties for being overweight.”
Once associated with play, exercise is now closer to a form of labor: measured, timed, and financially incentivized by employers and insurers. Like any kind of alienated labor, it assumes and intensifies the division between mind and body—indeed, it involves a kind of violence by the mind against the body. Ehrenreich is tired of being told to “crush your workout,” of being urged to develop “explosive strength” through a “warrior” routine. She cites the copy from an advertisement for a home fitness machine: “A moment of silence please, for my body has no idea what I’m about to put it through.” Exercise, for some reason, has become a struggle to the death. As Oscar Pistorius—the amputee and Olympic runner convicted of murder in 2015—has tattooed on his back, “I beat my body and make it my slave / I bring it under my complete subjection.”
While workout culture requires the strict ordering of the body, mindfulness culture has emerged to subject the brain to similarly stringent routines. Mindfulness gurus often begin from the assumption that our mental capacities have been warped and attenuated by the distractions of our age. We need re-centering. Mindfulness teaches that it is possible through discipline and practice to gain a sense of tranquility and focus. Such spiritual discipline, often taking the form of a faux-Buddhist meditation program, can of course be managed through an app on your phone, or, with increasing frequency, might be offered by your employer. Google, for example, keeps on staff a “chief motivator,” who specializes in “fitness for the mind,” while Adobe’s “Project Breathe” program allocates 15 minutes per day for employees to “recharge their batteries.” This fantastical hybrid of exertion and mysticism promises that with enough effort , you too can bend your mind back into shape.
“Whichever prevails in the mind-body duality, the hope, the goal—the cherished assumption,” Ehrenreich summarizes, “is that by working together, the mind and the body can act as a perfectly self-regulating machine.” In this vision, the self is a clockwork mechanism, ideally adapted by natural selection to its circumstances and needing upkeep only in the form of juice cleanses, meditation, CrossFit, and so on. Monitor your data forever and hope to live forever. Like workout culture, wellness is a form of conspicuous consumption. It is only the wealthy who have the resources to maintain the illusion of an integral and bounded self, capable of responsible self-care and thus worthy of social status. The same logic says that those who smoke (read: poor), or don’t eat right (poor again), or don’t exercise enough (also poor) have personally failed and somehow deserve their health problems and low life expectancy.
Of course, the body cannot really be mastered this way. For Ehrenreich, in fact, the body is not even a single thing, but rather a continuous, contradictory process. Immunology—her academic specialty—hinges on an essentially military metaphor of distinction between self and nonself: The immune system protects the homeland by destroying invaders. What, then, are we to make of routine episodes of intrabody conflict? There are obvious cases, such as cancer and autoimmune disorders. But Ehrenreich points out that even something as ordinary as menstruation appears to be the product of the adaptive struggle over resources between mother and fetus, an “arms race ... between the human endometrium and the human embryo/placental combination.” The body, like the body politic pictured on the frontispiece of Hobbes’s Leviathan, only gives the appearance of unity: It’s made of a “collection of tiny selves.” And for that matter, there’s not really a king to impose order. (...)
But Ehrenreich’s universe hums with life and activity. It’s warm, not cold. She wants to join it in her final years, not leave it behind by cloistering herself in the clinic, the gym, or the spa. For the elderly today, “the price of survival is endless toil” to keep fit, along with incessant trips to the doctor and avoiding all good food, right up till death. She’s not interested. She still works out, though less intensely than before, and she stretches every day—some of it even “might qualify as yoga.” “Other than that, I pretty much eat what I want and indulge my vices, from butter to wine. Life is too short to forgo these pleasures, and would be far too long without them.”
