Natural Causes: Life, Death And The Illusion Of Control

Barbara Ehrenreich

Granta, £16.99

Review by Susan Flockhart

"LOOK after yourself" may be an affectionate form of farewell in Scotland, but across much of the affluent world, the exhortation to attend to one's wellbeing can increasingly be seen as a kind of secular commandment; a stern reminder that it’s our moral duty to nourish, exercise and monitor our bodies to the extent that neither disease nor advancing decrepitude has a hope of taking root.

So argues Barbara Ehrenreich, the American social commentator who ripped the positive thinking movement to shreds in 2009's Smile Or Die, and now does the same for preventative healthcare. In her sparky new book, Natural Causes, she argues that the cult of wellbeing has gone so far that failure to exercise maniacally, binge on quinoa and submit to endless medical screening tests is effectively an invitation to early death. What's more, now that the evangelical pursuit of self-preservation extends well into old age, giving in to mortality becomes a kind of failure, so that “every death can … be considered suicide”.

If Ehrenreich’s reductio ad absurdum seems extreme, consider that there is now a large publishing sector dedicated to books on “successful ageing” – which effectively means not ageing at all - and that in the US at least, screening tests such as mammography are now offered to centenarians.

Natural Causes is a logical successor to Smile Or Die, in which Ehrenreich railed against the exhortation to fight cancer with positive thinking, the implied corollary being that anyone who succumbs to the disease is guilty of a failure of will. Her latest book takes aim at the contemporary notion that not only can we combat disease with the right attitude, we can also prevent it - but only if we dedicate our lives to the pursuit.

A cancer survivor and one-time fitness obsessive who is now in her eighth decade, Ehrenreich has opted out. In fact, she has pasted a figurative “do not resuscitate” notice across her own existence, declaring that she is “giving up on preventive care” and refusing to accept a “medicalised life”. “As the time that remains to me shrinks,” she writes, “each month and day becomes too precious to spend in windowless waiting rooms and under the cold scrutiny of machines. Being old enough to die is an achievement, and the freedom it brings is worth celebrating.”

The book's subtitle is Life, Death And The Illusion Of Self Control, and Ehrenreich’s thesis is that the lucrative “wellness industry" – fuelled in the US by the demands of private medical insurance companies – profits hugely by peddling the delusion that we can achieve mastery over the human body when, as she reminds us, the list of earnest fitness fanatics who died young is long. Take Rockefeller Foundation director John H Knowles, who declared illness to be the result of “gluttony, alcoholic intemperance, reckless driving, sexual frenzy and smoking” – only to die of pancreatic cancer, aged 58.

The truth, Ehrenreich reminds us, is that “we are not the sole authors of our destinies … You may exercise diligently, eat a medically fashionable diet, and still die of a sting from an irritated bee”.

She's right, of course, but isn't prevention better - and cheaper - than cure? Ehrenreich's point is that we are pushing that old adage to breaking point, and the artillery of expensive health monitoring equipment often does more harm than good. And while the UK screening "industry" may be less advanced than that of the US, where routine annual medical checks are demanded by many insurers, these tests do account for an increasing proportion of our NHS resources - which means sooner or later, tough conversations will need to be had about their cost effectiveness.

A former microbiology student, Ehrenreich takes a jaundiced view of doctors. She sees the white coat as symbolic of "mastery and control" and attempts to puncture medical arrogance with biochemical evidence that the human body may ultimately be ungovernable. Macrophages - microbes hitherto believed to play an important role in combating cancers – have apparently been caught aiding the growth of tumours, proving that even the body's immune system is capable of treason against its host and that when it comes to gaining ultimate control over our mortality, the game's a bogey.

That, at least, is my interpretation of this complicated argument, though I'm not sure I quite got it – or Ehrenreich's gallant attempt to make death itself seem more palatable by suggesting that if only we could let go of our egotistical perception of ourselves as the centre of the universe, dying would seem like a kind of reintegration with nature, rather than the terrifying obliteration of the thing we call "me".

Still, Ehrenreich is surely on to something with her caricature of narcissistic, affluent Westerners who, having failed to master the world, make do with controlling their own bodies, all the while flaunting the toned abs and vitamin shakes that are today's status symbols, and sneering at the junk-eating poor. Chef Jamie Oliver is named among the cheerleaders of this trend, as are “celebrity wellness entrepreneurs” such as Gwyneth Paltrow. However as Ehrenreich reminds us, you can log every footstep on your FitBit and swallow every gut-balancing, longevity-inducing elixir on Paltrow’s "lifestyle" website, but sooner or later, you'll be down there pushing up the daisies with the pie-munching gym-dodgers.

Sound gloomy? It isn't. Ehrenreich's bottom line is that if "the price of survival is endless toil", we may as well give up and enjoy our brief ride towards the inevitable. And with Natural Causes, she leads us on a journey that is anarchic, funny and fizzing with the joy of living..