Book Details ‘Epidemic of Wellness’ in U.S.

  • Natural Causes: An Epidemic of Wellness, the Certainty of Dying, and Killing Ourselves to Live Longer

The Washington Post
Friday, May 11, 2018

Americans have a history of obsession with fads designed to help us live forever. But to what end? Death, notes Barbara Ehrenreich in her new book, Natural Causes: An Epidemic of Wellness, the Certainty of Dying, and Killing Ourselves to Live Longer, still awaits us all. In this lively cultural history of our attempts to control our fate, she details the extreme lengths we will go to keep from dying.

Take the idea of preventive medicine, based upon the seemingly helpful notion that the regular physical or mammogram can detect an illness before it takes over and kills us. Yet when Ehrenreich was diagnosed with osteopenia, or thinning of the bones, for which an expensive pharmaceutical product was indicated, rather than being a compliant patient she decided to dig a little deeper. Osteopenia, it turns out, is common in anyone over age 35, and the medicine prescribed for her “condition” was later shown to advance bone degeneration. “A cynic might conclude,” she writes, “that preventive medicine exists to transform people into raw material for a profit-hungry medical-industrial complex.”

Ehrenreich compares doctors’ examinations to rituals that serve as much to cement the social order and the authority of physicians as they do to advance healing. For women in particular, physical exams have historically been invasive and frequently humiliating, and often with unproven results. In the 1970s, consumer advocates discovered that many medical tests were performed without scientific proof of their effectiveness, leading to a demand that such testing be justified. Yet a number of common procedures are still done despite questionable evidence that they prevent deaths. Challenging the received wisdom that early detection saves lives, Ehrenreich, who was diagnosed with breast cancer at the turn of the millennium, cites repeated international studies indicating that mammograms have not been shown to reduce mortality from breast cancer and even expose women unnecessarily to cancer-causing levels of radiation. Similar issues arise with screenings for prostate and colon cancer.

Beyond the doctor’s office, Ehrenreich takes us into the world of wellness, where, from CrossFit to gluten-free diets, we obsessively follow the latest trends that promise eternal health. She traces this “surge of interest in physical fitness” to the 1980s, when disillusionment with the failure of the 1960s counterculture movement led to a turning inward, a type of self-involvement “where if you could not change the world or even chart your own career, you could still control your own body.” For women, accustomed to decades of societal domination, “ ‘control over one’s body’ could be understood as a serious political goal.” Jane Fonda led the charge with her massively popular aerobics videos, accompanied by the rise of a multibillion-dollar empire of gyms and fitness centers. There are obvious social class dimensions, as working out became “another form of conspicuous consumption” while “unfit behavior like smoking or reclining in front of the TV with a beer signified lower-class status.” (Never mind, she notes, that the poor are too busy working to have time to exercise.) Cynically, Ehrenreich observes that the $6 billion industry of employee wellness programs, which aim to reduce employer health insurance expenditures, has no measurable impact on corporations’ health care spending.

Even another apparently positive development, the rising popularity of mindfulness, is nothing more in Ehrenreich’s eyes than a corporate attempt (originating in Silicon Valley, arguably the source of the problem) to shift our attention away from addictive electronic devices and improve our focus on productivity. The answer to a world of rapidly decreasing attention spans is “mass-market mindfulness,” disseminated through a “swarm of apps” available to those unable to afford the pricey meditation retreats favored by the Silicon Valley elite. “This is Buddhism,” Ehrenreich writes, “sliced up, commodified, and drained of all reference to the transcendent.” However, as with cancer screenings, yearly physicals and corporate wellness programs, Ehrenreich writes that large studies have shown that meditation is no more effective for stress than muscle relaxation, medication or psychotherapy. (There is also no scientific evidence that positive thinking can prolong life.)

Finally, Ehrenreich turns to the gnarly problem of death, which we seem to think we can stave off by dutifully adopting a healthy lifestyle. Culturally, many believe that bad choices (whether sugar, carbs, fats or cigarettes) are to blame for an early demise. Ehrenreich traces this insistence on personal responsibility to the collective shift away from the notion of a divine cause for unfortunate events and toward the idea that we are masters of our own fates. Yet ironically, many of the most prominent advocates of healthy lifestyles have nevertheless died, often early or from the types of diseases their lifestyles were supposed to prevent. Lucille Roberts, the nonsmoking owner of a women’s fitness chain, died from lung cancer, and Jerome Rodale, the organic-food devotee and creator of Prevention magazine, suffered a heart attack. Even Steve Jobs’ vegan diet did not save him from pancreatic cancer. So what gives?

In the final section of the book, Ehrenreich, who holds a Ph.D. in cellular immunology, switches to biology to demonstrate the futility of our quest for immortality. Our tendency to envision the body as a smoothly functioning system leaves no room for us to conceptualize how, for example, cells such as macrophages, whose usual role is to devour invading microbes or dead cells at the site of wounds, can also turn against us, supplying cancer cells with the material needed to grow and generally acting as “cheerleaders on the side of death.” Sometimes, despite our best efforts to think positively and treat the body like a temple, it nonetheless betrays us.

If all the yoga classes and paleo diets in the world can’t save us, then what prevents us from descending into total nihilism? For Ehrenreich, the answer seems to be that we should relax and enjoy being part of this complex world, rather than stressing about how to stay in it as long as possible. This book takes an important, albeit uncomfortable, look at the health-seeking practices of our era, documenting the tendency toward self-righteous cultural absolutism that has always accompanied American health fads.

Nevertheless, although this is not a line of inquiry Ehrenreich pursues, maybe immortality isn’t our only objective. Perhaps in collectively visiting the third spaces provided by gyms or yoga studios, we partake in rituals that point to another goal: the creation of community.

Newcomb is an anthropologist and the Diane and Michael Maher distinguished professor of teaching and learning at Rollins College. She is the author of Everyday Life in Global Morocco.