In her latest book, “Natural Causes,” Ehrenreich takes on the medical establishment, along with some less respectable institutions. As the Victorian-length subtitle suggests — “An Epidemic of Wellness, the Certainty of Dying, and Killing Ourselves to Live Longer” — “Natural Causes” is a work of sweeping social critique. Ehrenreich’s stated target is the fantasy that we can cheat the ravages of age and death. Fair enough. She directs a goodly portion of her wrath at the American candy store of quackeries: the “mindfulness” industry; Silicon Valley-style “biohacks” meant to engineer immortality; integrative holistic health; the mania for fitness (even though the author admits to being something of a gym rat herself).
“Natural Causes” asks us to accept that our bodies defy our control. Ehrenreich bases her case on a new paradigm in scientific thought which argues that, contrary to popular belief, the body is not a unified army able to repel dangerous invaders, but “at best a confederation of parts … that may seek to advance their own agendas.” Moreover, the immune system may be our enemy, not our friend. In her youth, Ehrenreich earned a Ph.D. in cell biology. Her subject was macrophages, big, hungry cells on the front lines of the defense. (“Macro” means big; “phage” means to devour.) “To me as a lowly graduate student,” she writes, “they were heroes, always rushing out fearlessly to defend the body against microbes or other threats.” Disillusionment occurred about a decade ago, when she read an article in Scientific American reporting that macrophages, previously thought to gobble up cancerous tumors, sometimes feed them instead, then send them off to wreak their merry havoc. Rather than massing for an assault, these macrophages, she writes, “are cheerleaders on the side of death.”
This is “cellular treason,” she says, and acknowledging the body’s betrayal means letting go of the fantasy that order can be imposed on chaos. Ehrenreich moves swiftly, to my mind too swiftly, from the metaphor of intrabody conflict to critiques of religion, psychology, philosophy and our cheerful American worldview. She has come to lay waste to utopian fallacies, she says, and replace them with dystopian realities. She contests almost everything that promises harmony between mind and body, self and world, God and universe. Remarkably, she begins her crusade with antiquity, specifically monotheism, which installed a single god to rein in an unruly pantheon. She skips ahead to the Enlightenment and the emergence of the notion of a unified self, and from there to 20th-century science, which regarded nature as a thing to be dissected and tamed, rather than as a multitude of rebellious forces animated by something like will.
The book concludes with an admonition to die well. We must undo the clutch of the ego and free ourselves of tortuous end-of-life interventions, finding comfort instead in the richness of the universe that will survive us. “It is one thing to die into a dead world and, metaphorically speaking, leave one’s bones to bleach on a desert lit only by a dying star,” she writes elegiacally. “It is another thing to die into the actual world, which seethes with life, with agency other than our own, and at the very least, with endless possibility.”
You can’t begrudge Ehrenreich her effort to assuage our and her own fears about mortality, even if her historical chapters sometimes read like freshman surveys. But “Natural Causes” has another message, and it’s decidedly questionable. Now that Ehrenreich has come to terms with her own decline (she’s 76), she says, she has grown deeply skeptical of modern medicine. In the first chapter, Ehrenreich, a breast cancer survivor, confides that she has given up on cancer checkups, mammograms and Pap smears. She has never gotten around to having a colonoscopy. “This was not based on any suicidal impulse,” she assures us. At first, she worried that she was just a slacker. Later, though, she realized that she had been put off by too many doctors pushing too many procedures and panaceas: tests for sleep apnea, medication for the thinning of the bones, dental X-rays. Moreover, as a woman, she had experienced a great deal of medical condescension. When a pregnant Ehrenreich, who already had her Ph.D., asked her obstetrician how much her cervix had dilated, he turned to the nurse and asked: “Where did a nice girl like this learn to talk like that?” A pediatrician prescribed one of her children unnecessary antibiotics to assuage the “nervous mother.” Medicine is puffed up with its own importance and obsessed with profit, she says, and she, for one, does not intend to spend her remaining days enacting its “ritual of domination and submission,” “in windowless waiting rooms and under the cold scrutiny of machines.”