Barbara Ehrenreich. Photograph by Peter Azbug

This article is a preview from the Summer 2018 edition of New Humanist

Natural Causes: Life, Death and the Illusion of Control (Granta) by Barbara Ehrenreich

In an uncertain world, it seems we find comfort in the idea that the body is in our control. No matter the disappointments swarming beyond the skin, at least we have agency over our bodies and their fate. Read “wellness” blogs, work out, eat your greens, and death won’t be for you, for now. But the American writer and activist Barbara Ehrenreich wants to shake us by the shoulders. In her new book Natural Causes, she unpicks the “quest for control” – from preventative screenings to fitness, mindfulness and outrage at ageing – and urges a new understanding of life, death and the body. At times, it reads like having a tough-talking friend trash your diet, your fitness fetish and your worldview to boot, reminding you that one day you’ll be nothing but “a morsel in a rat’s digestive system”, before giving you a hug and a Brecht poem for cold comfort. A motivational text this is not. It should come with a trigger warning for transhumanists, Gwyneth Paltrow and the generally entitled. But Ehrenreich is no nihilist. Drawing on science, sociology and more, she offers a celebration of pulsing life, and an approach to death superior to denial.

For Ehrenreich, it’s personal. A cancer survivor in her 70s, she started this book at a point where “death was no longer an entirely theoretical prospect”. But she also has a PhD in cellular immunology and ten years ago was sent spinning by a report suggesting that the immune system can actually facilitate tumours. This was “like saying that the fire department is indeed staffed by arsonists”. Ehrenreich had done her graduate research on hard-working Pacman-like immune cells called macrophages and thought them her “friends”. Yet, it now appears, they can enable cancer’s spread.

Far from being a slick unity of components striving for the common good, it seems the body is “at best a confederation of parts – cells, tissues, even thought patterns – that may seek to advance their own agendas”, even if they wreck the whole. It all sounds like a House of Cards plot line or metaphor for British politics. Try as you might to impose the whip, rebels can get in the way. Add to this the prospect of “cellular decision making”, plus further cases of cellular mischief, and big questions arise: might the natural world actually buzz with a kind of agency? Is full control an illusion? Should we devote more time to living, and less to living longer?

Unlike many of her demographic, Ehrenreich has given up on “the many medical measures . . . expected of a responsible person with health insurance”. It’s not that she has a death wish. Rather, having realised she was “old enough to die”, she decided she was “also old enough not to incur any more suffering, annoyance, or boredom in the pursuit of a longer life”. Mindful of the profit motives wrapped up with unnecessary tests, wary of ritual sanctified as science, and tired of tussles with medical professionals, Ehrenreich shuns not just medicalised death, but medicalised life. Life’s too precious to sit in “windowless waiting rooms . . . under the cold scrutiny of machines”.

Importantly, Ehrenreich is a feminist whose generation insisted, she says, on their right to ask questions of doctors without being branded “uncooperative”. Indeed, she became a feminist “in the fullest sense – a conscious woman, that is, and something other than an object or a moron” after a pelvic examination whilst pregnant. When Ehrenreich (who had recently got her PhD) enquired about her own cervix, the doctor turned to the nurse and asked: “Where did a nice girl like this learn to talk like that?” No wonder, then, that she suggests physicians have at times seen women’s bodies as their “property”, reports that women can be “traumatised” by examinations and points out that the first “patient” medical students typically encounter is, after all, a (silent) cadaver to dissect.

None of this is to say that Ehrenreich distrusts all science or cares not for her health. Far from it. She gets medical help when needed and started gym-going in the 1980s, enjoying its “enticing regressiveness”. As fitness culture rose against a backdrop of individualism, deindustrialisation and insecurity, the gym became one of few spaces in which people, including Ehrenreich, “could reliably exert control”. For women, she says, this could be political; here was a place to get strong. But Ehrenreich is also critical. Gyms, she suggests, are not sites of “spontaneity and play” but of rules and work. And fitness culture has grown more “combative”. Again, it’s worth remembering that Ehrenreich is writing on America. Her depiction of antisocial, plugged-in, clipboard-carrying gym-goers doesn’t quite ring true for my local leisure centre, which truly earns that name and is a site of diversity, sociability and subversion.

Still, she is right to point to the sinister side of our preoccupation with fitness. We tend to suspect, she says, that “if you can’t control your body, you’re not fit, in any sense, to control anyone else.” With the rise of employee wellness and widespread health insurance in America, fitness has become a “moral imperative”; fall off the wagon and you risk letting yourself down, your company down and perhaps your country too. Moreover, she says, we see those who don’t follow the rules as risking an early demise: “Every death can now be understood as a suicide.” But as she points out, the idea that we are singlehandedly responsible for our health omits a great deal, including environmental, socioeconomic and other factors.

Today, Ehrenreich observes, “the gap between rich and poor”, in the US but also the UK, “has widened to such an extent that a single word, ‘health’, no longer suffices to describe what was once a universally desirable biological status.” Now, we have the concept of wellness. Indeed, if conspicuous exertion has become a form of conspicuous consumption, so too has wellness, which Ehrenreich sees as largely the domain of the better off, to be sought at flashy resorts or signified by carrying a yoga tote and a bottle of something green. Indeed, a curious Google search reveals tote bags for sale brandishing kale-based slogans. Amongst them is a potential gift for Ehrenreich. It reads: “If we’re all going to die, why am I eating kale?”

Although Ehrenreich’s America is the epicentre of a world in which health is a virtue and food is poisoned by class judgement, it’s a world that UK readers will surely recognise. In the 2000s, TV schedules filled with shows such as the shame-fest You Are What You Eat and Fat Club, which saw overweight people being shouted at by a man called Harvey (the show tellingly became Fit Club for its celebrity version).

Those shows are gone, but today, the theme of control arguably looms large in “survival” shows such as The Island with Bear Grylls, which conveys the message that a sturdy mindset can triumph over even the most depleted of bodies; together, body and mind are a crack team. If only things were so simple, Ehrenreich would tell the islanders. The mind, often framed as the “moral overdog”, is hardly perfect – “its fundamental cognitive powers appear to be dwindling”, much as we try to tame it via mindfulness. Meanwhile, the body, she says, is a “battleground”. Try as you might to control it, you cannot entirely, nor will you dodge death.

Ehrenreich is aware that such thoughts may leave the modern reader lost. Today, she says, we are so invested in the self that we struggle to picture a world without it. But she doesn’t leave us to howl in existential despair. Instead, she takes our hand and tweaks our vision, nudging us towards the end of her book and life itself. If we can see ourselves as part of a natural world that in fact “seethes with life, with agency other than our own, and at the very least, with endless possibility”, she says, then death becomes “not a terrifying leap into the abyss, but more like an embrace of ongoing life”. And if we can “confront the monstrous self that occludes our vision”, all the better.

By the book’s end, Ehrenreich’s quoting Brecht, birds are singing and all seems well. The message of this wide-ranging, sometimes dizzying text seems an ultimately simple one: get over yourself and prepare to dissolve yourself too. Life, quite literally, goes on.