Barbara Ehrenreich is 76. She is an American, but despite our loathing of more or less everything American, we won’t hold that against her. She has a PhD in cellular immunology – an expert on macrophages, to be more specific. The author of around 20 books of social and cultural analysis, she has now published her latest: Natural Causes: An epidemic of wellness, the certainty of dying, and killing ourselves to live longer. Like the rest of her books this one is lucid and written in a razor-sharp style. It may be her most important book, because she focuses her objective and dispassionate analysis on the biggest topic of all: our death, and how we deal with it. She reminds us that despite all our efforts to stave off the final moment, eventually it comes: “everything devolves into a stinking pool or, what may sound even worse, a morsel in a rat’s digestive system.”
“everything devolves into a stinking pool or, what may sound even worse, a morsel in a rat’s digestive system”
This courageous realisation – that mortality is around the corner – doesn’t mean that Ehrenreich has given up, just that she has “decided that I was also old enough not to incur any more suffering, annoyance, or boredom in the pursuit of a longer life…As for medical care: I will seek help for an urgent problem, but I am no longer interested in looking for problems that remain undetectable to me. Ideally, the determination of when one is old enough to die should be a personal decision, based on a judgment of the likely benefits, if any, of medical care and – just as important at a certain age – how we choose to spend the time that remains to us.”
“A cynic might conclude that preventive medicine exists to transform people into raw material for a profit-hungry medical-industrial complex.”
Ehrenreich has form when it comes to cynicism, or, as I prefer to see it, clarity of thinking. One of her previous books, Nickel and Dimed: On Not Getting By in America, is a riveting account of three months she spent on trying to survive on minimum wages as a waitress, hotel maid, cleaner, nursing-home assistant, and serf at Walmart. She’s co-chair of the Democratic Socialists of America, a tiny organisation that regularly makes no inroads into mainstream American politics and is all the more important for representing decency in public life in the heart of the US.
It would be a mistake however to regard Natural Causes as her swansong, but even it it proves to be that she has done all those who read it a great service. Her experiences of the US medical trade – it’s not really a profession – are fascinatingly depressing. The dentist who tried to sell her “a terrifying skull-shaped mask that would supposedly prevent sleep apnea [of which she had no symptoms – he told her she might not be aware of it but it could kill her] and definitely extinguish any last possibility of sexual activity”; the pressure from the trade to get a colonoscopy, even though she had no symptoms of bowel cancer; the list goes on.
Her experiences of the US medical trade – it’s not really a profession – are fascinatingly depressing
She lays waste to the absurd rituals of modern medicine – why do doctors wear white coats? no obvious reason – and illuminatingly compares them with, for example, tribal rituals conducted in Zambia. She devastates what she calls the “veneer of science” and illustrates this by a particular bugbear of mine, the absurdity of testing for prostate cancer, which “consists of a blood test for prostate-specific antigen (PSA) plus a digital rectal exam. As with mammography, statistical studies have found no overall decrease in mortality that can be attributed to the PSA screening that has been in place since the late 1980s. Here too, the price can be high for overdiagnosis and treatment: radiation and hormonal therapies that can lead to incontinence, impotence, and cardiovascular disease.”
She wryly points out that “many of the people who got caught up in the health ‘craze’ of the late twentieth century – people who exercised, watched what they ate, abstained from smoking and heavy drinking – have nevertheless died.” Jim Fixx, who wrote the best seller The Complete Book of Running and who believed he could “outwit the cardiac problems that had carried his father off to an early death by running at least ten miles a day and restricting himself to a diet consisting mostly of pasta, salads, and fruit” was found dead at a roadside in Vermont (where else do the hipsters go?) in 1984 aged 52. She recalls the famously creative food faddist and general nut job Steve Jobs, a vegan evangelist who died aged 56 from pancreatic cancer. Jobs once started lecturing Mitch Kapor, founder of Lotus, for plastering his lunchtime bread with butter, taking him to task about cholesterol. Said Kapor: “I’ll make you a deal. You stay away from commenting on my dietary habits, and I will stay away from the subject of your personality.” Kapor is still happily alive at 67, and no doubt still smearing butter on his bread.
“I’ll make you a deal. You stay away from commenting on my dietary habits, and I will stay away from the subject of your personality.”
In the end, and there will always be an end, “death is not a terrifying leap into the abyss, but more like an embrace of ongoing life”. She quotes a poem Brecht wrote on his deathbed: “He was dying, but that was all right. The blackbirds would keep on singing.” Death is inevitable and because of that is all right; just live your life as you want to and don’t succumb to the illusory temptation that you can fend it off. Great book.