How Far Will We Go To Avoid Death?

Americans have a history of obsession with fads designed to help us live forever. But to what end? Death, notes author Barbara Ehrenreich in her new book, Natural Causes, 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.

A razor-sharp polemic which offers an entirely new understanding of our bodies, ourselves, and our place in the universe, Natural Causes describes how we over-prepare and worry way too much about what is inevitable. One by one, Ehrenreich topples the shibboleths that guide our attempts to live a long, healthy life — from the importance of preventive medical screenings to the concepts of wellness and mindfulness, from dietary fads to fitness culture.

But Natural Causes goes deeper — into the fundamental unreliability of our bodies and even our “mind-bodies,” to use the fashionable term. Starting with the mysterious and seldom-acknowledged tendency of our own immune cells to promote deadly cancers, Ehrenreich looks into the cellular basis of aging, and shows how little control we actually have over it. We tend to believe we have agency over our bodies, our minds, and even over the manner of our deaths. But the latest science shows that the microscopic subunits of our bodies make their own “decisions,” and not always in our favor.

She starts by looking at the many preventive medical procedures we are encouraged, even badgered, to undergo—those regular physical exams, colonoscopies, blood tests, mammograms. She had always pretty much done what doctors advised (she underwent chemotherapy), figuring that it made sense to treat disease before illness overwhelmed the body. But after watching many fitness-obsessed people die early, and realizing that she herself is now “old enough to die,” she questions that premise. Where is the evidence that all the effort at prevention saves lives or delays death?

It’s hard to find, she discovers. In people who have a strong family history of heart disease, treating high cholesterol does decrease mortality, on average. But for those who don’t have that predisposition, it doesn’t. Colonoscopies have not been proved more effective at reducing deaths from colon cancer than other, cheaper, less-invasive tests. Sometimes procedures cause more trouble than they prevent. Mammograms, for instance, detect tumors that might never be fatal, and can lead to over-treatment, which carries its own risks. The insight is counterintuitive—although finding diseases early on should prolong lives, the screenings we undergo don’t seem to lower mortality rates overall—and Ehrenreich decides that she will no longer get most preventive care.

In the final section of the book, Ehrenreich, who holds a PhD 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.