Review – “Natural Causes: An Epidemic of Wellness, the Certainty of Dying, and Killing Ourselves to Live Longer” by Barbara Ehrenreich

I was very excited to receive an ARC of this book because it sets itself up squarely within my interests—I finished Bright-Sided: How the Relentless Promotion of Positive Thinking Has Undermined America last year and loved it, and I have been on my own similar line of thinking about health/nutrition science and medicine in the pharmaceutical era. Natural Causes continues along in the same tone as Bright-Sided, setting up a scathing critique of generally accepted and often scientifically-unfounded practice as cultural dogma, and moves forward into being quite a companionable piece with Over-diagnosed: Making People Sick in the Pursuit of Health (another worthwhile read). The book presses us to look at what we assume to be normal and healthy practice and ask ourselves if this is actually to our benefit.

In my view, this book really is separated into three parts. The first expounds upon the (lengthy) title to eviscerate the longevity industry, laying out a convincing argument that they are marketing to and profiting off of an exploitation of a fear of death and a culturally perpetuated idea that death is a disease to be cured (and that we, in fact, can cure it). This is presented alongside evidence of rampant conflict of interest in the medical field and pharmaceutical companies that profit off of our illness and convince us that they are interested in our health. Ehrenreich also neatly ties in her critiques of US cultural philosophy of “Positive Thinking” (see Bright-Sided), metamorphosed into “Mindfulness” and its close ties to “Personal Accountability”, and paints a rather grim portrait of every death being tantamount to suicide (Did she ever smoke? Did she exercise regularly? Did she take supplements? What was her diet like?). In a litany of things that are assumed to be beneficial (without evidence), the victim of a tragedy is recast as the specter of death itself.

The second, and probably the most difficult to work through, is comprised of a mere two chapters: Chapter Eight, “Cellular Treason”, and Chapter Nine, “Tiny Minds”. Barbara Ehrenreich has a history in biochemistry and did her doctoral dissertation on the topic of macrophages, and so naturally she focuses in on these little gangsters of the immune system to deftly demonstrate that science can indeed be fallible; there are things that have been considered irrefutable truths that turn out to be completely false. Indeed, those beloved macrophages, the thugs that take out the “bad” microbes that are introduced into our systems, show some propensity for autonomy and can encourage the cancerous growth that they are supposed to suppress.

One of the primary “common sense” responses to diagnoses of cancer is to boost one’s immune system using a variety of tools and techniques. What does it mean if that cancer is being encouraged to grow by agents of our immune system? What does it mean if we look at our bodies, which have largely been described as single entities with systems that work toward the health of a “self”, and see that we are in fact potentially made up of many autonomous systems that may not always succeed at prioritizing the life of the host (ill-advised for a microbe, though it may be). It sets the reader up for the next philosophical dive.

Aye, there’s the rub. Ehrenreich brings the whole book around to death, which I was shocked by because we had been flirting with the concept and yet successfully skirting around it for the whole book. I should not have been shocked. The cover gave it away right from the get-go. In the final chapters, she confronts it head-on, and what it would mean if we took a different approach to thinking about our own death. What is the purpose of upholding draconian regimes that require so much of our finite energy to cast lots against death when our own immune system, those tiny macrophages, can “decide” to turn on us at any time? Is prolonging one’s life in the face of an ever-accumulating list of age-related disabilities actually prolonging one’s “life”?

Ehrenreich dares to propose that the price of survival may not be endless toil, but perhaps just a simple acknowledgment that we may not really have a whole lot of power over prolonged survivability anyway. And also, probably most of all, it requires an acknowledgment that we do all in fact die.

This book has a very broad scope and touches upon many things that I did not address here. I am going to absolve myself of this lapse by claiming it is so as not to give away the good bits. This book prompted me to think about my own life, think about the things that I am afraid of and to look at the choices that I make for my body and myself more critically. I highly recommend it, even though there are some moments (particularly at the end) that had me in tears amidst all of the laughter (Barbara continues to show her rapier wit).

**Thank you to NetGalley for providing an advanced reader copy of this book in exchange for an honest review.**

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