Review by New York Times Review
America is experiencing an outbreak of distrust. We doubt government, the media and climate change. In a 2016 Gallup poll, three-fifths of respondents characterized members of Congress as dishonest and unethical. Two-fifths felt the same way about journalists. In a Pew Research Center survey from the same year, about a fifth of interviewees said they didn't trust climate scientists to give them "full and accurate" information about climate change. Imagine what the pollsters are finding in 2018, after more than a year of tweets by our media-bashing, climate-change-denying bully pulpiteer. As of 2016, though, doctors still got some respect. They retained the esteem of 65 percent of the people who were polled. Nurses clocked in at 84 percent, making them among the most credible professionals in the nation. Enter Barbara Ehrenreich, a writer we ought to be able to rely on. In her masterwork, "Nickel and Dimed" (2001), she embedded herself in the unskilled labor market, serving as a waitress, cleaning-service maid and Walmart employee. A muckraking classic, "Nickel and Dimed" exposed in unignorable detail the tolls of poverty on the working poor in America, land of scant and grudging social relief. 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-oflife 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." It's true that end-of-life treatment has contributed to the ballooning cost of American health care (though some have questioned whether it's as big a drain as it's often made out to be). And medicine, like any other profession, has its charlatans and jerks, and is certainly being perverted by the bean counters. We would all feel better if hospitals weren't so cheerless. But Ehrenreich should know better than to dress up her dislike of doctors as a reasoned excuse to avoid them. To be sure, she cautions, none of what she says "should be construed as an attack on the notion of scientific medicine." But actions outweigh words, and her example could lead some readers astray. Doctors do more good than harm. So do nurses. They'd do even more good if more people had access to them. The more than 27 million Americans without health insurance would surely be glad to have the checkups and colonoscopies that Ehrenreich has chosen to forgo. Let us age with grace, but let us not spread the plague of distrust by tarnishing a group of men and women who do what they can for those they can reach, and under increasingly difficult conditions. So here's my advice, for what it's worth. Don't take this book too seriously. It could be harmful to your health. ? JUDITH SHULEVITZ is the author of "The Sabbath World: Glimpses of a Different Order of Time."
Copyright (c) The New York Times Company [June 17, 2018]
Review by Booklist Review
Americans are obsessed with their bodies. Too thin? Too fat? Does that mole look weird? Bombarded with advertisements for bodily functions that once were rarely discussed outside the physician's office, Americans have become consumers of vast amounts of medical information that engenders a false sense of competency, turning us into fierce advocates for commandeering our bodies and controlling our destiny. But is such a thing possible? Award-winning and best-selling writer and dedicated activist Ehrenreich (Living with a Wild God, 2014) looks at both sides of this conundrum, from the lifestyle adjustments promoted by a burgeoning wellness industry to the immutable facts of biology at the cellular level that propels the human body to either combat or embrace the aging process. Ehrenreich, who holds a PhD in cellular immunology, offers a healthy dose of reformist philosophy combined with her trademark investigative journalism. In assessing our quest for a longer, healthier life, Ehrenreich provides a contemplative vision of an active, engaged health care that goes far beyond the physical restraints of the body and into the realm of metaphysical possibilities.--Haggas, Carol Copyright 2018 Booklist
From Booklist, Copyright (c) American Library Association. Used with permission.
Review by Publisher's Weekly Review
Claiming to be "old enough to die," feminist scholar Ehrenreich (Living with a Wild God) takes on the task of investigating America's peculiar approach to aging, health, and wellness. She comes down hard on what she describes as "medicalized life": the unending series of doctor's visits, fads in wellness, and preventative-care screenings that can dominate the life of an aging person. Ehrenreich's core philosophy holds that aging people have the right to determine their quality of life and may choose to forgo painful and generally ineffective treatments. She presents evidence that such tests as annual physicals and Pap smears have little effect in prolonging life; investigates wellness trends, including mindfulness meditation; and questions the doctrine of a harmonious "mindbody" and its supposed natural tendency to prolong life. Contra the latter, she demonstrates persuasively that the body itself can play a role in nurturing cancer and advancing aging. Ehrenreich remains skeptical and scientifically rigorous throughout her inquiry, a combination she attributes to her time in the women's health movement and her doctorate in cellular immunology. That this knowledgable book arrives in the context of an urgent American healthcare crisis, when many people can't access or afford healthcare, may irritate some readers. Still, Ehrenreich's sharp intelligence and graceful prose make this book largely pleasurable reading. Agent: Kristine Dahl, Curtis Brown. (Apr.) © Copyright PWxyz, LLC. All rights reserved.
(c) Copyright PWxyz, LLC. All rights reserved
Review by Library Journal Review
With her trademark take-no-prisoners prose, Ehrenreich (Nickel and Dimed) argues that a desperation to control our fates leads us to cling to ritualized medical procedures, dietary fads, and gym exercises that generate corporate profits but do nothing to change our destiny. Ehrenreich criticizes the classist arrogance of framing sickness as a moral failing, when health largely hinges on uncontrollable vagaries of our genes and cells (not to mention poverty). The author combines two themes: the first is the fiery treatise against medicalization and the "cult of wellness," while the second is a mishmash of theories of the human body at war with itself and notions of an "animate universe." With a PhD in cellular immunology, the author's credentials in science and medicine are unimpeachable, and her ability to make the her subjects accessible is unsurpassed. In this book, she drifts into a dystopian and idiosyncratic scientism, softening the potency of the text's first half. VERDICT A welcome reminder to relax in the face of our own mortality, this is fast-paced, hard-nosed discourse. Sure to appeal to dissidents from the cult of wellness.-Michael Rodriguez, Univ. of Connecticut, Storrs © Copyright 2018. Library Journals LLC, a wholly owned subsidiary of Media Source, Inc. No redistribution permitted.
(c) Copyright Library Journals LLC, a wholly owned subsidiary of Media Source, Inc. No redistribution permitted.
Review by Kirkus Book Review
Ehrenreich (Living with a Wild God: A Nonbeliever's Search for the Truth about Everything, 2014, etc.) returns with research and rumination on the complexity of our human bodies and the misconceptions of our minds.The author has a doctorate in cellular immunology, and throughout the text, she employs the erudition that earned her degree, the social consciousness that has long informed her writing, and the compassion that endears her to her many fans. Ehrenreich leads us through the recent biomedical research that shows us, among other things, that our immune systems can turn on us, actually easing (rather that preventing) the spread of cancer cells. Elsewhere, she writes about the puzzles of menstruation (why do human women bleed far more than other creatures?), autoimmune diseases, and the pervasive belief that we can control our lives. "We are not," she writes, "the sole authors of our destinies or of anything else." The author also explores the social and cultural aspects of health and aging: She notes how wealthier, healthier people look upon the poorwho are more likely to smoke and eat poorlywith moral disdain. She goes after the medical establishment for what she believes are superfluous, redundant tests and procedures, and she assails the self-help industry for our currently dominant, and often unhelpful, ideas of selfhood and wellness. Ehrenreich sees the body-mind connection as incredibly complex and discusses the odd notion that cells often do what they want rather than what they're "supposed" to do. The author will certainly not endear herself to the pious among us; her discussions of the origins and evolution of religious ideas are hardly orthodox. Mostly, she urges that we recognize that death is natural, that we enjoy our lives while we can, and that we disabuse ourselves of any self-serving notions of post-mortem permanence or even influence.A powerful text that floods the mind with illuminationand with agonizing questions. Copyright Kirkus Reviews, used with permission.
Copyright (c) Kirkus Reviews, used with permission.
