(Book Review) Natural Causes… by Barbara Ehrenreich

The Medicalized Life

Natural Causes: An Epidemic of Wellness, The Certainty of Dying, and Our Illusion of Control by Barbara Ehrenreich (Twelve, 2018)

A Review by Pam Munter

We all want to live forever, right? And we do everything we can to approach that ideal. We eat the “right” foods, exercise daily, get regular checkups, decline desserts. We follow the advice of experts, with the expectation we will live a longer, healthier life. Everywhere we turn, we’re told if we rely on the pundits, we can accomplish just that. But at what cost?

Professional curmudgeon Barbara Ehrenreich turns this assumption on its head, saying we’re all in denial, not the least of which is the medical establishment that propagates these seductive myths. Her newest book, Natural Causes: An Epidemic of Wellness, the Certainty of Dying, and Our Illusion of Control rides on the myth-busting wave that characterized her earlier outstanding work, Bright-Sided: How the Relentless Promotion of Positive Thinking Has Undermined America. In it, she contends that “thinking positive” (sic.) makes little if any difference in outcome, even as it reassures the thinker, and can even be toxic. Natural Causes is another provocative and engaging book, doing what so few others accomplish these days: it compels us to reexamine our treasured assumptions.

Ehrenreich has a Ph.D. in cell biology, is the author of over 20 books, and at 76 years old, “old enough to die,” she tells us. Resistance is futile. “I present the emerging scientific case for a dystopian view of the body—not as a well-ordered machine, but as a site of ongoing conflict at the cellular level, which ends, at least, in all the cases we know of, in death.” We would like to think we can do something to stop it or slow it down but the reality is, aging is not a preventable disease. It’s part of the cycle of life.

She’s personally acquainted with mortality, having survived metastatic breast cancer, and as a result, has decided to focus on living her life in the present tense without monitoring her rear-view mirror. There will be no regular checkups, diagnostic tests (unless there’s a demonstrable symptom), no food deprivation or daily weigh-ins. She exercises because “it feels good,” not because it will help her live longer. She knows better.

Much medical treatment, she avows, is a procedure intended to quell the patient’s anxiety. “Rituals are about…the cementing of the doctor-patient relationship” and not much more. In fact, in 2014, the American College of Physicians announced that standard gynecological exams were of no value in asymptomatic women. The American Medical Association has said the same about routine annual physicals. Yet physicians are still charged with finding out what’s wrong, even when the answer may be, “nothing.”

Regular prophylactic contact with a doctor is like gym membership, she says. It’s the province of rich people trying to master their own mortality. She thinks the fitness craze has more to do with a desire to appear more youthful and attractive than it does improving one’s health. “Affluent people do it, and especially if muscular exertion is already part of their job, lower-class people tend to avoid it.”

Holistic health labors under the reassuring but false precept that we can control most everything and that mind and body are irretrievably connected. She is similarly critical of those who find refuge in New Age beliefs such as mindfulness and spirituality, telling us there’s “a complete lack of evidence supporting the usefulness of these applications.”

Worse still, New Age thinking leads to blaming the victim. Did the deceased smoke? Eat too much? Avoid exercise? Hold in too much anger? “We dissect their moral failings” to find an explanation to reinforce the fiction that death is under our control—and, if we fail—it’s our own fault. Poverty, race and occupation are stronger signifiers than lifestyle choices but, “the doctrine of individual responsibility means that the less-than-fit person is a suitable source not only of revulsion but resentment.”

“A cynic might conclude that preventive medicine exists to transform people into raw material for a profit-hungry medical-industrial complex.” And a cynic she is, though many would declare her instead to be an avatar of common sense, a refreshing antidote to the anti-intellectual pablum that poses as “solutions” to the natural process of decay. Instead, she values a doctor who will avoid regular tests, one who will protect her from unnecessary procedures. There is a growing prevalence of overdiagnosis, she says, especially as we age.

There’s more than polemical philosophy here. As a cellular biologist, she offers information on how cells can randomly betray us in spite of our best efforts. The diseases of aging “are active and seemingly purposeful attacks by the immune system on the body itself. Why should this happen? Perhaps a better question is: Why shouldn’t it happen?”

Her forays into biochemistry are well-written but dense. She uses extensive research to support her argument that we are wasting our time prolonging our life via discomfort and deprivation. She wants to avoid the medicalized life and take responsibility for her own well-being. “Being old enough to die is an achievement, not a defeat, and the freedom it brings is worth celebrating.”

If there’s a vacuum here, it’s the absence of alternatives. Clearly, she’s not advocating becoming a couch potato, ordering takeout pizza every night, or lighting up a Camel. We assume she wants us to focus on what we can control, while seeking to maintain and even improve the quality of life, savoring everyday pleasures. If going to church or playing tennis makes you feel good, then enjoy it for its own sake not as a hedge against immortality.

Some toward the end of their life desperately look for ways to “leave something” of themselves. “I have seen accomplished people consumed in their final years with jockeying for one last promotion or other mark of recognition. This is all that we in the modern world have learned how to do.” We continue to yearn for the impossible: immortality.

In spite of society’s revulsion, there are upsides to aging. There is often a decline in ambition, competitiveness and lust. Escalating the search for meaning seems to be an inferred subtext with Ehrenreich. Who am I, and how can I make my remaining years worthwhile and meaningful?

To paraphrase Alcoholics Anonymous, we need to accept the things we cannot change, change the things we can and have the wisdom to know the difference. Life is best lived in a state of reality with an awareness and acceptance of the capricious sovereignty of cells.

Pam Munter has authored several books including When Teens Were Keen: Freddie Stewart and The Teen Agers of Monogram (Nicholas Lawrence Press, 2005) and Almost Famous: In and Out of Show Biz (Westgate Press, 1986) and has been a contributor to many others. She’s a retired clinical psychologist, former performer and film historian. Her essays and short stories have appeared in over 70 publications. She has an MFA in Creative Writing and Writing for the Performing Arts and is a Pushcart Prize nominee. Her memoir, As Alone As I Want To Be will be published by Adelaide in October.


  1. I enjoyed Pam Munter’s book review of Natural Causes. It is a pertinent subject to me, a man of 65 years of age with chronic cancer. Healthy living is a balancing act and most points of view have their merits. I liked the exposure to a cell biologist’s perspective, especially since our culture tends to preach that exercise and controlled eating are the means to longer lives. I liked reading an alternative take on the subject in the quickly absorbed form that Munter offered. However, in any case, I am aware that living longer may not be the boon we assume. Nursing homes shelter many a poor aged soul trapped in pain or mental affliction- doomed to an extended stay on this earth “long after the joy of living is gone.”


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