Barbara Ehrenreich, author and journalist - from Natural Causes
In the health-conscious mindset that has prevailed among the world’s affluent people for about four decades now, health is indistinguishable from virtue, tasty foods are “sinfully delicious”, while healthful foods may taste good enough to be advertised as “guilt-free”. Those seeking to compensate for a lapse undertake punitive measures such as hours-long cardio sessions, fasts, purges or diets composed of different juices carefully sequenced throughout the day.
Of course I want to be healthy, too; I just don’t want to make the pursuit of health into a major life project. I eat well, meaning I choose foods that taste good and will stave off hunger for as long as possible, such as protein, fibre and fats. But I refuse to overthink the potential hazards of blue cheese on my salad or pepperoni on my pizza. I also exercise – not because it will make me live longer but because it feels good when I do. As for medical care, I will seek help for an urgent problem, but I am no longer interested in undergoing tests to uncover problems that remain undetectable to me. When friends berate me for my laxity, my heavy use of butter or habit of puffing (but not inhaling) on cigarettes, I gently remind them that I am, in most cases, older than they are.
So it was with a measure of schadenfreude that I began to record the cases of individuals whose healthy lifestyles failed to produce lasting health. It turns out that many of the people who got caught up in the health “craze” of the last few decades – people who exercised, watched what they ate, abstained from smoking and heavy drinking – have nevertheless died. Lucille Roberts, owner of a chain of women’s gyms, died incongruously from lung cancer at the age of 59, although she was a “self-described exercise nut” who, the New York Times reported, “wouldn’t touch a French fry, much less smoke a cigarette”. Jerry Rubin, who devoted his later years to trying every supposedly health-promoting diet fad, therapy and meditation system he could find, jaywalked into Wilshire Boulevard at the age of 56 and died of his injuries two weeks later.
Even more disturbing was the untimely demise of John H Knowles, director of the Rockefeller Foundation and promulgator of the “doctrine of personal responsibility” for one’s health. Most illnesses are self-inflicted, he argued – the result of “gluttony, alcoholic intemperance, reckless driving, sexual frenzy, smoking” and other bad choices. The “idea of a ‘right’ to health,” he wrote, “should be replaced by the idea of an individual moral obligation to preserve one’s own health.” But he died of pancreatic cancer at 52, prompting one physician commentator to observe, “Clearly we can’t all be held responsible for our health.”
Still, we persist in subjecting anyone who dies at a seemingly untimely age to a kind of bio-moral autopsy: did she smoke? Drink excessively? Eat too much fat and not enough fibre? Can she, in other words, be blamed for her own death? When David Bowie and Alan Rickman both died in early 2016 of what major US newspapers described only as “cancer”, some readers complained that it is the responsibility of obituaries to reveal what kind of cancer. Ostensibly, this information would help promote “awareness” of the particular cancers involved, as Betty Ford’s openness about her breast cancer diagnosis helped to destigmatise that disease. It would also, of course, prompt judgments about the victim’s “lifestyle”. Would Bowie have died – at the quite respectable age of 69 – if he hadn’t been a smoker?
Maybe it’s just the way the human mind works, but when bad things happen or someone dies, we seek an explanation, preferably one that features a conscious agent – a deity or spirit, an evil-doer or envious acquaintance, even the victim. We don’t read detective novels to find out that the universe is meaningless, but that, with sufficient information, it all makes sense. We can, or think we can, understand the causes of disease in cellular and chemical terms, so we should be able to avoid it by following the rules laid down by medical science: avoiding tobacco, exercising, undergoing routine medical screening and eating only foods currently considered healthy. Anyone who fails to do so is inviting an early death. Or, to put it another way, every death can now be understood as suicide.
Affluent reformers are perpetually frustrated by the unhealthy habits of the poor, but it is hard to see how problems arising from poverty – and damaging work conditions – could be cured by imposing the doctrine of “personal responsibility”. I have no objections to efforts encouraging people to stop smoking or add more vegetables to their diets. But the class gap in mortality will not be closed by tweaking individual tastes. This is an effort that requires concerted action on a vast scale: a welfare state to alleviate poverty; environmental clean-up of, for example, lead in drinking water; access to medical care including mental health services; occupational health reform to reduce disabilities inflicted by work.
The wealthier classes will also benefit from these measures, but what they need right now is a little humility. We will all die – whether we slake our thirst with kombucha or Coca-Cola, whether we run five miles a day or remain confined to our trailer homes, whether we dine on quinoa or KFC. This is the human condition. It’s time we began facing it together.
Extracts; the whole text
Four years ago, Barbara Ehrenreich, 76, reached the realisation that she was old enough to die. Not that the author, journalist and political activist was sick; she just didn’t want to spoil the time she had left undergoing myriad preventive medical tests or restricting her diet in pursuit of a longer life.
Now Ehrenreich felt free to enjoy herself. “I tend to worry that a lot of my friends who are my age don’t get to that point,” she tells the Guardian. “They’re frantically scrambling for new things that might prolong their lives.”
It is not a suicidal decision, she stresses. Ehrenreich has what she calls “a very keen bullshit detector” and she has done her research.
Part polemic, part autobiographical, Ehrenreich – who holds a PhD in cellular immunology – casts a skeptical, sometimes witty, and scientifically rigorous eye over the beliefs we hold that we think will give us longevity.
She targets the medical examinations, screenings and tests we’re subjected to in older age as well as the multibillion-dollar “wellness” industry, the cult of mindfulness and food fads.
These all give us the illusion that we are in control of our bodies. But in the latter part of the book, Ehrenreich argues this is not so. For example, she details how our immune systems can turn on us, promoting rather than preventing the spread of cancer cells.
“I really have no hard evidence about when exactly one gets old enough to die, but I notice in obituaries if the person is over 70 there’s not a big mystery, there’s no investigation called for. It’s usually not called tragic because we do die at some age. I found that rather refreshing.”
Ehrenreich would rather relax with family and friends or take a long walk than sit in a doctor’s waiting room.
“I just said [to my children]: ‘This is bullshit. I’m not going to go through this and that and the other. I’m not going to spend my time, which is very precious, being screened and probed and subjected to various kinds of machine surveillance.’ I think they’re with me. I raised them right,” she laughs.
“The last time I had to get a new primary care doctor I told her straight out: ‘I will come to you if I have a problem, but do not go looking for problems.’”
Ehrenreich won’t be giving up the gym anytime soon. She works out most days because she enjoys cardio and weight training and “lots of stretching”, not because it might make her live longer.
“That is the one way in which I participated in the health craze that set in this country in the 70s,” she says. “I just discovered there was something missing in my life. I don’t understand the people who say, ‘I’m so relieved my workout is over, it was torture, but I did it.’ I’m not like that.”