When I was kid, I thought that part of growing up would mean that I would get to make decisions on my own, without having a bunch of grownups telling me what I should do. I was wrong. The older we get, the more advice we get from doctors, self-help books, personal trainers, advertisers, and well-meaning vegetarian friends. I have probably retained too much of my childhood views of growing up, and I tend to resist advice. For example, at the risk of beginning this review with too much information, I feel compelled to confess that I am a fifty-three-year-old oncologist who has not had a colonoscopy. Some people—my doctor, for example—are not satisfied with busyness as a reason for me not to get the exam, but I can generate other rational reasons for my failure. I was told to get the exam when I turned fifty, and then to have it every ten years. The lifetime risk of colon cancer in men is roughly 4.5 percent. The median age at diagnosis is roughly sixty-five. This means the odds are in my favour. The exam probably would have been negative at fifty. Since I would not have had the exam again anyway for another ten years, maybe I can wait until I am sixty for my first colonoscopy. And by then, they might have an app for that. When I started reading Barbara Ehrenreich’s book Natural Causes: An Epidemic of Wellness, the Certainty of Dying, and Killing Ourselves to Live Longer, I realized that I was not alone in my small, private rebellion against some of my doctor’s opinions about how to be a happier, healthier, more productive version of myself.
For those of us who are looking for reasons to resist the medicalization of our lives, Ehrenreich provides a compelling, and sometimes disarming, book filled with reasons not only to avoid medicalization but also to avoid trends that obsess over wellness, mindfulness, and other benevolent-sounding approaches to our embodied lives. With well-informed, if somewhat curmudgeonly, wit, she aims her critique at ways that corporate businesses have latched on to our fear of death as a potent motivator for generating profit. The product these companies claim to provide for their customers is control over sickness, aging, and death. But Ehrenreich argues that this control is an illusion produced by a massive and complex corporate system that prods and pampers us in order to distract us from our mortality. Though she forcefully criticizes this system, she aims her primary critique at those of us who prefer such distractions and illusions of control to the acknowledgment of our limitations as beings who will die.
Ehrenreich raises important questions that have become possible only in an age where Silicon Valley executives can pioneer high-profile programs aimed at defeating death. When aging is framed as optional, then normal features of aging that have been accepted as part of the human condition become “diseases” that are amenable to medical interventions. In the many cases for which there is not yet a successful medical intervention, we are encouraged to stick to rigorous diet and exercise programs so that we can survive long enough to benefit from future medical interventions, which are surely just around the corner. The great sustainer of false confidence in the power of medicine and wellness programs to help us escape aging and death is the phrase “We’re working on it.” Such a magical phrase prevents the limits of our technology from dampening our optimism that we need not age, and we need not die. We need only be patient, and avoid the disconcerting fact that patience implies time, and time passes as we are being patient.
When aging is framed as optional, then normal features of aging that have been accepted as part of the human condition become “diseases” that are amenable to medical interventions.
Ehrenreich has decided that she has reached an age at which dying is not an unexpected outcome. She does not wish for death, but she is sufficiently aware of the limitations of her days that she loathes the idea of trading her days for time spent in doctors’ offices or hospitals getting tests for hypothetical diseases, or “diseases” that are actually nothing more than the result of aging. She would rather spend her days doing things she enjoys. The doctor she wants is one who helps her avoid tests and procedures that are not necessary.
This raises the question, Necessary for what? One reasonable way to construe Ehrenreich’s project is to think of it as a provocation to make us ask this question. For her, a physician’s pronouncement that a test is “necessary” is not an adequate definition of necessary. After all, it is far from clear that doctors always act rationally, nor that they even have concept of what they might mean by rationality. Medicine’s alliance with science has brought many benefits, which she acknowledges. Indeed, she argues that the only cure for bad science is more science. (Though as someone who has many articles on his CV that did more to win me tenure than to advance the medical field in any meaningful way, I think it might also be true that one way to cure bad science is to have less “science.”) And there are plenty of reasons to question the “scientific” merit of many medical studies, and to account for the well-documented diminishing truth of medical studies over time: Journals have a bias toward reporting positive results, studies large enough to be reasonably generalizable are difficult to execute, and there are so many variables from patient to patient that the concept of scientifically sound generalization is often stretched to the point of incredulity. And given the variability in the quality of medical studies, she is right to question the capacity of most physicians to assess results reliably, especially given the time constraints that come with corporatized medical practice in which, to paraphrase Aristotle on art, “the appointments are short, and the documentation long.” Even excellent data can be somewhat like the doctrine of scriptural inerrancy: if I am not capable of receiving perfect information perfectly, the effect of the information is rendered imperfect.
One conclusion to draw from her book is that we do not just need better doctors: we need better patients. And we only become better patients by becoming better people. By “better people,” she seems to mean people who are capable of acknowledging reality, embracing limits, and refusing to be drawn into fear of inevitable events (such as death) or loathing of incremental changes that we experience only if we are quite fortunate (such as aging). Her version of self-improvement not only has the potential to increase our happiness by increasing our peace with world as it is, but it also stands as a fairly radical form of resistance against the juggernaut of for-profit forces that would usurp our relationship to morality in a way that intensifies our fears and coddles our worst inclinations toward entitlement—the sense that I deserve the same body at seventy that I had at twenty, and a life that goes as long as I want it to go. The problem with the for-profit wellness industry is that the only real motives the corporation can tap into are our desire to be desirable, and our fear of death. But the desire to be desirable can so easily become a plasticized substitute for, or obstacle to, real love. And the fear of death, with no grasp of what makes a life truly good, is the stupendously irrational desire for mere duration. We become obsessed with multiplying the days of our life, despite the fact that we are unhappy and dissatisfied with each of the actual days we currently live. Indeed, our current emphasis on the quantity of our days might be related to our loss of a coherent account for what constitutes true quality in a day, what makes a day, or a life, genuinely good.
Ehrenreich is dismayed by the billionaires’ presumptions in their pursuit of deathlessness. I agree with her. After, say, three hundred years of additional life, what would a Silicon Valley vampire with acquired immortality hope to experience? More food? More sex? More money? More sitcom reruns? Silicon longevity might promise the multiplication of ever more pleasurable experiences, but past a certain point such motivation becomes grotesque. To merely extend the duration of a life, without addressing the meaning of a life, is to condemn oneself to the peculiar horror of boredom without end, a kind of perverse variation on the story of Midas, in which everything we touch turns into more “life,” while none of that unlimited “life” can be truly enjoyed because we missed the secret ingredient of human flourishing.
The desire to be desirable can so easily become a plasticized substitute for, or obstacle to, real love.
So, what is the secret ingredient of human flourishing? Ehrenreich has some thoughts about this that are grounded in her view of the universe, which, though it is not embedded in a theistic religious tradition, nonetheless requires a substantial act of faith. For her, the contemporary fervor for self-regard, self-improvement, and, at the extreme end reserved for the very wealthy, self-cryopreservation is the heir-apparent to the equally egregious excesses of religious commitments to the false god enshrined in major religions. These gods promise the exact same things as contemporary self-help gurus—unfettered bliss in an existence that is not touched by sickness or death. She views these as variations on “positive thinking,” desperately hanging on to the desire for personal immortality in a universe that “survives the deaths of about fifty-five million unique individuals a year quite nicely.”
Even the non-spooky view of immortality that takes solace in bequeathing a well-wrought oeuvre to the great human chain of being that continues after our own deaths is flawed in its pompous anthropocentrism. What about all the other creatures that showed up before us, and that will exist after human beings have disappeared from the face of the earth? Indeed, as a scientist she is intrigued by new discoveries of the agency, if not downright decision-making power, that exists at the cellular or even subatomic levels. At the very least, the dismissal of agency in tiny places as mere “Brownian motion” or “stochastic noise” is an arrogance real science can no longer afford. We will be far better off, she thinks, if we can relinquish our illusions of self, which in turn allows us to defuse our distracting obsession with preservation of that illusory self. Then we will be free to enjoy the universe as the animate reality it is, and free to see that “death is not a terrifying leap into the abyss, but more like an embrace of ongoing life.”
To much of what Barbara Ehrenreich writes, I want to say a resounding yes. At the same time, I want to suggest one caution to any reader of her book who is interested in the central question that hovers over every chapter, namely, What is a good life? While Ehrenreich gives us the sober gift of opening our eyes to contemporary excesses that help us answer the question, What is not a good life? the question of what actually constitutes the best life for creatures like us depends on our answer to the question, What do we mean by “creatures like us”? This in turn depends on our answer to the question, What kind of universe do we live in? At the end of her book she writes about her fascination with the coming shift of science away from the paradigm that assumes “a dead universe to one that acknowledges and seeks to understand a natural world shot through with nonhuman agency.” This is indeed an astonishing shift in our background assumption. But the deep embrace of reality-as-it-is, which she values so much, demands that we remain open to the truth of this “nonhuman agency,” no matter what it turns out to be. Perhaps it will turn out to be a beautiful, if purposeless, pervasive agency that arose from nothing. But if we move past the tremulous, self-serving, god-as-Santa versions of religious belief that are little more than expressions of the will to power with some incense and candles added in, the great theistic traditions offer profound accounts of a “nonhuman agency” that is not merely one more being among beings. In the spirit of Ehrenreich’s book, we should remain open to this possibility as well. Admittedly, because our lives—cryopreserved or not—are inevitably rather short at this stage of technological development, we must choose a worldview with woefully incomplete information, and this choice will influence our own answer to the question, What is a good life? Good luck.
For readers who are worried that embracing a theistic account of the “nonhuman agency” in the world will inevitably lead back to the grosser excesses of self-absorbed religious escapism: Perhaps the most interesting and important feature of this “nonhuman agency” added by most religious traditions (both through philosophical thought and, prima facie, through experience) is that this agent, whatever it is, is capable of love, rather than simply capable of power. For any currently mortal journeyer, the only way into the mystery is through lived experience, engaged contemplation, and sustained attention to life. I can assure you that even at the very heart of the religion that has been most mangled in service to militant, greed-based politics, and name-it-claim-it delusions of invincibility, is a simple observation that is deeply compatible with the best parts of Ehrenreich’s book: “You must lose yourself if you wish to find yourself.”