In Natural Causes, Barbara Ehrenreich offers a wide-ranging critique of the culture of wellness. From preventative care and exercise to positive thinking and mindfulness, Ehrenreich sees these modern health practices as futile attempts to experience some sense of control over the inevitability of death. But worse, she argues, they are based on a fundamental misrecognition of the nature of human bodies. The logic of all of these health practices is one of harmony, where the body is made up of constituent parts (muscles, immune cells, the mind) whose natural function is to support the continuity of life. In Natural Causes, Ehrenreich argues the opposite. She presents, “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” (XV). Thus death and its inevitability make an appearance on the book’s seventh page.
Considered against the incontrovertible fact of human mortality, Natural Causes makes a strong case against a variety of common-sense health practices. Ehrenreich begins by describing her decision to forgo preventative care. This opens a wider set of questions about the goals and values of medicine. Taking inspiration from medical anthropologists, Ehrenreich points out that the practices that constitute modern medicine are mostly not justified in a scientific sense; rather they are rituals designed to produce an emotional effect (though, sadly, she mostly does not engage the many careful ethnographic studies of contemporary healthcare).
Importantly, a key dimension of this ritual performance of medical care is the achievement of a “veneer” of science, which is central to the authority of physicians in US society. Building on this critique of biomedicine’s neutrality and objectivity, Natural Causes argues that more democratic modes of attaining good health—exercise and mindfulness—are in fact hopeless efforts at taming deep anxieties about control and mortality through a systematic project of self-discipline. Ehrenreich suggests that the evidence for the efficacy of exercise or meditation is questionable (and, of course, depends on how one construes the objectives of these activities). What is clear is that they produce a powerful affective pattern—the feeling of efficacy—which can be sold to a broad consumer market.
This argument is not only convincing, but highly satisfying. In fact, perhaps too satisfying. Ehrenreich is drawing from a deep well of modern anxieties about health, fitness, and self-care and producing a critique that, in its absolutism, is actually quite reassuring. The book grips its reader not by simply asserting the impermanence of human life, but by comfortingly telling us that we have been tricked into our exhausting concern with health. While Ehrenreich suggests her project is one of old age—“I gradually came to realize that I was old enough to die” (p. 2)—there is a kind of youthful energy in the revelatory power of Natural Causes, which urges us to see clearly the way that society, not human nature, has put us in the predicament we are in. Dismantling the legitimacy of mainstream as well as alternative health practices is an effective critique and it produces a real sense of relief. But I want to suggest that Ehrenreich has given a half-analysis here, in the sense that what is missing from this book is an account of the people who pursue these healthy objectives. It is not enough, I suspect, to merely assert that they have been tricked by the seductive rituals of techno-scientific medical practice. I will return to this question in Part II.