Josh Franklin //

In Natural Causes, Barbara Ehrenreich gives a withering critique of the wellness movement, from mindfulness to fitness and preventative medicine. In Part 1 of my review, I examined the way that Ehrenreich focuses on the inevitability of death to counter the moralistic optimism of healthy living and its fantasy of ultimately coming to control every aspect of human biology. While health practices—from cancer screening to corporate mindfulness initiatives—are supported by different kinds of evidence, Ehrenreich shows that they are held together by a common belief that the human body naturally tends towards harmony and health. This is a pleasant fantasy, she argues, but we ought to see the human body as a dystopian one: “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). This way of thinking is seductive because, in our state of anxiety about the health and fitness of our bodies, we desperately want to believe that wellness is a scam. It is a critique affectively propelled by the relief we experience as we let ourselves off the hook.

I want to offer a counterpoint to Ehrenreich’s project in Natural Causes by asking a simple question: who are the people in Natural Causes? The subtitle of the book tells us that we are “killing ourselves to live longer.” Who is this “we” who are killing ourselves? While the book seems to imply a broader collective, the only person who really occupies a position of agency in the text is the author herself. She writes about her own struggles with medical care, from misogynistic obstetric treatment to her decision to forgo many forms of preventative care. We learn about her own physical fitness regimen, which she began in the 1980s. The way that she tells about these experiences is valuable, and of course a worthy basis for a critique of the wellness movement. Yet as she describes the motivations for physical fitness programs or mindfulness practices, the picture that emerges feels frustratingly like an overgeneralization.

To take one example, Ehrenreich writes, “Many gym-goers will tell you cheerfully that it makes them feel better, at least when the workout is over. But there’s a darker, more menacing side to the preoccupation with fitness, and this is the widespread suspicion that if you can’t control your own body, you’re not fit, in any sense, to control anyone else…” (62) Yet I wonder what would emerge from engaging with the people who are pursuing health in all kinds of varied ways themselves, and to allow them to have a voice in this conversation about the meaning of wellness in their lives; we ought to at least give their points of view a thorough consideration without dismissing them. How, in their view, does it make them feel better? What is the meaning of these positive feelings for them? While the gym is the object of careful consideration in Natural Causes, the gym-goers themselves are missing.

As two reviews of the book in the New York Times note, it is easy to imagine how one’s experience of the imperative to be healthy might be shaped by race, class, and gender. As such, it seems particularly important to account for the diverse ways that wellness is understood in different communities. Of course, Ehrenreich is not the only person to study the culture of wellness without fully engaging the points of view of those people who participate in it. In his 2004 article, “Against Exercise,” Mark Greif raises many similar critical points about modern exercise, also referring to a generalized subject of exercise culture, denoted as “men,” “women,” or simply, “we.” This is an anthropology of wellness in the worst sense: an account of a sliver of human life that does not try to understand these activities from the point of view of the people who are actually participating in them.

The problem is not simply a lack of varied perspectives on the contemporary pursuit of health, but a failure to imagine the complex motivations and subjective experiences of wellness. For example, in her book Fat-Talk Nation, medical anthropologist Susan Greenhalgh draws from narratives composed by hundreds of college students about their experiences of dieting, weight loss, and body image to argue that America’s war on fat has damaged young people of all weights while failing to measurably improve health. The overwhelming majority of young people quoted in her book recount painful and futile experiences with weight loss, dieting, and at times extreme exercise. What is curiously absent, however, is any representation of positive experiences of fitness, besides what she terms the “health freak” (155). The two women who identify with this label are quite positive about their pursuit of physical fitness. Yet Greenhalgh is dismissive, asking, “Will Jade wake up some day and realize that she gave up her youth to the pursuit of an impossible goal?” (166) How can we take Jade’s perspective seriously, even if it conflicts with the critical project of exposing the many ways that the biopolitics of fat harm young people?

One might say that all of this has missed the point, which is not about any particular wellness practice but rather Ehrenreich’s legitimately fascinating portrait of the human body, which she calls dystopian. And imagining a collective and speaking in generalities are necessary features of critical writing. Yet we shouldn’t mistake this for the final word on wellness, since a dystopia, being a way of making sense of our situation, is one story among many—we only have to ask what we could find in those other stories.

Works Cited

Ehrenreich, Barbara. 2018. Natural Causes: An Epidemic of Wellness, The Certainty of Dying, and Killing Ourselves to Live Longer. New York: Twelve.

Greenhalgh, Susan. 2015. Fat-Talk Nation: The Human Costs of America’s War on Fat. Ithaca, NY: Cornell University Press.


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