“COMFORT FOOD” IS, for me, an awkward phrase, evoking images of hard work. Hearing it, I see my blue-collar father’s lunchbox and its salvaged Cool Whip containers of leftover stroganoff, pierogies, or “k’bossi” (as one pronounces “kielbasa” in Pittsburgh, my hometown). Still, I prefer it to “rich foods,” which I had never heard until my Waspy ex-boyfriend said it shortly after meeting my family, wrinkling his nose at the dense meals they had served him. “Rich foods” is even more awkward than “comfort foods.” It’s absurd, really: I grew up on these “rich foods,” but I am emphatically not what I have eaten, contrary to the proverb. Which is to say, I am not rich.
Am I not rich precisely because I prefer these “unwholesome” foods? I think not. But in her book Natural Causes: An Epidemic of Wellness, the Certainty of Dying, and Killing Ourselves to Live Longer, Barbara Ehrenreich argues that the underlying logic of “wellness” insinuates this reductive message and other equally troubling ones. After all, a diet top-heavy in carbs and dairy supposedly signals a failure of self-control that augurs fatal consequences. I have eaten what is forbidden, and now surely I will die — not of natural causes, but of unnatural carelessness.
This “bio-moral autopsy” bears an uncanny resemblance to theories about poverty — and not by coincidence, as Ehrenreich illuminates in this book. Drawing on her PhD in cellular immunology and her impressive resume as an “amateur sociologist,” Ehrenreich plots out the classist heritage of the now $3.7 trillion wellness industry. She uncovers a set of unsound assumptions and power dynamics beneath the medicalized moralism of being one’s “best self.” Wellness, for Ehrenreich, proffers an “illusion of control” when in fact all that is certain is that “we all gotta die of something,” as my father used to say when I would nag him about his tobacco dipping habit (he hasn’t quit).
His sentiment aligns with Ehrenreich’s in this book, which draws its strength and weaknesses from her firsthand experience. She grew up in a working-class milieu. She “became a feminist in the fullest sense” when a scandalized obstetrician asked where such “a nice girl” like her, pregnant at around 28, learned words like “cervix” and “dilate.” She has patronized fitness clubs for 30 years. She survived breast cancer. Now 76, she can write from experience that “no matter how much effort we expend, not everything is potentially within our control, not even our own bodies and minds.”
Yet, “scientific medicine” and “holistic wellness” — the two components of 21st-century wellness she delineates and then deconstructs — presuppose the opposite: that poor health and death are, at least in part, failures of the mind to control the body. “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,” this reasoning goes. “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.”
Such thinking has classist implications, whether judgments about my family’s recipes or stereotype-ridden discourse around the opioid crisis. However, things did not have to be this way. As Ehrenreich discovers, not only is the science of wellness dubious, but its systems of self-control (like dieting and preventative medicine) also reify class and gender hierarchies. What’s more, the “self” we’re supposedly controlling may not even exist. In this sprawling book, Ehrenreich puts forth an explanation for how these ideas evolved into what she considers “our” epidemic of wellness, as well as suggestions for how “we” might escape.
Early in Natural Causes, Ehrenreich declares herself “old enough to die,” as well as “old enough not to incur any more suffering, annoyance, or boredom in the pursuit of a longer life,” whether by having mammograms and bone density tests or colonoscopies. “All of these forms of intervention invite questions about the limits of human control” that researchers increasingly answer with paradoxes, which, in the world of the hard sciences, dangerously resemble no answers at all.
One paradox in particular captivates Ehrenreich and forms the book’s metaphorical through line: the immune system’s relationship to cancer. She points to a 2008 article in Scientific American claiming that certain immune-related cells called “macrophages” can, under certain circumstances, abet the growth of cancer. This knowledge purportedly “change[d] everything” for Ehrenreich, who studied macrophages as a “lowly graduate student.” Back then, she called them “heroes,” but now she writes of them with palpable heartbreak: “I thought they were my friends.” In fact, they’re Janus-faced. The element of betrayal here is personal. At heart, Natural Causes is a form of memoir. Ehrenreich’s inquiry hinges on her asking herself: Why should this have been a betrayal?
For the answer, Ehrenreich turns to the history of preventative health care. The roots of its contemporary form, she tells us, are in the late 19th century. American medicine, envious, grafted the philosophies and lab-based format of Germany’s research universities onto this country’s hitherto eclectic array of rogue healers. The practical effect of reform was to insulate the nascent medical profession from black, brown, female, and “crude boy or … jaded clerk” candidates.
Instead, doctors would henceforth “be recruited from the class of ‘gentlemen,’” who learned the science of living bodies from dead ones — medical cadavers, the perfect patients. Medicine’s “epistemologically normative” body thus became one whose surfaces and holes would politely yield to (white) gentlemanly fingers in “rituals of humiliation,” like yearly physicals and gynecological exams.
Such “regularly scheduled invasions of privacy” are “anchored […] symbolically, in laboratory science” but nevertheless demonstrably “do not save lives or reduce the risk of illness,” according to Ehrenreich. Never mind if she’s right. The point is such medico-managerial gaslighting maintains our “illusion of control,” even more so now after the merger of “scientific medicine” with “holism” in the 1960s and ’70s.
Holism figured the body and mind as a whole mechanical “system,” like a car. Very much like a car, in fact. Despite its hippie origins, it somewhat counterintuitively arrived on the legitimizing coattails of “systems analysis,” a business fad promoted by elite men like US Secretary of Defense Robert McNamara, formerly of Ford Motor Company. All told, it was capitalism, not science, that catalyzed this next phase of wellness, ensuring “holism opened a new avenue of control — exercised by the mind over the body.”
Around this same time, deindustrialization and “downsizing fervor” were reshaping “the entire sociological map.” This upheaval distinguished the 1970s and ’80s, Ehrenreich recalls, a time when, if you were a young adult who felt “you could not change the world or even chart your own career, you could still control your own body — what goes into it and how muscular energy is expended.” Fitness clubs opened in droves, the upwardly mobile (like Ehrenreich herself) became avid subscribers, and healthy eating and “successful aging” became signifiers of personal worth. Corporate policies amplified the trend: Ehrenreich believes it was “the existence of widespread health insurance that turned fitness into a moral imperative.”
Within this context of generational disruption, Ehrenreich portrays a kind of Cartesian renaissance in which fitness culture took “dualism further — to an adversarial relationship in which mind struggles for control over the lazy, recalcitrant body.” To control the body became the first indication of one’s ability to control one’s finances, and beyond that, the livelihoods of others. As she writes: “Flabby people are less likely to be hired or promoted.” Cue the fit body as a marker of “class.”
Accordingly, through the 1980s and ’90s, the “rich foods” of the working class became the rations of lesser beings, while “the educated classes turned against fat in all forms” and anathematized cigarettes. As the classes diverged amid the erosion of labor protections, “the new stereotype of the lower classes as willfully unhealthy quickly fused with their old stereotype as semi-literate louts.” But by the early 21st century, something altered this landscape: affluent Americans began to fear the loss of their imagined birthrights when the upwardly mobile mind encountered its own crisis.
Digital technology and social media fueled an “inattentiveness epidemic” that Silicon Valley failed to contain — on purpose, Ehrenreich insinuates. After all, a crisis is a terrible thing to waste: if the world was losing its mind because of Silicon Valley’s products, the solution was more product. Specifically, the salvific product was the concept of mindfulness, which “began to roll out of the Bay Area like a brand-new app.”
Soon, a tech CEO had “blurbed a seminal mindfulness manual,” and other Silicon Valley powerbrokers were proselytizing the idea of biohacking oneself through meditation. Once again, it was the scientific imprimatur of elite men that legitimized these ideas, far more so than scientific breakthroughs. After all, mindfulness, Ehrenreich asserts, is little more than a secular derivative of early ’00s Bay Area elite Buddhism. For her, its scientific support is paltry in comparison to what wellness claims it to be. She has no patience for those who argue otherwise.
Quite apart from questioning mindfulness’s legitimacy or truth value, what are we to make of a mind that controls itself, of a self that cares for itself, perhaps only for itself? This is the “epistemological crisis” Ehrenreich believes underpins the compulsory self-improvement of the 21st-century wellness industry. She investigates its backstory in the sharply different second half of her book, which at times feels too sweeping in terms of its tidy but tenuous causal connections.
Ehrenreich traces the “self” to the late 16th century and the Protestant reorientation of salvation around the individual soul. This “austere, reformed version of monotheism” influenced Western science’s crusade to eliminate “agency from the natural world.” Centuries later, God was dead and salvation moot, but the soul was still here, secularized into the “self” and the sole “agent” in an inert world. Rogue, willful cells like macrophages had no place in such a world.
In fact, Ehrenreich argues this self-centered, inert paradigm corrupted her beloved cell science in the 20th century. Under its aegis, the field turned away from “close observation of individual macrophages,” which are unruly by definition. Instead, it conceptualized molecular biology as a type of chemistry (read: law-abiding molecules), setting the stage for a utopian mind-body that could be managed into health; “Put in more mechanical terms, wellness is the means to remake oneself into an ever more perfect self-correcting machine capable of setting goals and moving toward them with smooth determination.”
So, the “epidemic of wellness,” located in the confluence of capitalism, bad-faith science, and classism, has thus been centuries in the making. It is especially optimized for this historical moment, when the “increasingly polarized economic situation demands the more nebulous and elastic concept of ‘wellness.’”
The antidote Ehrenreich recommends for this wellness “epidemic” paradoxically capitulates us to the more unscientific aspects of wellness culture. Since the “self” sits at the center of the past four centuries’ illusions of control, dissolving it will release us from relentless and ultimately pointless self-maintenance. (She recommends psilocybin to facilitate the process.) At the same time, science must inaugurate “a dystopian view of the body — not as a well-ordered machine, but as a site of ongoing conflict at the cellular level.” Together, these paradigm shifts will presumably shatter wellness’s illusion of control, reconciling our living selves with their inevitable ends.
Who exactly is this “our”? Indeed, it’s unclear whose “epidemic of wellness” is at stake in Natural Causes when, for so many people, there is not too much wellness, but not enough. Ehrenreich at times undercuts her working-class solidarity with white working-class solidarity, tethering her polemic to a body coded as white. And yet I wonder if the expectation that Natural Causes would not be so tethered is unfair. After all, it germinated from Ehrenreich’s sense of personal betrayal by the macrophages 11 years earlier. It makes sense that the resulting book is as personal as that catalytic treachery.
Natural Causes is not a Grand Unified Theory of How We Live Life Now; it is Ehrenreich’s reflection on how she has lived her own extraordinarily productive life. The best parts draw their force from her institutional knowledge, her experience of medicine and wellness from the 1950s to the present, and even her grudges. Her theories are so convincing and her prose so captivating because she herself saw the events that contoured wellness culture into its 21st-century shape. To decenter herself and her body from that narrative would have been to write an entirely different book.
To be sure, Ehrenreich’s narrative isn’t quite so linear as I’ve suggested here. With each chapter, the scope of inquiry broadens, so that what begins as a polemic against hypermonitized health care becomes a mystical homily on “the actual world, which seethes with life.” Certainly by the time I completed it, I felt like the book I finished was not the one I began. For a reader anticipating long-form science reporting, this sprawling grandiosity can register as a betrayal of expectations.
Such betrayal is by design, as Ehrenreich confesses: “The question I started with has to do with human health and the possibility of our controlling it. If I had known that this is just part of a larger question about whether the natural world is dead or in some sense alive, I might have started in many other places.” This confession in the final pages reprises an earlier message. “This book cannot be summarized in a sentence or two,” Ehrenreich cautions in the introduction, right before sketching “a rough road map to what follows.”
That she sets out to help us control our journey through this delightfully unruly narrative — one that is about the dubiousness of control — epitomizes the spiritual message of Natural Causes: to live better, we must embrace paradox. More importantly, we must recognize that our instinctive desire to resolve paradoxes can drive us mad.
The inexplicability and injustice of who gets to live a long, healthy life and who does not is among the oldest and most uncomfortable of paradoxes. For Ehrenreich, wellness is our latest attempt at resolving it, replacing religion’s ars moriendi with the moralism of healthy living. The insatiable drive to be well, in other words, is a desire that consumes the very thing it intends to preserve: more of our lives for us to live. To live better, we should be at peace with the paradox of “death by natural causes” and stop trying so hard to live so well.