JUNE 7, 2018
FOR MANY OF US who are older than say, 42, fighting old age has become part of our weekly routine. We devote hours and dollars to “aging well,” which we often take to mean: without external indicators of said progression. Anti-aging is part hobby, part team sport, part schadenfreude: “Did you see what she had done to her lips? Does she think no one will notice she looks like a duck?”
Aging well — or, ideally, not at all — has also become another realm of personal responsibility-taking, one that can be both self-indulgent and privation-focused. We must pull ourselves up by our bootstraps — or in this case, pull our faces up by Botox, and filler, and maybe surgery. Any faltering on this goal can seem a sign of laziness and lack of grit. The medical establishment is in on the act, admonishing us if we miss a screening or stray from a healthy diet. Alternative practitioners participate too, selling creams and elixirs, adjustments and massage, personal training packages and energy healing. In my own neighborhood in Santa Monica, when I walk the dog I pass two med-spas, two yoga studios, two Pilates studios, a place called “StretchLab,” and the drop-in laser facial boutique “Skin Laundry.” Self-help books on the topic abound, promising that we can be Younger Next Year or Disrupt Aging, or if we follow quarterback Tom Brady’s advice, Achieve a Lifetime of Sustained Peak Performance.
Into this dubious world enters investigative journalist Barbara Ehrenreich with her own contribution, Natural Causes: An Epidemic of Wellness, the Certainty of Dying, and Killing Ourselves to Live Longer. In a legion of guides for combating aging, this is not one of them, as Ehrenreich emphatically notes in the introduction.
Here you will find no tips for living longer, eating better, or developing a more positive mental attitude. Instead, this part polemic, part essay collection offers a wide-ranging critique of the anti-aging industry as well as a call to its victims to stand down and face the facts, which as a plastic surgeon I recently visited for a consultation put it: “We grow old. We get ugly. We die.”
Ehrenreich is not concerned with the ugly part of aging, but rather with a culture that insists we must take control over everything, even death. Her examination of the topic began with a story she read 10 years ago in Scientific American about a discovery she found so provocative and disturbing, it upended her concept of the body — namely that the immune system can fuel the growth of malignant tumors and even aid cancer’s spread.
She took this news personally, partly because she’d had breast cancer, one of the many types of cancer that the immune system can fuel, and partly because she’d had a long, warm relationship with the immune system dating back to graduate school. Ehrenreich, who is probably best known for her classic work on inequality Nickel and Dimed, also has a PhD in cellular immunology. As a grad student, she did research on macrophages, large cells that kill microbes by eating them, the “frontline defenders” of our immune system. Macrophages are also the ones that go rogue and start attacking health tissues. As Ehrenreich reports, “I thought they were my friends.”
The discovery of this cellular betrayal — a one-sided treachery, clearly, as it seems impossible that macrophages loved her back — underlies one of the book’s key insights, that the body is not a smooth-running machine working in complete harmony with itself for the benefit of the common good. “It is at best a confederation of parts — cells, tissues, even thought patterns — that may seek to advance their own agendas, whether or not they are destructive of the whole.”
This truth feels intuitively correct to anyone who has experienced goal-conflict — and who hasn’t? The mind can simultaneously advocate for losing 10 pounds and eating a box of brownies, now. For Ehrenreich, this news launched an effort to understand how something long believed to be a “good guy” can go so seriously bad, and how the uncontrollability of our bodies at the cellular level relates to aging more broadly. Her investigation winds through a wide range of topics only someone with such a varied educational and professional background would undertake: rituals of healing in pre-modern societies and at your local doctor’s office, the dogma of wholeness, mindfulness, the tech industry, and biology, to name a few.
While an impressive display of erudition, Natural Causes brings something far rarer to the discussion of aging in print: a sense of humor. Ehrenreich is a very funny companion on the aging “journey,” especially when sharing her own experiences and conflicts. She devotes one chapter to skewering our national obsession with working out, and also expounds on her personal infatuation with the gym.
“Early in the 1980s,” she writes,
a friend got me going with her to an unchallenging women’s-only gym in a nearby shopping enter. She wanted to lose weight; my lower backaches had forced me to realize I could no longer treat my body as mere scaffolding for keeping my head upright […] We waved our arms, crunched our abs, or lay on the floor and raised our legs to the beat of Billy Idol’s version of “Mony Mony.” […] In normal life I like to think I am a modest and cooperative person; in the gym I was always covertly comparing myself to others and seething with ambition to outdo them.
Another chapter opens with this observation: “Many of the people who got caught up in the health “craze” of the late twentieth century — people who exercised, watched what they ate, abstained from smoking and heavy drinking — have nevertheless died.” Morbid? Maybe. But also pretty funny.
Her personal story also helps ground some of the sharpest critiques, such as the profit motive in medicine driving treatments that may actually harm more than help. Her primary care physician, for example, recommended a bone-density scan. The results showed “osteopenia,” or thinning of the bones. She did some easy research and learned that thinning of the bones is a normal feature of aging for women, not a disease, and that routine bone scanning had been promoted and subsidized by the manufacturer of the drug prescribed to fight it. The drug itself can cause further bone degeneration. “A cynic might conclude that preventative medicine exists to transform people into raw material for a profit-hungry medical-industrial complex.”
That’s putting it lightly, and this section, structured largely around her own revolt against mainstream screenings, makes a compelling case for questioning and probably forgoing many of them. It’s a graceful critique of a topic that could fuel a shelf full of fiery attacks, and has.
This light touch is not uniform throughout, and some of the book’s arguments are weakened by what feels like gratuitous snark, a knowing tone gone snooty that can distance the reader, cropping up in parts not leavened by her own experience.
Still, even with these intrusions, and despite her own stated intention to offer no guidance, Natural Causes provides insight and solace. It’s hard to imagine a reader of a book on aging not looking for advice. In the final two chapters, largely concerned with the invention of the notion of “self,” Ehrenreich does offer some suggestions, including removing our gaze from our own navels, or letting go of our fixation on ourselves. She writes about recent clinical studies of psilocybin, the active ingredient in “magic mushrooms,” for people struggling with depression and even cancer. The drug suppresses the part of the brain concerned with the self, which in turn has been shown to lessen depression and fear of death.
She also shares her own approach to old age, which, to an admirer of her longevity and enduring intellectual feistiness, feels like a model to follow. She eschews the recommended annual medical screenings, goes to the gym regularly, retains “a daily regimen of stretching, some of which might qualify as yoga,” and eats whatever she wants. She also obviously sees friends and family regularly and continues to apply herself to work that feels meaningful and important.
This is good advice, and I came away with a few more specifics: I will not get a colonoscopy, ever, despite having passed 50. I should probably take magic mushrooms at least once. And I did the right thing by joining Equinox, though I need to make time to get myself there. The book also helped explain the radical decrease in depression that has accompanied aging for me.
My own approach to dealing with middle age has been to shift my ambitions toward service — spending more time lifting up others and less time (though not no time) on my own byline and success. This change in focus (also suggested by organized religion) has yielded similar results as the studies with magic mushrooms; giving a peace-inducing sense of connection to something beyond myself, albeit without the psychedelic part.
Ehrenreich shares her own consolation in the face of eventual demise, the conclusion that dying is not so bad if we recognize that the world “seethes with life, with agency other than our own, and, at the very least, with endless possibility.” Death is not a terrifying leap into an abyss. The world will keep on singing, and this is some comfort to those of us who love it, for all its flaws.
Wendy Paris is the author of Splitopia: Dispatches from Today’s Good Divorce and How to Part Well (Atria, 2016) and the co-author of the forthcoming Buy the Change You Want to See: Use Your Purchasing Power to Make the World a Better Place (TarcherPerigee, 2019).