Natural Causes: An Epidemic of Wellness, the Certainty of Dying, and Killing Ourselves to Live Longer

by Barbara Ehrenreich

The article, written by one of Scientific American’s editors,1 reported that the immune system actually abets the growth and spread of tumors, which is like saying that the fire department is indeed staffed by arsonists.

The paradox of the immune system and cancer is not just a scientific puzzle; it has deep moral reverberations. We know that the immune system is supposed to be “good,” and in the popular health literature we are urged to take measures to strengthen it. Cancer patients in particular are exhorted to think “positive thoughts,” on the unproven theory that the immune system is the channel of communication between one’s conscious mind and one’s evidently unconscious body. But if the immune system can actually enable the growth and spread of cancer, nothing may be worse for the patient than a stronger one.

In the ideal world imagined by mid-twentieth-century biologists, the immune system constantly monitored the cells it encountered, pouncing on and destroying any aberrant ones. This monitoring work, called immunosurveillance, supposedly guaranteed that the body would be kept clear of intruders, or any kind of suspicious characters, cancer cells included. But as the century came to a close, it became increasingly evident that the immune system was not only giving cancer cells a pass and figuratively waving them through the checkpoints. Perversely and against all biological reason, it was aiding them to spread and establish new tumors throughout the body.

As an amateur sociologist, I had seen the health care system in my own country grow from a “cottage industry” to a three-trillion-dollar-a-year enterprise—employing millions, dominating neighborhoods and even skylines, setting off political fights over who should pay for it, and dooming politicians who choose the wrong answer. And what does this enterprise have to offer those who are not actually employed by it? Longevity is promised, among other things including freedom from disability, safe childbirth, and healthy babies. In a word, it offers us control—not control over our government or social milieu, but over our own bodies.

The more ambitious among us seek to control the people around them, their employees, for example, and subordinates in general. But even the most unassuming and humble of us is expected to want to control what lies within the perimeter of our own skin. We avidly seek to control our weight and shape through diet and exercise and, if all else fails, surgical intervention. The entire penumbra of thoughts and emotions that originates in our physical bodies also demands attention and manipulation.

But no matter how much effort we expend, not everything is potentially within our control, not even our own bodies and minds. This to me is the first lesson of the macrophages that perversely promote lethal cancers. The body—or, to use more cutting-edge language, the “mindbody”—is not a smooth-running machine in which each part obediently performs its tasks 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. What, after all, is cancer, other than a cellular rebellion against the entire organism? Even such seemingly benign conditions as pregnancy are turning out to be driven by competition and conflict on a very small scale.

The major interaction that goes on in gyms is not between members or between members and staff, but between the fitness devotee and his or her body. The body must be trained, disciplined, and put to ever more demanding tests, all administered and evaluated by the devotee’s conscious mind. Compared to the mind, the body can be thought of as an animal, usually a domesticated or partially domesticated animal—capable of reflex and habit, though not of course conscious decision making.

Western philosophy has long separated body from mind; fitness culture takes this dualism further—to an adversarial relationship in which mind struggles for control over the lazy, recalcitrant body. I plan to work out today, but I will not tell you exactly what I’ll do, lest my body find out.

Never mind that poverty, race, and occupation play a huge role in determining one’s health status, the doctrine of individual responsibility means that the less-than-fit person is a suitable source not only of revulsion but resentment. The objection raised over and over to any proposed expansion of health insurance was, in so many words: Why should I contribute to the care of those degenerates who choose to smoke and eat cheeseburgers?

There is of course a major difference between the intellectual groundwork of the eighteenth century and that of the twenty-first: Our predecessors proceeded from an assumption of human helplessness in the face of a judgmental and all-powerful God who could swoop down and kill tens of thousands at will, while today’s assumption is one of almost unlimited human power. 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: avoiding tobacco, exercising, undergoing routine medical screening, and eating only foods currently considered healthy. 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.

scientific world view itself.”1 We may think of the counterculture as a laid-back philosophical stance opposed to the very concept of control, but holism opened a new avenue of control—exercised by the mind over the body. Mind and body were disconnected in the reductionist scheme of things; it was not even clear that they belonged in the same sentence.

If you didn’t understand that, don’t worry. Aside from the syntactical disarray illustrated by this quote, it should be pointed out that there is no solid evidence that, aside from the effects of extreme stress, negative thoughts affect physical health, or that optimists live longer than pessimists.* Nevertheless, the author reassures us that “participating in a holistic health program or going to a practitioner often brings back a sense of control and hope, which, in and of itself can strengthen the body’s capacity to fight disease and stay healthy.”3 An amulet would probably work just as well.

Perhaps the most spectacular, and most spectacularly wrong, application of systems analysis was the Gaia hypothesis, advanced by chemist and atmospheric scientist James Lovelock in 1974. Influenced by the increasingly popular science of ecology and made intuitively plausible by the first photos of our planet from space, the hypothesis proposed that Earth and all that live on it comprise a single “system,” in fact, a self-regulating, living system in which the parts (humans, for example, or algae) interact to make Earth habitable for living creatures. That majestic image of a blue planet in space came to symbolize all that was good and desirable—wholeness, unity, ecology, interconnectedness, peace, harmony. It also decorated the cover of the Whole Earth Catalog, which featured subsistence farming techniques, outdoor gear, and DIY technologies for hippies and geeks seeking self-sufficiency. Humans were subunits of that greater whole represented by the planet Earth, although unfortunately the smooth-running system that was Gaia has never figured out how to correct for the profligate human consumption of fossil fuels.

Cancer is hard enough to explain: Why would a cell undertake a campaign of conquest that can only end in that cell’s own death?

Many phases of women’s reproductive cycle, from menstruation to labor, resemble the kind of inflammatory response the human body usually mounts when invaded by pathogens, except that in the reproductive case the targets are not pathogens but human cells and tissues. Menstruation, for example, is not the gentle, autumnal-sounding process of “shedding” an endometrial lining that it is usually described as. When no embryo implants, the uterus releases chemical signals summoning immune cells to come in from the bloodstream and devour its thick endometrial lining, which quickly becomes a killing field, with the debris pouring out of the vagina.

Fortunately, from the point of view of the organism as a whole, there are plenty of mechanisms to keep adventurous cells in place. Tissue cells are bound to each other by “intercellular glue” as well as by “junctions,” some of them so tight as to be almost unbreakable. As an additional precaution, organs are often enclosed in membranes that may be difficult or impossible for a cell to breach. Then there is the steady hail of chemical signals that one cell receives from others, some of them sent from considerable distances. We can translate very few of these signals, and they appear to say things like “Danger!” or “Come here right away!” And—who knows?—some of the messages may be propagandistic, urging cells to carry on stalwartly with their appointed tasks. Then there is the final sanction for a recalcitrant cell: death. Signals come in saying “Die!” and, in a process called apoptosis, the cell obligingly shuts down its metabolism, folds neatly into its membrane, and awaits disposal.

So much, then, for the hours—and years—you may have devoted to fitness. The muscles that have been so carefully sculpted and toned stiffen when calcium from the dead body leaks into them, causing rigor mortis, and loosening only when decomposition sets in. The organs we nurtured with supplements and superfoods abandon their appointed functions. The brain we have tamed with mindfulness exercises goes awry within minutes after the heart stops beating. Soon after, reports a forensic anthropologist, “the brain liquefies very quickly. It just pours out the ears and bubbles out the mouth.”27 Everything devolves into a stinking pool or, what may sound even worse, a morsel in a rat’s digestive system.

But no one has detected this entity. There is in fact much firmer evidence for the existence of “dark matter,” the hypothesized substance that is invoked to explain the shape of galaxies, than there is for any spirit or soul. At least dark matter can be detected indirectly through its gravitational effects. We can talk about someone’s soul and whether it is capacious or shriveled, but we realize that we are speaking metaphorically. Various locations for an immaterial individual essence have been proposed—the heart, the brain, and the liver—but autopsies yield no trace of it, leading some to speculate that it is delocalized like the Chinese qi. In 1901, an American physician reported that the human body loses three-quarters of an ounce, or twenty-one grams, at the moment of death, arguing that this meant the soul is a material substance. But his experiment could not be replicated, suggesting that the soul, if it exists, possesses neither location nor mass. One can’t even find the concept of the “immortal soul” in the Bible. It was grafted onto Christian teachings from the pagan Greeks long after the Bible was written.2

Megalomania, or the proud claim of a rebellious political thinker? Contemporary thought has leaned toward the latter; after all, Rousseau was a major intellectual influence on the French Revolution, which, whatever its bloody outcome, was probably the first mass movement to demand both individual “Liberté” and “Fraternité,” or solidarity within the collective. There is something bracing about Rousseau’s assertion of his individual self, but the important thing to remember is that it was an assertion—no evidence was offered, not that it is easy to imagine what kind of evidence that might be. As historian John O. Lyons put it, the self was “invented.”5 Another slippery abstraction was taking hold at around the same time as the self, and this was the notion of “society.” Like the self, society is not something you can point to or measure, it is a concept that has to be taught or shared, a ghostly entity that arises from an aggregate of individual selves. In material terms, you can imagine a “super-being” composed of numerous subunits clumsily trying to coordinate their movements. It is no coincidence that the concept of society arose along with that of the self, if only because the newly self-centered individual seemed to be mostly concerned with the opinion of others: How do I fit in? How do I compare to them? What impression am I making? We do not look into mirrors, for example, to see our “true” selves, but to see what others are seeing, and what passes for inner reflectio...

Or, as somewhat more simply put by a Spanish historian, “the modern Rousseauist self, which feels and creates its own existence, would appear to be the heir to attributes previously assigned to God.”8

What could go wrong? Of course, with the introduction of “self-knowledge” and “self-love,” one enters an endless hall of mirrors: How can the self be known to the self, and who is doing the knowing? If we love ourselves, who is doing the loving? This is the inescapable paradox of self-reflection: How can the self be both the knower and the content of what is known, both the subject and the object, the lover and that which is loved? Other people can be annoying, as Sartre famously suggested, but true hell is perpetual imprisonment in the self. Many historians have argued that the rise of self-awareness starting in roughly the seventeenth century was associated with the outbreak of an epidemic of “melancholy” in Europe at about the same time, and subjective accounts of that disorder correspond very closely with what we now call “depression.”10 Chronic anxiety, taking the form of “neurasthenia” in the nineteenth century, seems to be another disease of modernism. The self that we love and nurture turns out to be a fragile, untrustworthy thing.

Wherever we look, if we look closely enough, we find nature defying the notion of a dead, inert universe. Science has tended to dismiss the innate activities of matter as Brownian motion or “stochastic noise”—the fuzziness that inevitably arises when we try to measure or observe something, which is in human terms little more than a nuisance. But some of these activities are far more consequential, and do not even require matter to incubate them. In a perfect void, pairs of particles and antiparticles can appear out of nowhere without violating any laws of physics.

Then, the mind, the conscious mind, and here I am relying, appropriately I think, solely on subjective experience: We may imagine that the mind houses a singular self, an essence of “I-ness,” distinct from all other selves and consistent over time. But attend closely to your thoughts and you find they are thoroughly colonized by the thoughts of others, through language, culture, and mutual expectations. The answer to the question of what I am, or you are, requires some historical and geographical setting. Nor is there at the core of mind some immutable kernel. The process of thinking involves conflict and alliances between different patterns of neuronal activity. Some patterns synchronize with and reinforce each other. Others tend to cancel each other, and not all of them contribute to our survival. Depression, for example, or anorexia or compulsive risk taking, represent patterns of synaptic firing that carve deep channels in the mind (and brain), not easily controlled by conscious effort, and sometimes lethal for the organism as a whole, both body and mind. So of course we die, even without help from natural disasters or plagues: We are gnawing away at ourselves all the time, whether with our overactive immune cells or suicidal patterns of thought.

Regret, certainly, and one of my most acute regrets is that I will not be around to monitor scientific progress in the areas that interest me, which is pretty much everything. Nor am I likely to witness what I suspect is the coming deep paradigm shift from a science based on the assumption of a dead universe to one that acknowledges and seeks to understand a natural world shot through with nonhuman agency. It is one thing to die into a dead world and, metaphorically speaking, leave one’s bones to bleach on a desert lit only by a dying star. It is another thing to die into the actual world, which seethes with life, with agency other than our own, and, at the very least, with endless possibility.

He was dying, but that was all right. The blackbirds would keep on singing.