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

by Barbara Ehrenreich

If there is a lesson here it has to do with humility. For all our vaunted intelligence and “complexity,” we are not the sole authors of our destinies or of anything else. You may exercise diligently, eat a medically fashionable diet, and still die of a sting from an irritated bee. You may be a slim, toned paragon of wellness, and still a macrophage within your body may decide to throw in its lot with an incipient tumor.

Numerous studies have shown that caloric restriction or intermittent fasting can prolong the lives of rats and other animals, but the debate over its effectiveness in humans goes on,9 despite the fact that most of us would find a semi-starved life not worth living. If I can discern a general rule, it is governed by deprivation: Anything you like to eat—because it is, for example, fatty, salty, or sweet—should probably be put aside now in the interests of successful aging.

But as even the most ebullient of the elderly eventually comes to realize aging is above all an accumulation of disabilities, often beginning well before Medicare eligibility or the arrival of the first Social Security check. Vision loss typically begins in one’s forties, bringing the need for reading glasses. Menopause strikes in a woman’s early fifties, along with the hollowing out of bones. Knee and lower back pain arise in the forties and fifties, compromising the mobility required for “successful aging.” As we older people mutter to each other in the gym, “It’s just one damn thing after another,” most of these things are too commonplace and boring even to serve as small talk. The U.S. Census Bureau reports that nearly 40 percent of people age sixty-five and older suffer from at least one disability, with two-thirds of them saying they have difficulty walking or climbing.

The truly sinister possibility is that for many of us, all the little measures we take to remain fit—all the deprivations and exertions—will only lead to a longer chance to live with crippling and humiliating disabilities. As a New York Times columnist observed, “The price we’re paying for extended life spans is a high rate of late-life disability.”16 There are no guarantees.

It is known that human infants and probably those of many other mammals only thrive when held and touched. Extrapolating from that, some wellness purveyors surmise that even adults in modern societies suffer from “touch deprivation”—most of all the elderly ones, who may have lost, or lost interest in, their partners and simply aged out of the dating pool.

In one of his last novels, Everyman, Philip Roth’s protagonist, who is essentially the same Rothlike, sex-obsessed character who has starred in most of his novels, must face his own physical deterioration. Well into his seventies, retired and largely estranged from his family, he is still hitting on women at least a half century younger than himself. Mostly though, he is aging—tormented by his increasingly unreliable penis and by atherosclerosis, which comes to require heart surgery every year. The setting is increasingly claustrophobic as it moves among waiting rooms and hospitals before returning to the cemetery where the story started, at a family funeral, and where his own body will eventually rest. It is unlikely that Roth knew anything about inflammaging or the cellular basis of atherosclerosis, but he accurately summed up the biological situation when he wrote that “old age isn’t a battle; old age is a massacre.”

Certainly the cells of the immune system are in constant communication, and are capable of rather dramatic forms of cooperation. For example, if a macrophage needs to expand its supply of cell-killing digestive enzymes, all it has to do is gobble up a neutrophil and add the neutrophil’s stockpile of enzymes to its own. So the immune system seems to qualify as a “system,” but does it possess the autonomy we expect to find in a “living entity”? If so, we should probably call the nervous system a kind of living entity too, since it is capable of plotting and carrying out the death of the organism—in the form of suicide by gunshot or poison—on its own.

When the organism dies, as signaled by the cessation of the heartbeat and respiration, not all body cells die simultaneously, though many begin to ail within minutes or hours. Their mitochondria swell, their disabled proteins are not replaced, their cell membranes start to leak. Macrophages and other phagocytes, which are not wholly dependent on the bloodstream for nutrients, may last slightly longer and perhaps enjoy a brief orgy as they rush around devouring damaged cells, but they too soon succumb to the lack of oxygen from circulating blood. Bacteria from the gut—collectively known as the microbiome—find their way through leaky membranes to the rest of the body and begin the process of putrefaction. Next come the insects, including beetles, flies, and, should they be in the neighborhood, butterflies.

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.

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 The idea of an immortal soul did not survive the Enlightenment unscathed. The soul depended on God to provide its immortality, and as his existence—or at least his attentiveness—was called into question, the immortal soul gave way to the far more secular notion of the self. While the soul was probably “discovered” by Christians (and Jews) reading Plato, the self was never discovered; it simply grew by accretion, apparently starting in Renaissance Europe. Scholars can argue endlessly about when exactly the idea of the self—or any other historical innovation—arose; precedents can always be claimed. But historians have generally agreed on the vague proposition that nothing like either the soul or the self existed in the ancient world. Ego, yes, and pride and ambition, but not the capacity for introspection and internal questioning that we associate with the self. Achilles wanted his name and his deeds remembered forever; he did not agonize over his motives or conflicted allegiances. That sort of thinking came later.

Today we take it for granted that inside the self we present to others, there lies another, truer self, but the idea was still fresh in the 1780s when Jean-Jacques Rousseau announced triumphantly: I am forming an undertaking which has no precedent, and the execution of which will have no imitator whatsoever. I wish to show my fellows a man in all the truth of nature; and this man will be myself. Myself alone. I feel my heart and I know men. I am not made like any of the ones I have seen; I dare to believe that I am not made like any that exist. If I am worth no more, at least I am different.4 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.”

A psychological “mutation” of this magnitude cries out for a historic explanation. Here, historians have generally invoked the social and economic changes accompanying the increasing dominance of a market economy. As fixed feudal roles and obligations lost their grip, it became easier for people to imagine themselves as individuals capable of self-initiated change, including upward mobility. You might be an artisan and learn to dress and speak like a merchant, or a merchant who takes on the airs of an aristocrat. Traditional bonds of community and faith loosened, even making it possible to assume the identity of another person, as in the famous case of the sixteenth-century adventurer who managed to convince the inhabitants of a village that he was their missing neighbor Martin Guerre. He took over the family inheritance and moved in with the real Guerre’s wife, at least until the ruse was uncovered three years later.6 If you could move from village to village, from village to city, from one social class to another—and surely the disruptions of intra-European wars played a part in the new mobility—you have to constantly monitor the impression you are making on others. At the same time, those others are becoming less trustworthy; you cannot be sure what true “self” lies behind the façade.

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.

“All too often,” wrote philosopher Robert C. Solomon, “we approach death with the self-indulgent thought that my death is a bad thing because it deprives the universe of me” (italics in the original).13 Yet if we think about it, the universe survives the deaths of about fifty-five million unique individuals a year quite nicely.

There is one time-honored salve for the anxiety of approaching self-dissolution, and that is to submerge oneself into something “larger than oneself,” some imagined super-being that will live on without us. The religious martyr dies for God, the soldier for the nation or, if his mind cannot encompass something as large as the nation, at least for the regiment or platoon. War is one of the oldest and most widespread human activities, and warriors are expected to face death willingly in battle, hoping to be memorialized in epics like the Iliad or the Mahabharata or in one of the war monuments that have sprung up since the nineteenth century. For frightened soldiers or, later, their grieving survivors, dying is reconfigured as a “sacrifice”—the “ultimate sacrifice”—with all the ancient religious connotations of an offering to the gods.

Socially isolated adults are less likely to survive trauma and disease than those embedded in family and community. We delight in occasions for unified, collective expression, whether in the form of dancing, singing, or chanting for a demagogue. Even our most private thoughts are shaped by the structure of language, which is of course also our usual medium of interaction with others. And as many have argued, we are ever more tightly entangled by the Internet into a single global mind—although in a culture as self-centric as ours, the Internet can also be used as a mirror, or a way to rate ourselves by the amount of attention we are getting from others, the number of “likes.”

Then there is a deeper, more existential problem with my effort to derive some comfort from the notion of an ongoing human super-being: Our species itself appears to be mortal and, in many accounts, imminently doomed, most likely to die by our own hand, through global warming or nuclear war. Some scientists put the chance of a “near extinction event,” in which up to 10 percent of our species is wiped out, at a little over 9 percent within a hundred years.19 Others doubt our species will survive the current century. As environmentalist Daniel Drumright writes—and I can only hope he is an alarmist—with the growing awareness of extinction, “We’re dealing with a discovery of such epic proportion that it simply reduces everything in existence to nothing.” He goes on to say that our emerging circumstances require “a diabolic consciousness to which no living human being has ever had to bear witness. It is an awareness which requires a degree of emotional maturity that’s almost indistinguishable from insanity within western culture.”20 If your imagination is vigorous enough, you may take comfort from the likely existence of other forms of life throughout the universe. Earth-sized planets abound, potentially offering other habitats similar to our own, with reasonable temperatures and abundant water. In addition, sci-fi fans know that our vision of life based on carbon and water is likely to be far too provincial. There may be life forms based on other chemicals, or self-reproducing...