Natural Causes

An epidemic of wellness, the certainty of dying, and killing ourselves to live longer.

In her 20th book, 76-year-old journalist Barbara Ehrenreich ’63 flies in the face of preventive health care: she proclaims that she is old enough to die. No more bone-density scans for her. No more painful and humiliating mammograms or colonoscopies. No sleep apnea tests. No self-martyrdom at the dinner table. And if she goes on working out in a gym, it will be for the pleasure of it.

From its subtitle, you might guess that Natural Causes is a sequel to Bright-Sided, her 2009 polemic about the cult of “positive thinking” and how it demoralizes people who are already contending with crushing financial or medical issues. Nearly half of the book revisits her deep skepticism about modern medicine, with its aggressive promotion of dubiously valuable medical tests and pharmaceuticals; the cult of “mindfulness,” divorced from any desire for enlightenment; and the Silicon Valley billionaires who pursue ever more arcane mind-body regimens in hopes of outliving us all.

But, the actual genesis for Natural Causes was a 2008 article in Scientific American describing how the immune system—macrophages, to be precise—actually abets the growth and spread of tumors. To Ehrenreich, who earned a PhD in cellular immunology from Rockefeller University, this was like saying that “the fire department is indeed staffed by arsonists.”

The idea that the body’s first-line defenders against microbes and cancer cells can change roles and actually welcome them is for Ehrenreich a stunning reversal of the notion of the body as a harmonious system. And this role switching represents a form of “cellular decision making” that suggests profound metaphysical possibilities. If cells have agency, she says, perhaps so do other things we normally think of as inert. “If cells are alive and can seemingly act in their own interests against other parts of the body,” she writes, “then we may need to see ourselves . . . as confederations, or at least temporary alliances, of microscopic creatures.”

The second half of Natural Causes plunges into the behaviors of macrophages and other leukocytes, made visible by intravital microscopy, which follows cell movement in living tissue. Macrophages have often been described as the body’s garbage collectors, but some of them become serial killers, accessories not only to cancer’s spread but also to the inflammation associated with arthritis, diabetes, osteoporosis, strokes, and heart attacks.

In her final chapters, she builds a rather breathless case for redefining selfhood in the face of such bodily revelations. She is certainly not immune to the universal wish to outsmart death. At Powell’s Books this May, she noted that much of her energy goes to the Economic Hardship Reporting Project, which she founded in 2011 to fund journalists who document poverty and economic insecurity. “We nurture them,” she said. “You might say that is my bid for immortality.”