science of us

How ‘Wellness’ Culture Creates an Illusion of Control Over Death

Photo: Gusto Images/Getty Images/Science Photo Library

I don’t know why I did it. But when Ken, one of the physician’s assistants in the liver transplant wing, walked into my room to deliver my daily shot of heparin, I stopped him.

“Hey,” I said, looking up from my computer. “What does heparin even do?”

“It prevents blood clots for patients who aren’t moving around,” he replied.

I swiped over to the pedometer app on my phone and held it up. “I’ve been walking circles around the floor,” I replied. “I’m over 3,000 steps. I don’t need heparin.”

Ken shrugged. “Okay.”

Just like that, he left. I was stunned. For the first time in the four years I’d been on-again, off-again with cancer, I’d said no to something — and actually got my way. After that, I felt unstoppable. I began waving away anyone who dared offer to prick my finger to check my glucose levels. I started strolling around different floors of the hospital. I now question, if not reject, certain medical decisions in the same way that author Barbara Ehrenreich does in her new book, Natural Causes: An Epidemic of Wellness, the Certainty of Dying, and Killing Ourselves to Live Longer. In it, she argues that we don’t need this sort of godly oversight, and opens by sharing the revelation that encouraged her to begin ignoring her doctors’ orders. “I gradually came to realize that I was old enough to die,” she explains.

From there, Ehrenreich declares her intent to spend her remaining time as she chooses. “I was also old enough not to incur anymore suffering, annoyance, or boredom in the pursuit of a longer life,” she writes. “As for medical care: I will seek help for an urgent problem, but I am no longer interested in looking for problems that remain undetectable to me.” The rest of the book serves as sometimes persuasive, sometimes antagonistic explanation for this declaration.

Ehrenreich cuts straight to the chase in her first chapter, in which she compares the usual medical procedures, from annual physicals to a breast-tissue biopsy, to the rituals of ancient civilizations, concluding that both mainly exist for show. (Think of it as a performative placebo effect.) As someone who has a doctor’s appointment every ten seconds — and has reaped the benefits of showing up, like early detection of new tumors — I’m skeptical at first. But Ehrenreich has the research to back it up, arguing that many of these procedures are grounded in little science. “In 2014, the American College of Physicians announced that standard gyn[ecological] exams were of no value for asymptomatic adult women and certainly not worth the ‘discomfort, anxiety, pain and additional medical costs’ they entailed,” she writes.

With this, she gets my attention (and applause). But Ehrenreich then zeroes in on personal health, which she maintains is the new way of minding your body between those sparse doctor visits. And with it, she says, comes the “continuous, convenient, unobtrusive self-monitoring of dozens of variables, including blood pressure, heart rate, calorie intake, number of steps taken in a day, even mood.” This, coupled with the increasing popularity of tough fitness regimens (see: ClassPass), has given people a sense of more autonomy over their respective bodies. Ehrenreich likens the #fitfam movement to “the mind’s struggle for mastery over the body.” But I consider it the opposite. There’s a reason that I began speed-walking in circles around the hospital floor, dragging my IV cart behind me. I rely on daily exercise — usually, a morning run along the East River — to feel invigorated, balance my mood, and calm my mind. I know I can’t be the only one.

Speaking of the mind: Mindfulness gets its own chapter. As it’s the darling du jour of the Silicon Valley set, Ehrenreich asks us to consider how suspect it is that that the same people who brought us the devices that stress us out are also peddling $10 a month guided meditations to counterbalance it. Fair enough, and yet she undercuts her insight by targeting meditation itself. Her answer to the mounting evidence of meditation’s benefits is the least convincing in the book. “So maybe meditation does have a calming, ‘centering’ effect,” she writes. “But so does an hour of concentration on a math problem or a glass of wine with friends.” I, for one, would rather sit quietly after a long day than do long division. And I’m good at math.

But Ehrenreich’s analysis of our approach to death will resonate with anyone who’s ever had a serious illness, and she’s particularly incisive about the world’s collective need to know how others died so one can avoid making that same mistake, whatever it is. “Did she smoke? Drink excessively? Eat too much fat and not enough fiber? Can she, in other words, be blamed for her own death?” she writes. I recognized myself in this. Sure, I wasn’t dead, but during chemotherapy (when my bald head served as a cancer-patient billboard) everyone from co-workers to cab drivers grilled me on my lifestyle, eager to find out what I’d done wrong. And I’d sit there and answer them like an idiot, when really it a) wasn’t their damn business, and b) wouldn’t save them. I had cancer for no reason. So can you.

Okay, that’s not entirely true — or so I learn. In the most fascinating section of the book, Ehrenreich (who has a Ph.D. in cellular immunology) sheds light on the new, little-known research that shows how our immune systems may actually aid and abet cancer development and metastasis. (You’ll want to lay off those immune-boosting chaga tea lattes once you learn just how enthusiastically certain immune cells try to screw you over.) But it makes sense when you consider her final conclusion, which is that your body is programmed to kill itself. After all, we’re designed to be mortal, like everything else on the planet.

Ehrenreich finally reveals some optimism when she shares what makes her want to keep living — even if she is, as she puts it, old enough to die. “It is the idea of a continuous chain of human experience and endeavor that has kept me going through an unexpectedly long life,” she writes. She then lists simple pleasures, such as sitting in the sun and spending time with friends, that she’ll eventually pass along to others. In a roundabout way, she makes death seem less morbid — and, encouragingly, more like paying it forward on a grand scale.

I love the peaceful acceptance in her conclusion. But while Ehrenreich’s points are all well-informed, there’s one thing I can’t agree with: Namely, that I’m old enough to die. I’m 28, and would happily get weekly CT-scans if that’s what it takes to detect (and promptly treat) a recurrence of cancer. I don’t care if they come with their own risks and discomfort; I’ve had cancer enough times to know the alternative is worse. And, in the meantime, I run and meditate and try to last more than two seconds in side crow, not to live longer but to enjoy my time, however much of it I get.

‘Wellness’ Culture Creates an Illusion of Control Over Death