Nursing Book Club

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

A Contrarian View of Aging

Barbara Ehrenreich has authored or coauthored almost 20 books, many of them on topics other than healthcare and science. Thus, I was surprised to learn that she has a Ph.D. in cellular immunology and is well qualified both as scientist and author to explain why she has given up on many health screenings that most reasonable people subject themselves to.

In her recent book Natural Causes, Ehrenreich says she has discontinued annual exams, pap smears and many other preventive or diagnostic procedures. She explains that it’s not because of procrastination, cost or lack of insurance coverage, but because she’s decided that if she is old enough to die — she recently turned 77 — she is also old enough “not to incur any more suffering, annoyance or boredom in the pursuit of a longer life.”

She goes on to say she isn’t completely avoiding medical care and will continue to seek help for anything she terms an urgent problem. However, she no longer wants to spend her remaining time searching for problems that are not immediately detectable or sacrifice her quality of life for the sake of longevity.

In the succeeding chapters, Ehrenreich discusses our collective obsession with wellness, which she sees as pernicious, redefining health in terms of class or cultural cues such as thinness, the ability to maintain a healthy diet or having a gym membership. She argues that in many cases, “wellness” is really about victim-blaming, treating death as a personal failure rather than a natural and inevitable part of life.

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She also points an accusing finger at mass-marketed mindfulness and yoga, which have been ripped from their Buddhist roots, embraced by pop psychologists and Silicon Valley and transformed into smartphone apps. Do they really have the desired effect or are they just another health fad? She is skeptical.

Drawing the Line

Ehrenreich notes that evidence-based practice has led to a revolt against many medical practices that were once widely accepted. However, old habits die hard, and because most of us don’t have the time (or the background) to read through clinical studies and determine how best to apply them, we have to trust our providers’ judgment. Too often, Ehrenreich argues, they still push us in directions that provide little real return for what they cost us.

The last few chapters present a more complicated, controversial argument: that our holistic conception of our bodies and our cells may be faulty. In Ehrenreich’s view, our individual cells are basically selfish, following their own individual imperatives even when the results are destructive to the body as a whole (as in the case of cancer or autoimmune disease). If that’s true, the “healthful balance” the wellness industry advertises may be little more than smoke and mirrors.

Hiring Now

My first reaction to this book was, “Please! Help me climb up onto that bandwagon!” I too have had my fill of waiting rooms and expensive time traps whose results have caused no change at all in my health or lifestyle. I’m often tempted to refuse to actually reveal anything personal during a visit — disclosing a recent fall resulted in six weeks of physical therapy for balance training that I’m not sure I really needed.

This book is a great read that made me feel better about delaying some of the wild goose chases my primary care provider sends me on. Ehrenreich is a smart woman, and while some of her ideas may go against the grain, there’s a lot here that I secretly wanted — and needed — to hear.

That said, it’s important not to divorce Ehrenreich’s perspective from the context of her age. It’s one thing for a 77-year-old to decide she’s done with cancer screenings and being told not to butter her toast, but for younger people, the same choice might not be wise. Knowing where to draw that line is a very individual matter.

Natural Causes: An Epidemic of Wellness, the Certainty of Dying, and Killing Ourselves to Live Longer by Barbara Ehrenreich (Twelve Books/Hachette Book Group, 2018)


Christine Contillo, RN, BSN, PHN, is a public health nurse with more than 40 years of experience, ranging from infants to geriatrics. She enjoys volunteering for medical missions.


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