Natural Causes: An Epidemic of Wellness, the Certainty of Dying, and Killing Ourselves to Live Longer by Barbara EhrenreichMy rating: 5 of 5 stars
There's plenty of punch in this slim volume, and it goes beyond what most reviews note. And, for this blog post, I have further expanded my original Goodreads review.
That alone, what is in the reviews, is notable enough. Doctors overexamine most Americans, whether out of profit motives, an overdoing of precautionary principles, the idea of doctor as superman or some combination of all of the above. For two biggies specific to men and women, Ehrenreich references mammograms for women and PSA tests for men. Colon cancer testing, she says, is probably also overdone.
And, then, she dives into issues related to this and beyond. First, our mix of individual genes, the fact that many cancers are hugely multigenic in nature beyond environmental factors and other things, means that outside of things like BRCA, a lot of genetic findings are probabilities, no more, and probabilities not much different from random chance.
So, most such tests aren't worth a whole lot. If they do find anything, "watchful waiting" is much better in most cases than surgical, radiative or chemotherapeutical undertakings. But, a doctor may not tell you that. For one or more of those three reasons above, or others.
Then we get to the real fun.
Your own body may exacerbate many cancers.
Ehrenreich looks at how macrophages can be "bad guys" as well as "good gals." They can "encourage" cancer cells in the area of tumors to continue reproducing rather than killing them. They supply cancer cells with chemical growth factors. They build new blood vessels for them. They help them enter blood vessels they couldn't on their own. This all is best documented with breast cancer, but also shown with lung, bone, gastric and other cancers, she says.
In addition, the spread of arthritis and other inflammation-generated diseases, are also assisted by macrophages.
So, from this, riffing on her previous book "Bright-Sided," Ehrenreich says New Agey ideas of visualizing your body, or "your body," attacking cancer is nonsense. The "your body" goes in scare quotes, because she also documents other ways in which macrophages can be free agents of sorts. She goes back to Russian zoologist Elie Metchenikoff, who first talked about this a century and more ago, but was roundly rejected. Now, his ideas are gaining acceptance. Some other immunological cells have lesser, but not insignificant, degrees of free agency, Ehrenreich says.
We're still not done, though.
Next comes philosophy.
If these cells have that much independence, what does this mean for the idea of a unitary "self"? And, if they're not conscious, but seem to have some independence, what word do we use for that?
Ehrenreich starts by referencing Jessica Riskin and her book "The Restless Clock." Riskin talks about "agency" as a purpose-based set of actions that is below the mental level (if we can even talk about mental levels of a single cell) of consciousness. Ehrenreich notes that we as a species are believed to have evolved highly sensitive agency detectors, but says that dismissing the idea of agency, especially non-conscious agency, from the non-human natural world altogether is a mistake. She says it's a greedy-reductionist view of biology, wanting to cut down to genes, not cells, and base biology on chemistry.
And, we're still not done.
Ehrenreich, paralleling somewhat Irvin Yalom, written up in The Atlantic two years ago about "How to Die," talks about "successful aging" next. That means accepting that aging will happen. Accepting that many blows of aging cannot be fully dodged, not even by rich anti-aging gurus. Accepting and embracing that aging has positive sides. With that, people can stop wasting money on gimmicks and brainwaves on stressing out. They can accept that aging is a normal evolutionary process, too. And, those macrophages that are quasi-free agents, along with other parts of "our" immune system? Just maybe their biggest job is to help kickstart the process of decomposition when each of us dies. (For insightful quotes from Yalom, go here.)
From here, back to philosophy.
Ehrenreich talks about the invention of the "self." In Europe, she says it probably started with the Renaissance and the rise of humanism, then took off in the Enlightenment. Rousseau, of course, majorly boosted the idea.
From there, we've gotten to the modern bombardment with selfhood, "branding" oneself on social media, selfie sticks for smartphone photos and more. (Ehrenreich politely doesn't call a lot of this "dreck," which it is.)
And, thus, it is harder for a modern Westerner, at least in the US, vaguely religious or "spiritual but not religious," to memento mori than it was a medieval Christian who was regularly reminded of that idea at Mass.
Ehrenreich's conclusion? Kill the self, or at least diminish the attachment to it. She mentions psychadelic drugs; on the other hand, many modern Americans who talk about using them seem to look at attaching more to a "self" afterward than before. But, there's potential there, along with long, distracted walks in nature and other things.
Don't rage against the dying of the light; accept that you don't control the sunset or the light switch.
Ehrenreich also refers to the perennial existential insight that while none of us can truly conceive of a world going on its merry way of existence after we're gone, at the same time, none of us can conceive of the world that was merrily going on before we were born, reincarnation claims aside.
But, the problem is ... we as individuals have existed. So, death, or post-death, anxiety hits us in a way that pre-birth trembling doesn't.
One thing that Ehrenreich does not really dive into is the differentiation between fear of death, which is largely existential in nature, and the fear of dying, or of specific types of dying, which is largely empirical in nature. Many of us have had a relative or friend of some sort, if not a loved one, die from some gruesome cancer or something else horrible.
But, with her notes on ixnaying overdone medical testing, Ehrenreich does, however, bring in an existential angle to fears of dying, too. Stop overdoing them.
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