This is an ambitious book. It will challenge, console, frustrate and enlighten as it stretches the mind in multiple directions in its endeavour to grapple with fundamental questions concerning what it means to be a human being.
Natural Causes, Life, Death and the Illusion of Control requires the reader to leave the comfort of the familiar as the author, Barbara Ehrenreich, ambitiously traverses the sciences and the humanities and in doing so almost has no other option but to unsettle and frustrate the reader. My hunch is that Ehrenreich might consider such an effect on the reader as an indication of a job well done.
Ehrenreich sets out incensed by the knowledge that the immune system can go rogue and rather than defending the body, attacks it. The paradox of the “immune system and cancer is not just a scientific puzzle; it has deep moral reverberations”. And so, Ehrenreich’s scientific and moral inquiry begins.
Ehrenreich rose to prominence with her last book Smile or Die: How Positivity Fooled America and the World. It is a robust and raucous read challenging the contemporary preoccupation with positive thinking. It is acidic and potent with an intellectual rigour uncommon to this genre.
Natural Causes bears many of the same hallmarks – brimming with acidity and potency. However, there are times when the sheer scope of Ehrenreich's ambition compromises her rigour somewhat. Some of the issues considered in Natural Causes such as the privatised healthcare industry, for example, are primarily features of US culture. Ehrenreich's occasional tendency to extrapolate on the nature of humanity from such a narrow US-centric lens is regrettable.
That said, this is a book that makes a fine contribution to an essential dialogue on what it means to be human. Such a dialogue is in itself both humanising and civilising. This type of dialogue is under threat in democratic societies where policy concerning complex social issues is reduced to pronouncements on Twitter, and where dialogue concerning what it means to be human is often dismissed as a liberal-elite indulgence.
Intellectual inheritance
Ehrenreich’s capacity to consider the complexities, contradictions and paradoxes inherent in the human condition is significant and humbling. She displays a regard and appreciation for the intellectual ground she stands on. This ground, kindly gifted through the generous curiosity of our predecessors, is a form of intellectual inheritance. Ehrenreich also knows the ephemeral nature of this intellectual knowing, but there is nothing romantic or vague about this, her grasp of the ephemeral is muscular and delicate.
Ehrenreich describes the US healthcare industry that grew from a cottage industry to a “three-trillion dollar-a-year enterprise” on the basis of promising its consumers one simple thing: control. Control over our bodies. But Ehrenreich walks the reader through scientific, cultural and philosophical territory that demonstrates the body is not the obedient pacifist many would have us believe – particularly those that profit from the illusion of control, namely the private healthcare industry.
She describes the paradigm shift taking place in cellular biology where certain cells are now identified as autonomous and having “cellular decision-making capacity”. Such emerging science challenges so many of our assumptions across an array of philosophical, psychological, theological and scientific traditions. It is also a fundamental challenge to privatised healthcare, the wellness industry and medical screening programmes because it reveals, according to Ehrenreich, the illusion of control these endeavours are built on.
This radical new understanding of activity at a cellular level could verge on the dystopian. However, in Ehrenreich hands this understanding does not induce despair. It induces a sense of mystery, possibility and reverence for the unknown.
Bio-moral autopsy
Ehrenreich was diagnosed with breast cancer in 2000 and it is likely that this experience sharpens her thinking, and her tongue, when it comes to the various industries associated with illness and so called “wellness industry”. She describes the now common “bio-moral autopsy” which occurs when someone dies; did she smoke, drink too much, eat too much butter? The bio-moral autopsy is a function of the “doctrine of personal responsibility”, the doctrine that seeks to lay blame at the feet of the individual, independent of social context.
Ehrenreich guides the reader from consideration of cellular biology towards a consideration of the very nature of the self. She draws towards a conclusion by asserting that perhaps instead of devoting our lives to simply extending our years, we might instead focus on the more consequential projects humans have the capacity to execute.
Ehrenreich has executed such a consequential project in Natural Causes by making a fine contribution to the essential civilising dialogue concerning what it means to be human.
Dr Paul D’Alton is principal clinical psychologist at St Vincent’s University Hospital and adjunct associate professor at the School of Psychology UCD
