The War Against Death

With the exception of those of us who have not been born, we are all going to die. We take it as an article of faith. We know it to a certainty. Our name is on the list. It is settled science.

One might say that until we all die we do not know to a scientific certainty that we are all going to die. We are convinced that the sun will rise in the West tomorrow morning, but it is merely a hypothesis until reality affirms or denies it.

Philosophers, that is people who know as little about medicine as I do, assure us that death is the meaning of life. Bertrand Russell opined that we accept religion because we are afraid of dying. Those who do not accept religion are presumably not afraid of dying. Or perhaps they are looking forward to it. Unless they are too stupid to think about it at all. 

Famed Nazi philosopher Martin Heidegger postulated that we all die alone. You might see this as a meaningless notion, unless you see that he is trying to convince us to see ourselves as irreducibly individual. In one gesture Heidegger erased our status as social beings and reduced us to our biology. As biological creatures we are very likely to die, but, to die alone— that's another question. Recall that this same Heidegger embraced a genocidal maniac named Adolph Hitler… a man who wanted certain peoples to die together.

Anyway, Barbara Ehrenreich has a new book, called Natural Causes, where she takes aim at the medical-industrial complex. She especially questions our willingness to reduce living and dying to medical issues and to allow the medical-industrial complex tell us how to live… thus how to forestall a biological imperative.

Since I have no real knowledge of many of the topics she discusses, aka microphages, I will limit myself to presenting some of her ideas. I find them intriguing and sufficient contrarian to be interesting.

Ehrenreich, a 76 year old breast cancer survivor had an epiphany one day when she saw that she was old enough to die. And that perhaps she had better things to do with her time than to submit herself to a myriad of tests designed to prevent illness. Might we not ask about the psychological consequences of all that poking and prodding and pricking... into feeling like a medical research subject.

Dr. Victoria Sweet reviewed the book in the Atlantic. She explained:

She [Ehrenreich] starts by looking at the many preventive medical procedures we are encouraged, even badgered, to undergo—those regular physical exams, colonoscopies, blood tests, mammograms. She had always pretty much done what doctors advised (she underwent chemotherapy), figuring that it made sense to treat disease before illness overwhelmed the body. But after watching many fitness-obsessed people die early, and realizing that she herself is now “old enough to die,” she questions that premise.

To question the premise is to question the promise. Which promise would that be? It would be the promise that we can conquer death, or, to be more precise, that we should devote our lives to fighting it, battling it and struggling against it.

Sweet explains:

In her new book, Barbara Ehrenreich ventures into the fast-growing literature on aging, disease, and death, tracing her own disaffection with a medical and social culture unable to face mortality. She argues that what “makes death such an intolerable prospect” is our belief in a reductionist science that promises something it cannot deliver—ultimate control over our bodies. The time has come to rethink our need for such mastery, she urges, and reconcile ourselves to the idea that it may not be possible.

One hastens to add that all of these tests and procedures, all of the poking and prodding, to say nothing of the attendant anxiety… are good for business. They are good for a physician’s business. Plus they enhance the social status of physicians, that is, of medicine men.

Since Ehrenreich herself is a cancer survivor, so she does not reject all such preventative and diagnostic tests. But, just because some of them are useful does not mean that all of them are useful.

Sweet continues:

In people who have a strong family history of heart disease, treating high cholesterol does decrease mortality, on average. But for those who don’t have that predisposition, it doesn’t. Colonoscopies have not been proved more effective at reducing deaths from colon cancer than other, cheaper, less-invasive tests. Sometimes procedures cause more trouble than they prevent. Mammograms, for instance, detect tumors that might never be fatal, and can lead to over-treatment, which carries its own risks. The insight is counterintuitive—although finding diseases early on should prolong lives, the screenings we undergo don’t seem to lower mortality rates overall—and Ehrenreich decides that she will no longer get most preventive care.

So, Ehrenreich has chosen to stop getting preventative care. It is her right. And yet, somehow it feels like heresy. It feels as though she is rejecting science and falling back on superstition. And yet, isn’t that her point. How much does our faith in science and in science’s ability to cure death—assuming that that is the great hope—a lure, a ploy inviting us to allow science to tell us how to live our lives.

Deanna Pai, herself a cancer survivor, explains some of it in New York Magazine:

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.

I would remark here that I am a firm believer in fitness and exercise. While I can see the point that testing for everything creates a false sense of control over biological processes that we do not entirely understand, exercise has been shown to be beneficial… even if it caused Ehrenreich to have bum knees. My solution—use elliptical trainers.

Within a world where psychology supposedly explains everything we have a tendency to see illness within a narrative framework. We think that, when we get sick, it means something. It says something about us, about our bad moral habits or about our bad health habits. Psycho professionals have happily concocted compelling narratives about what cancer means, what heart disease means and what eczema really, really means. As it happens, we can invent a narrative to explain almost anything. In the prescientific era people did exactly that. And yet, these narratives, when applied to medical science and even when applied to human behavior, have no real value.

We recall Susan Sontag’s 1978 book, Illness as Metaphor where she argued that we err in thinking that illness has a deep meaning or that it reflects on our moral character… in the sense that it is God’s punishment for our aberrant behavior.

Something similar is happening in the medical world, especially as a function of the health and fitness craze… the one that incites people to munch on almonds instead of Snickers’ bars.

Pai explains:

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. 

Can we blame her for her death? A sobering thought, to say the least. In a world where psycho professionals are beating the drums for non-judgmentalism, here we see the new accepted way of judging people. We do not judge them for their degenerate and decadent behaviors. We do not judge them for their bad manners. But, we happily pile on to the man with cancer because he ate too many fatty foods and did not eat enough fiber.

Blaming others for their deaths tells the living that they are better, that they have better, healthier habits. Does this allow them to believe that they have a say in when and how they die? I am hardly persuaded that it’s all about control. The term has become the psycho cliché du jour.

While I believe that Ehrenreich has every right to dispense with preventative tests and that we should be far more critical of the influence the medical industrial complex has over our lives, sometimes we choose certain habits because they make us feel better. As it happens, feeling better is not necessarily the same as feeling healthier. Being sick makes us feel bad but the absence of notable illness does not necessarily correspond to feeling good. Ehrenreich seems clearly to be aiming at the difference between being healthy and feeling good.  If we think that it's all about health, we will likely spend so much time tending to our biology that we forget our moral responsibilities, not just to friends and family, but to our jobs.

Living in constant anxiety over the last test result, measuring out our lives in portions of fruits and vegetables is worth questioning. After all, enjoying your life is not such a bad thing. And depriving ourselves of food that tastes good, even indulging a few sinful pleasures, might not be the worst thing that can happen. It was only yesterday that the latest study suggested that drinking two glasses of wine a day would shorten your life by two years... or some such thing. And yet, we had previously been told that red wine contains a magical chemical that saves you from heart disease. What do you do now... except tell yourself that you should read fewer such studies.

Come to think of it, do you really want to live forever?