One paradox in particular captivates Ehrenreich and forms the book’s metaphorical through line: the immune system’s relationship to cancer. She points to a 2008 article in Scientific American claiming that certain immune-related cells called “macrophages” can, under certain circumstances, abet the growth of cancer. This knowledge purportedly “change[d] everything” for Ehrenreich, who studied macrophages as a “lowly graduate student.” Back then, she called them “heroes,” but now she writes of them with palpable heartbreak: “I thought they were my friends.” In fact, they’re Janus-faced. The element of betrayal here is personal. At heart, Natural Causes is a form of memoir. Ehrenreich’s inquiry hinges on her asking herself: Why should this have been a betrayal?
For the answer, Ehrenreich turns to the history of preventative health care. The roots of its contemporary form, she tells us, are in the late 19th century. American medicine, envious, grafted the philosophies and lab-based format of Germany’s research universities onto this country’s hitherto eclectic array of rogue healers. The practical effect of reform was to insulate the nascent medical profession from black, brown, female, and “crude boy or … jaded clerk” candidates.
Instead, doctors would henceforth “be recruited from the class of ‘gentlemen,’” who learned the science of living bodies from dead ones — medical cadavers, the perfect patients. Medicine’s “epistemologically normative” body thus became one whose surfaces and holes would politely yield to (white) gentlemanly fingers in “rituals of humiliation,” like yearly physicals and gynecological exams.
Such “regularly scheduled invasions of privacy” are “anchored […] symbolically, in laboratory science” but nevertheless demonstrably “do not save lives or reduce the risk of illness,” according to Ehrenreich. Never mind if she’s right. The point is such medico-managerial gaslighting maintains our “illusion of control,” even more so now after the merger of “scientific medicine” with “holism” in the 1960s and ’70s.
Holism figured the body and mind as a whole mechanical “system,” like a car. Very much like a car, in fact. Despite its hippie origins, it somewhat counterintuitively arrived on the legitimizing coattails of “systems analysis,” a business fad promoted by elite men like US Secretary of Defense Robert McNamara, formerly of Ford Motor Company. All told, it was capitalism, not science, that catalyzed this next phase of wellness, ensuring “holism opened a new avenue of control — exercised by the mind over the body.”
Around this same time, deindustrialization and “downsizing fervor” were reshaping “the entire sociological map.” This upheaval distinguished the 1970s and ’80s, Ehrenreich recalls, a time when, if you were a young adult who felt “you could not change the world or even chart your own career, you could still control your own body — what goes into it and how muscular energy is expended.” Fitness clubs opened in droves, the upwardly mobile (like Ehrenreich herself) became avid subscribers, and healthy eating and “successful aging” became signifiers of personal worth. Corporate policies amplified the trend: Ehrenreich believes it was “the existence of widespread health insurance that turned fitness into a moral imperative.”