On this week’s episode of my podcast, I Have to Ask, I spoke to Barbara Ehrenreich, the author of Natural Causes: An Epidemic of Wellness, the Certainty of Dying, and Killing Ourselves To Live Longer. The health-and-wellness crazes that have led to increased gym memberships, calorie-counting, jokes about gluten and mindfulness, and much else seem to now be a permanent part of American society. But Ehrenreich, the author of Nickel and Dimed and Bright-sided: How Positive Thinking is Undermining America, as well as a prolific essayist, looks askance at many of these trends, and believes society is refusing to come face-to-face with the realities of death and aging. Below is an edited excerpt from the show, in which we discuss why people are so intent on fighting against aging, whether smoking bans show condescension toward the working class, and the problems with Oprah’s very real ideology.
You can find links to every episode here; the entire audio interview is below. Please subscribe to I Have to Ask wherever you get your podcasts.
Isaac Chotiner: Barbara, thank you for being here.
Barbara Ehrenreich: Oh, I’m delighted.
Delighted? Are you just saying that or you’re actually delighted?
I’m trying to work myself into being delighted.
OK. All right.
No, I am really pleased to be talking to you, Isaac.
This is a clichéd question, but I think it will lead us in good directions: Why did you decide to write this book now?
It was a mistake since it’s not about Trump.
I wasn’t going to say it.
There are two things that motivate me to write a whole book as opposed to a little essay. One is usually anger, outrage at something I perceive as an injustice, or an illusion. The other thing that motivates me is curiosity. Once I get going on a subject, I really want to keep tracking it down. This book starts with some concerns about our health care and what it’s actually doing to us, and moves on … to go into a deeper level to look at ourselves and our chances of living forever, or for at least 20 years more than we should live.
What exactly is your complaint about the American health care system?
I think in addition to covering those issues of clear class and racial injustice in access to care, we should look at the care we get. What I began to find once I got to be about 50 is that most of my interactions with the medical system had to do with doctors and clinics demanding that I go through certain kinds of tests. I thought, “OK, this is the preventative care that accounts for American longevity,” although our longevity no longer compares that well with other advanced countries. But anyway, I went along with it, and then I began to become more and more skeptical about what these tests were achieving and whether they added anything to our longevity.
And test after test, and I’m talking mammograms and colonoscopies, bone-density scans, the results were not reassuring. Isaac, I’ll tell you exactly how I started doing this. It was very simple. Take the procedure, say bone-density scan, now you’re going to google that with the word “controversy” or the phrase “evidence-based,” and you’ll find all the problems with all the issues. I would do this for everything that came along and determined rationally that these things were not worth my time.
One of the critiques of the massive amounts of testing in the American health care system is that it leads to higher health care cost and America has very high health care costs for an industrialized Western democracy. The critique in your book is not just that we’re spending lots of money on these things, and this fits into a lot of your earlier work, it’s rather how it affects our mindset and our own thinking about aging and death.
Oh, definitely. I mean the sort of cultural idea is that aging does not have to be unpleasant in any way. You can age “successfully” if you do everything that you’re told, and that dying itself [can] be postponed further and further and further away if again you adhere to all the rules of diet, exercise, medical care, etc. And that’s a cultural illusion, I would say. We do not control our own health completely. Yeah, there’s some obvious things you can do like not smoking. I don’t even know what the current dietary do’s and don’ts are so I won’t mention those, but there’s always a set of things, dos and don’ts, to regulate this. If you’re not conforming to that, then you will not age successfully.
We have a larger and larger percentage of the population living longer. Do you really think that there is nothing to be said for the increased focus people are putting on their health and their wellness and keeping their body fit?
I think that needs to be examined. We have to look at that statistically. Yes, we have a lot of older people who can afford various things that might well support a healthy old age like, say, a gym membership. But if you take it case by case, like mammograms, again there’s a debate, which has I think have really been won by this time by the side saying that all that screening mammography does not do anything. In fact, what it can do, and this goes for prostate screening too, is that they find something that seems wrong, then they can go on to the biopsy. They may go onto surgery and drastic procedures like chemotherapy.
Now when you’re in your 70s and 80s, you might want to weigh whether those are things you want to spend the time that remains for you doing. My answer is no.
Because I have other things to do. Partly this seems to start for me with the kind of trade-off decision: Do I want to go sit in a windowless doctor’s office waiting room, or meet my deadline, or go for a walk. It always came down to the latter, or at least meeting the deadline first.
You seem to always have had a distaste for self-help type literature and for this idea that we can kind of improve ourselves. It seems like you connect it to a certain American creed that you find distasteful. Is that a fair summary?
I haven’t thought of it that way. I would say that implicit in a lot of these things is a strong level of narcissism. Focus on yourself. You can do self-care. Try to follow the rules, the current rules, for being healthy. That it is all about controlling what’s within the perimeter of your skin, really. It’s not about actually doing anything in the world or with other people.
It seems like your larger critique is that this has some role in the way American society and even politics are kind of constructed. I’m just asking because I’ve a read a lot of your stuff in preparation for this interview and that seems like one of the through-lines to me.
I have to say I am fairly disgusted by a lot of the pop psychology illusions that have been propagated in recent years. I wrote a whole book countering positive thinking, which I supposed makes me some kind of real Grinch. Again, it’s something that is going to affect, say, the outcome of a disease or the outcome of a war or anything else. In this book, I take on some of those other things that suggest you have great deal of control over your body and your mind, but actually don’t deliver much, and one of them is “mindfulness.” I guess what it boils down to is the idea that you should meditate or think of something different for a few minutes every day. That’s a cure created by Silicon Valley’s promotion of their mindfulness apps. I’m always dubious about these things.
What makes you so dubious? I’m sure you have people in your life, I have people in my life who meditate and say it’s very helpful. It’s not something I think I could ever do or would be interested in doing, but a lot of people say it’s very helpful, and it offers them a certain kind of solace. What’s your response to that?
That’s fine. I mean I have people I’m close to who do it, too, and I support them in doing it. But I think what is lacking in so many of our lives is a real connection with other people, a connection with something that is overwhelmingly important to us and it involves us in some sort of community. All this stuff about prolonging your life more and more is entirely individual. And that’s not bad. I mean I’m not against individualism, but it sort of takes you away often from the things that might meaningfully keep you going in life.
In the book, you write, “As more affluent people gave up the habit, the war on smoking, which was always presented as an entirely benevolent effort, began to look like a war on the working class.” Can you expand upon that a little bit more? I think probably most people listening to this podcast think that the “war on smoking” saved many lives and was a real progressive step forward in American society.
Well, here I refer you to an essay written by June Thunderstorm. That’s her name.
All right. A nom de plume. Anyway, as a working-class woman, she wrote a wonderful essay, which was going into the best essays of the year book, about just this. I’ll give you one vivid example: You can’t smoke indoors anymore. There goes the working-class bar. Where are these working-class bars now? It’s not the same to gather without smoking. Workers at work like smoking breaks. Why do they like smoking breaks? Because the rest of the time they’re running around stocking shelves, doing what they’re told, serving meals. When you smoke, that’s a working-class kind of self-care.
You could say, “Well, it’s nonsense. It’s a bad thing to do,” but that’s when you have nothing else. It can calm you very quickly. It’s very tragic when I see employees gathered outside a workplace like a big-box store or an office building trying to smoke in the wind and the rain because that’s the only place they can go.
Wouldn’t the answer here be to create a society where working-class people, or people who work difficult jobs, can find some degree of camaraderie and companionship on the job around something that doesn’t kill lots of people every year?
Of course, I totally agree with you. This is a desperate measure in the face of overwhelming stress. I mean look how many people now work sort of on-call. You don’t even have a regular shift to show up for. You wait and get the call from an employer to show up, so you don’t know from day-to-day what you’re going to be earning. How can you make any plans? How can you do anything? That is as stressful, I would say, as being a laboratory animal getting shocks at irregular times. That’s the working conditions that we have created for so many Americans, white-collar as well as blue-collar.
It seems to me with something like smoking, which we know does have such horrific health effects and also things like secondhand smoke, which have horrific health effects on people who are not just the ones smoking, that the push from the top, which could be categorized as kind of elitist or whatever you want to say was in fact something that would lead to a lot fewer working-class people dying from lung cancer now and that seems like a good thing.
Are there more deaths from lung cancer among the working class? I’ve been looking at statistics.
I said there would be less.
I don’t know if that’s one of the elevated things. The white working-class in America is experiencing a quite astounding rise in mortality, but as far as we know, the causes are things like opioids, which are mixed with alcohol and suicide. These are the “diseases of despair,” as the economist who brought all this to light said. If you were my boss and you were just giving me that little talk about smoking, I would say, “Damn it. Make life easier. Stop with this on-call, just-in-time business of working when you get to work. Stop with these fairly murderous forms of surveillance of workers as they work.” I mean there are just so many things I would say to you if you were my boss.
I’ve got the CDC numbers here. It seems like between 2003 and 2012, lung cancer deaths decreased by all genders and ethnic groups or racial groups, but I see what you’re saying about we know that there’s been a huge rise among working-class people in deaths from opioids and something else. I guess again I would just say it seems like the answer would be to find a way in society that people don’t feel left behind where at the same time they aren’t doing things that are unhealthy for them.
Oh, I’m with you. Anytime you want to start organizing for that society, just call me right away. Right now, a lot of people feel pretty desperate. Let me just mention the opioid epidemic, although this is not in my book or anything. What makes me very mad about all the attention to the opioid epidemic is how little attention there is to pain. We have a pain epidemic in America. Where does that come from? Because if you work, particularly in a manual labor kind of job, by the time you’re 45 or 50, your back is out, your knees are going, your rotator cuffs are gone. Everything hurts. You want to keep doing that job? You need to take opioids. I think that’s horrible, and I would rather work on diminishing the pain of so many people’s labor.
You wrote one of the first critical things I can remember reading at least on Oprah in the New York Times. The “Oprah for President” boomlet has kind of passed a little bit I think, although it could come up again. Could you talk a little bit about your critique of Oprah, and what she represents, and what you make of it manifesting itself in politics.
Well, actually it was only a tweet.
No, you wrote a piece in the New York Times. I read it.
No, it’s all right.
I would much prefer Oprah to our current president and to many of the other possibilities. What she has represented is this kind of self-help, self-improvement approach to life. That’s where I actually quarreled with her once on TV. Very bad for my career as an author, but she was just urging poor women to change themselves and their attitudes so that they could get what they wanted. I said it’s not that easy. If you’re living in a single-wide trailer with a husband and three children and no access to fresh produce or something, that’s a situation that you can’t overcome by positive thinking or changing your attitude.