Book Review: Barbara Ehrenreich is old enough to die, but still has plenty to say

Bar­bara Ehren­re­ich’s Nat­ur­al Caus­es is a short, sol­id piece of prose about what it means to suf­fer from age, accept­ing the real­i­ty of death, and the sorts of things a per­son ought to con­sid­er when weigh­ing both.

At sev­en­ty-six, the jour­nal­ist and polit­i­cal activist says she’s real­ized that she’s now “old enough to die”, that is, her death will no longer be a sur­prise any­one or require any expla­na­tion beyond “nat­ur­al causes”.

There­fore, she isn’t going to waste what time she has left on doc­tors vis­its, check­ups, and exam­i­na­tions that have only a dubi­ous rela­tion­ship to longevi­ty and cer­tain­ly not to enjoy­able longevity.

This real­iza­tion serves as a jump­ing-off point for her to explore — most­ly crit­i­cal­ly — all sorts of top­ics relat­ed to med­i­cine, aging, and death.

The sub­ti­tle is “An Epi­dem­ic of Well­ness, the Cer­tain­ty of Dying, and Killing Our­selves to Live Longer”, but that does­n’t come close to ful­ly describ­ing her scope.

Ehren­re­ich is like­ly known to most peo­ple for her 2001 book Nick­el and Dimed, and around that time was diag­nosed with breast cancer.

Had she actu­al­ly been liv­ing off of Wal-Mart wages and its relat­ed health­care restric­tions instead of inves­ti­gat­ing what it’s like, she might not have dis­cov­ered the can­cer then or sur­vived it. But, as she says, cal­cu­la­tions about how one ought to spend their time change from your late-50s to your mid-70s.

I also read this short­ly after two stud­ies of inequal­i­ty and mor­tal­i­ty rates received more pub­lic­i­ty by way of a Wash­ing­ton Post analy­sis, most provoca­tive­ly titled “Seniors Are More Con­ser­v­a­tive Because the Poor Don’t Sur­vive to Become Seniors” when shared by New York Mag­a­zine.

This book also is not about that aspect of death and dying, although Ehren­re­ich touch­es on these relat­ed issues occa­sion­al­ly. Instead, it’s high­ly per­son­al and par­tic­u­lar to its author, suf­fer­ing no short­com­ings for that. Ehren­re­ich is very good at what she does, and writes with the con­fi­dence of some­one who knows it.

She’s engag­ing and easy-to-fol­low even as she explains com­pli­cat­ed con­cepts like cel­lu­lar immunol­o­gy — the field for which she orig­i­nal­ly earned her PhD—or when pro­vid­ing con­text to lit­er­ary ref­er­ences, from Philip Roth to Shake­speare.

She knows she’s get­ting old­er but still has worth­while things to say, and if she ever did tip-toe around say­ing them, she cer­tain­ly isn’t going to waste time doing it now. This is two hun­dred and sev­en pages of pithy, burly prose.

Tak­en as a whole, though, Nat­ur­al Caus­es comes across a bit like a writer who had a note­book full of sub­jects she was inter­est­ed in, and rather than pick one to focus on depth, she dumped them all into her next con­trac­tur­al project.

It reads as a series of essays loose­ly grouped much more than the sequen­tial chap­ters as labeled and vague­ly segued.

Ulti­mate­ly, I sus­pect Ehren­re­ich fol­lowed her own advice.

This is in no way slap­dash, but the amount of extra work it would have required to turn this into a more coher­ent, pol­ished prod­uct would­n’t have ele­vat­ed it that much more, and it was­n’t like­ly to push any of her ear­li­er life’s accom­plish­ments out of their place in the “obit­u­ary resume”, in any case.

Instead we got an enter­tain­ing look at some of her cur­rent con­cerns late in life:

• the dis­re­gard of mod­ern med­i­cine for patients as peo­ple and dis­re­gard for wom­en’s pain in particular;
• the rel­a­tive mer­its of New Age quack­ery and sim­i­lar­i­ty of estab­lished med­i­cine to rit­u­al behavior;
• exer­cise as a form of exert­ing con­trol over some­thing in a mad world and how smok­ing cig­a­rettes pro­vides a sim­i­lar func­tion for low-wage workers;
• the agency of macrophages in fight­ing infec­tion but also spread­ing cancers;
• how the sense of con­scious­ness that evolved to be use­ful also turns against us;
• and how ego-destroy­ing hal­lu­cino­gens can help make death less frightening.

She has a mind that’s not pre­dictable, so you’re nev­er sure just where she’s about to go or will end up.

If you squint, there’s a through-line in there, but it’s a mean­der­ing one.

Nat­ur­al Caus­es is delight­ful, some­times dis­gust­ing, often dis­qui­et­ing, and always thought-pro­vok­ing when­ev­er Ehren­re­ich is on the attack, which is her default. When it comes to solu­tions, she def­i­nite­ly has some­thing that works for her, at the age and place she is in life.

I don’t know how applic­a­ble it will be for oth­ers, but she also seems not to care to con­vince you of any­thing in par­tic­u­lar at this point in her life.