Abstract
Barbara Ehrenreich is a prolific writer. She may be best known to social workers for her 2001 book, Nickel and Dimed: On (Not) Getting by in America, which powerfully portrays the hardships of low-income individuals working in service industries in the United States after 1996 welfare reform. Now, after writing many other books, Ehrenreich, at the age of 76, has written Natural Causes: An Epidemic of Wellness, the Certainty of Dying, and Killing Ourselves to Live Longer, a book about the aging process and death and dying.
Ehreneich has a PhD in cellular immunology and considers herself an activist; and it is these two roles that animate Natural Causes. In the book, Ehrenreich spends most of the time writing about cellular activity—for example, hormones, viruses, antibodies—that play dual good and bad roles in promoting and maligning body functions. She believes we may have little control over our health or illness due to this cellular activity. It is here that Ehrenreich’s activist role takes on the wellness industry for its profiteering and marketing. She proposes that many diets, exercise regimes, and preventive medical procedures that are advertised as promoting health, despite a lack of evidence-based findings, may be harmful. Ehrenreich also emphasizes that aging individuals are often blamed for their own illnesses. She notes medical procedures that may be offensive to women, and she is particularly concerned about costs, time spent and wasted, and unrealistic expectations based on little or no evidence of effectiveness in deterring and improving the aging and dying process.
As the older population and longevity increase, there is a lot more interest and concern, on a personal and societal level, about issues of aging, life expectancy, and the process of dying. There is an extensive body of knowledge generated by gerontologists on these topics. The work of gerontology is interdisciplinary, research-based, and deals with many aspects of aging beyond health. However, Ehrenreich only very briefly cites any work by gerontologists. Although Chapter 10 is entitled “successful aging,” the chapter mainly continues to focus on activity on the cellular level. Ehrenreich cites a number of books on successful aging and concludes that a major theme of these books is that aging is abnormal and unacceptable; and further, that each of us is responsible for our own well-being, ignoring such factors as genetic defects and poverty over which we may have little or no control. “Except for your fitness trainer or successful-aging guru, you’re on your own” (p. 165). Although Ehrenreich believes there may be little one can do to alter aging outcomes, the extensive work by gerontologists to understand and optimize the aging and dying experience runs counter to this perspective. These professionals believe that there is great variation in how individuals age and die and that it is not all predetermined. The fact that we have extended life expectancy from 46.3 years for men and 48.3 years for women in 1900 to 76.4 years for men and 81.2 years for women in 2014 raises questions about the potential for change throughout history and the life cycle.
It is important to offer a critique of the wellness industry, with its ritualistic, expensive, possibly ineffective, and blame-inducing methodologies because these practices can interfere with more productive and life-enhancing behaviors and policies. As social workers and feminists, we want to challenge misguided and false practices and beliefs that interfere with an enhanced quality of life. For those of us who believe in social change, the way we age and the way we die are subjects that warrant discussion, scrutiny, and research. All individuals in the society have a stake in this process, and it is important that issues of gender, race/ethnicity, social class and other group, and individual differences are recognized and included.
Ehrenreich has made an important contribution by helping us understand how biological processes operate to enhance and obstruct the aging process and by raising questions that need to be addressed. By challenging nonproductive practices, she frees us to explore and implement more productive and effective ways to age successfully. It is important that these topics are discussed, and Natural Causes contributes to a conversation that needs to go beyond bodily functions to a more holistic approach to aging, dying, and social change that also includes the multidisciplinary wisdom of gerontology.