Barbara Ehrenreich is an American writer with an enviable breadth of knowledge, an acerbic wit, and a willingness to tackle the big issues of contemporary society — as the subtitle of her latest book attests. She has a PhD in cellular immunology, and the genesis of this book lay in her shock on learning that macrophages play an apparently dual role in the body, on the one hand encouraging inflammatory responses to invasive agents, and on the other aiding tumour growth and metastasis. This prompts her to ask: if we cannot trust the workings of our physiology at the cellular level, to what extent can or should we aim to control our bodies and minds, and hence our health and longevity?
After ranging across a diverse array of topics including gym workouts (for which she is a practising advocate in her eighth decade), evidence-based medicine, the abuse of power by the medical profession, the growth of narcissism in our self-obsessed culture, the solipsistic practice of mindfulness, and our changing attitudes towards death, she returns to the ‘self vs. non-self’ paradigm of immunology and its implications for auto-immune disease, pregnancy and menstruation, and the ageing process.
Along the way are brief diversions on the emergence of the very notion of ‘the self’, attributed to Rousseau and other Enlightenment thinkers; the evolution of religious beliefs from animism through polytheism and monotheism to their widespread abandonment; and the ever-widening gulf between the rich and the poor, the former indulging in luxury ‘wellness retreats’ and the latter being held morally culpable for their ill health (and dying earlier).
Having argued convincingly that we have much less control over our fates than we are led to believe by doctors, lifestyle gurus, priests, and Gwyneth Paltrow, the atheistic Ehrenreich takes solace from the thought that the universe, even in its inanimate components, is full of unpredictability and what she rather mystifyingly calls ‘agency’. Personally I find little comfort in ‘the ghostly flickerings of quantum fluctuations’ that she celebrates; on the other hand I do like the idea that a carefully induced psychedelic trip can ease the existential pain of terminal illness. Put it on my death plan, please.
- © British Journal of General Practice 2018