Barbara Ehrenreich takes on life, death and the illusion of control

by Peter Calder / 31 July, 2018
Barbara Ehrenreich: skin in the game on both sides of the clinician-patient divide.

Barbara Ehrenreich: skin in the game on both sides of the clinician-patient divide.

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Veteran muckraker Barbara Ehrenreich's new work examines the subject of modern medicine and consumer expectations of it.

A mythbuster whose writing style has more of the cosh than the rapier, Barbara Ehrenreich has been talking sense about senselessness for a long time. The New Yorker’s description of her as a “veteran muckraker” was probably intended as a compliment, though it seemed an odd choice of words. Her work has always been about ferreting out the obvious; what she points at is not so much hidden in plain sight as visible but ignored.

Her best-known book, Nickel and Dimed: On (Not) Getting By in America, which charted her three-month experiment of trying (and failing) to live on the minimum wages she earnt in dead-end jobs, put flesh on the bones of statistics.

She’s doing the same here, in a sense, unpicking the abstractions of healthcare and inviting us to consider them as though living might be a better way to spend our time than constantly seeking to postpone dying: the question, she poses in the introduction, is whether to think of “death as a tragic interruption of your life [or] of life as an interruption of an eternity of personal non-existence … a brief opportunity” to engage with the world.

This is not the wittering of a self-help airhead. Ehrenreich has a PhD in cellular immunology and was diagnosed with breast cancer in 2001, so she has skin in the game on both sides of the clinician-patient divide. She brings both knowledge and experience to a searching examination of our preoccupation with delaying death.

Modern medicine and consumer expectations of it drive the search for potential rather than actual disease, and legitimise interventions that may be entirely unnecessary and are far from risk-free. In exploring the implications of this, Enhrenreich does not presume to speak globally  –  about screening programmes, for instance  –  but about the pressure on individuals to submit to procedures and the epidemic of overdiagnosis that results.

Most of the ideas in this book are not new – Ehrenreich credits Ivan Illich’s groundbreaking 1975 book Medical Nemesis, which popularised the concept of iatrogenic (doctor-caused) illness that Florence Nightingale had described – and it focuses, understandably, on the privatised and profit-driven US healthcare system.

But whether analysing medical examination as a ritual humiliation, stripping away the “veneer of science” that covers much practice or exploring diet fads and gym obsession, Ehrenreich brings her trademark style to bear. Baby boomers, in particular, should pay attention.

Natural Causes: Life, Death and the Illusion of Control, by Barbara Ehrenreich (Granta, $32.99)

This article was first published in the July 7, 2018 issue of the New Zealand Listener.

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