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Natural Causes
by Barbara Ehrenreich, Twelve (Hachette Book Group) 2018
P13 So far this is preaching to the choir. I’ve been negotiating with my dentist about X-rays for years. I was going to follow the six month interval between cleanings this time, but we agreed I would also get X-rays next time so I’m going to wait nine months -- which puts it into my target of 2020. It’s still pretty silly as I’ve never had a regular cavity and my one problematic tooth now has a crown. But your dental health is supposed to get worse as you age so I’m willing to compromise on once every four years. Since I don’t have a PCP at the moment, no one is urging me to do any other tests.
P50 Well... I have to admit I’ve found fault with my doctors the past few years for being so hands off. I wonder if Ehrenreich is aware of the previous tradition of physicians not touching patients? We do seem to be heading back to a largely talk-based diagnostic practice. Where the doctor listens to your description of your symptoms and prescribes some kind of “physic.” It would be nice to have Victoria Sweet's response to this.
P70 The fitness chapter was interesting and perfectly timed. I was procrastinating going into the gym but did go in after I read it. As she mentions, it was my back problem that got me started but now I do it to keep in shape for my event greening work. The odd thing is that my back has been great for over a year but for almost a year now I’ve been dealing with a re-injury to my shoulder, which was a gym-related injury. My gym participation has had both positive and negative effects on my health.
P90 Mindfulness and neural plasticity considered. She doesn’t present much science here. These are easy targets, but she doesn’t land any hard blows.
P95 The Lisbon Earthquake yet again. She does an excellent job of covering this topic.
P97 ...”We can, or think we can, understand the causes of diseases in cellular and chemical terms, so we should be able to avoid it by following the rules laid down by medical science... Anyone who fails to do so is inviting an early death... every death can now be understood as suicide.”
This is interesting. And I’m certainly guilty of looking for reasons to blame people for their deaths -- but this is primarily so that I can imagine myself safe from the same fate. In addition to the celebrity deaths she sites, I remember Nick who was the person I knew most concerned with electrical fields, detecting them and avoiding spending time within them. And he died early of cancer. Sometimes there’s almost a Death in Samara quality to these things.
P108 “...the American working class -- or at least the white part of it -- which could once hope for steady work at decent pay, has lost much of its way of life.” This is a good point. Related to my War on South of the Slot, idea. But for how long was that really true? Twenty years? Thirty years? If we go by Detroit it was a very brief golden age.
...”An advantage of wellness as a status symbol is that it is less likely to incite the envy of the lower classes than, say furs and diamonds, plus the practice of wellness goes on largely out of sight...” And yet to the extent that wellness is appreciated to be a status symbol by the lower and under classes they will find a way to participate. So I do hope there is some value to it -- though I rather suspect it will be adopted as a kind of ritual over their existing bad habits. But we shall see.
P136 I’m not quoting much, but I’m really enjoying Ehrenreich’s exploration of this topic. This makes for a great summary and overview of the past century and more. I, of course, can’t avoid also considering all this in a military perspective, which actually seems to work quite well with the self against self aspect she’s just been talking about. Armies and militaries are rarely the well-ordered “systems” we imagine them to be. Besides Napoleon’s ever feuding corps commanders, there are the US bureaus that let down their forces in WW2 by providing faulty weapons and then defending their mistakes rather than responding to their shortcomings when the problems began to appear. And there is the conflicting “selves” of the two lobes of the brain not to mention the underlying “self” that I’ve frequently likened to an operating system.
I like the way Ehrenreich thinks. And writes.
P161 Agency - I love the way she took this down to the quantum level. What she hasn’t done is take it to the level of Logos. So maybe she doesn’t have a Classical philosophical background. Here’s what I have in mind, and it’s even nuttier than attributing agency to macrophages:
Today I went to the gym, but it was a cold morning and it took me a while to get moving so I started at the gym later than I would like. After my workout I lollygagged before starting my shower. I figure I was running at least an hour late when I finally headed out to lunch.
In the alley I noticed a guy in construction clothes with a camera looking through the fence next door to us and asked him what he was looking for. He explained that he was trying to get a photo of the back of a building that is about to be rehabilitated. You can’t see it from the alley, but I let him in and took him to our rear fire escape where you can see it. He got his pictures. But he only got his pictures because I was in the right place at exactly the right time. A minute earlier or later and it wouldn’t have worked. This goes beyond simple agency and requires we consider the possibility of the Logos. Or pantheism.
In our last book Rick Hanson wanted us to remember those moments when we feel gratitude, but what I most enjoy are the moments when I feel completely in sync -- when I feel I’m exactly where I should be. As in this instance above, there’s no earth shaking consequence to this. I made a random guy’s day a little better. If I hadn’t been there to help him he might have been able to get access to one of the other properties that would give him a view of the building in question, but I wouldn’t like his odds at that, and the angle from our building is actually better. Again, this was not important but it was perfect in it’s very particular way. The mirror image of all the buses and streetcars that pull away just as I arrive. And I believe I have to give Darling credit for suggesting that we have looped back to the Logos after the long Western adventure of pursuing objective scientific truth.
And, I suppose, this is my adult alternative to my childhood belief that God (or Jesus?) loved me. If you can’t have a personal god watching your six, the next best thing is to believe the Logos is doing its job if only in small ways like this.
P180 Hans Castorp would have enjoyed this chapter immensely. The details of death. The notion that macrophages may still be just doing their jobs when they contribute to the medical crises of aging and dying is quite interesting. This goes beyond Zeke Emmanuel in "The Atlantic" who also suggested stopping elective medical routines after a certain point. Ehrenreich is, if I read her correctly, suggesting that “fighting” heart disease is a mistake because the “function” of heart disease is to get rid of the elderly (and useless.) This, by the way, is why both Settembrini and Naphta were ultimately arguing from a weak position in TMM -- Naphta in particular should have been delighted to simply die of his disease rather than fight it in the Alps.
I tend to favor this outlook and I can’t think of any good arguments against her here.
P196 Extinction - I thought it was interesting that both Avengers Endgame and the Battle of Winterfell episode of GOT came out the same weekend. Both of these fictions dealt with kinds of existential crisis which we do, as a species, seem quite interested in. They were also entirely magical. It almost seems like we are more comfortable with magic than science. Maybe this is because many of us can “understand” magic better than science.
P207 “Two years ago, I sat in a shady backyard around a table of friends, all over sixty, when the conversation turned to the age-appropriate subject of death. Most of those present averred that they were not afraid of death, only of any suffering that might be involved in dying.” [This is what people think but it would be nice to have some real data. I suspect they would in fact be like Hans Castorp’s special cases when actually faced with death.] “I did my best to assure them that this could be minimized or eliminated by insisting on a nonmedical death, without the torment of heroic interventions to prolong life by a few hours or days...” [And I maintain that, in the end, we have very little control over how this goes.] “...there is little personal suffering to fear. Regret, certainly, and one of my most acute regrets is that I will not be around to monitor scientific progress in the areas that interest me, which is pretty much everything. Nor am I likely to witness what I suspect is the coming deep paradigm shift from a science based on the assumption of a dead universe to one that acknowledges and seeks to understand a natural world shot through with nonhuman agency.” [Me too.]
“It is one thing to die into a dead world and, metaphorically speaking, leave one’s bones to bleach on a desert lit only by a dying star. It is another thing to die into the actual world, which seethes with life, with agency other than our own, and, at the very least, with endless possibility. For those of us... who... have caught glimpses of this animate universe, death is not a terrifying leap into the abyss, but more like an embrace of ongoing life....”
Here, Ehrenreich has in mind the “Perennial Philosophy” brand of spirituality, which I’m fond of myself. However, as I sometimes remind people recounting near-death experiences, as nice as it would be to believe that these positive spiritual experiences are a foretaste of actual death, there’s really no reason to jump to that conclusion as a near-death experience is not death. At best we can expect a positive experience leading up to death. This is what Dostoevsky described so well in The Brothers K. After death it’s still anyone’s guess. If I had to bet, I would go for the experience we are so familiar with already, what we experience when we lose consciousness. Which is to say, nothing... until the self can pull itself together. And after death that would be impossible.
I really didn’t expect this book to be so philosophical. It’s probably just as well Ehrenreich doesn’t know about the Logos as it is probably better to avoid that Hellenic jargon and to stick with her description of the world as having agency. I do wish she had gotten into how our bodies seem to have agency independent of our selves. She may need to read more Oliver Sacks books.
Back to the Introduction. This book contains content that was forced, somewhat against its will (like with a mammogram) to blend together and form a whole. I wonder if it wouldn’t have been better to go with the essay collection model. My guess is that essay collections don’t sell as well as “books.”
What this book is about: That our immune system can turn against us. Macrophages. The health care system. Our desire to control our mindbody. Pxiii “The body -- or, to use the more cutting-edge language, the ‘mindbody’ -- is not a smooth-running machine in which each part obediently performs its tasks for the benefit of the common good. It is at best a confederation of parts -- cells, tissues, even thought patterns -- that may seek to advance their own agendas, whether or not they are destructive of the whole...”
Pxiv “It turns out that many cells within the body are capable of what biologists have come to call ‘cellular decision making.’ Certain cells can ‘decide’ where to go and what to do next without any instructions from a central authority, almost as though they possessed ‘free will.’ A similar freedom... extends to many bits of matter that are normally considered nonliving, like viruses and even atoms.
“Things I had been taught to believe are inert, passive, or merely insignificant -- like individual cells -- are in fact capable of making choices, including very bad ones. It’s not going too far to say that the natural world, as we are coming to understand it, pulses with something like ‘life’...
Pxv “I present the emerging scientific case for a dystopian view of the body -- not as a well-ordered machine, but as a site of ongoing conflict at the cellular level, which ends... in death... What is the ‘self’ if it is not rooted in a harmonious body, and what do we need it for anyway?”
I think we’ve read better books on the nature of the “self.” (Ones that started with neurological oddities like a lack of short term memory or total amnesia. Also the consciousness of the two lobes and the suggestion that there is an underlying agent that decides what to present to us as reality and “helps” us decide things like who would be a good mate.) But what is interesting here is her focus on the body and how much of it is not “us.” That our bacterial cohabitants have their own agendas is one thing, but that macrophages which would seem to be part of us also have agendas is curious.
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