‘You could spend all your time steaming your vagina’

The day I was due to talk to Barbara Ehrenreich to discuss her new book, Natural Causes: Life, Death and the Illusion of Control, a beloved uncle died so I had to reschedule the interview. It was as though he were conspiring with Ehrenreich to make a point. That would be just like him. It would also be typical of Ehrenreich, who has over the course of her career documented the effect of "welfare reform" on low wage workers (in Nickel and Dimed), the destruction of the middle class (in Bait and Switch) and, in the wake of a cancer diagnosis, the emptiness of positive psychology (in Smile or Die).

Her new book is a gutsy polemic that takes aim at a swath of supposedly life-prolonging obsessions, from the medicalisation of old age to the cult of fitness, to the “madness of mindfulness”. Ultimately, she seeks to undermine all the ways in which contemporary middle-class westerners try to control their lives and forestall their inevitable doom.

One of the things that inspired her to write the book, she says, was the realisation that she was “old enough to die”. “Well, I am old,” she says. “I’m 76. That’s respectably old, isn’t it?... If you think about obituaries in the newspaper, once a person is over 70 there’s not usually a lot of fuss. There’s no ‘We must have an investigation!’ Deaths stop being called tragic over a certain age. I was not old enough to die when I was 47, for example. It would have been seen as odd. But once I hit 70, I realised, ‘Hey, I’m old enough to die!’ And that was a big relief. If eating too much butter is a bad thing. I am now old enough to eat it and take the consequences.”

She was also, she says, getting irritated by the health-obsessed behaviour of her peers. “[Health] has become a full-time occupation,” she says. “Among educated middle-class people with health insurance, their lives have become consumed with how to prolong their lives . . . This isn’t in the book but I began to get pretty irritated with friends who constantly chided me for what they thought were self-destructive habits like buttering toast – ‘How can you eat that?’ – or having a drink. I got irritated by all of it and that led me to research the preventative procedures doctors were always pressing on us.”

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She found that, in fact, the worth of many such procedures and tests was scientifically spurious and they were more about ritualistic reassurance than actual healthcare. “The pressure to do these tests comes partly from the medical profession and the medical supply and equipment industries,” she says. “The problem that they have always faced is ‘What do you do with well people?’ And here’s the answer: you test them until you can find that they’re not well by some standard. You’ll always find something.”

You could spend all your time applying skin products or doing odd things like Gwyneth Paltrow's idea about steaming your vagina

She is not anti-science, she stresses, and she is a believer in "evidence based" medicine. She is not criticising tests carried out when a physician actually suspects there is a problem or treatments carried out when there is a serious diagnosis. She has a PhD in cellular immunology from Rockefeller University and she is not the only one who is critiquing healthcare from this perspective. She references a team of doctors at Dartmouth Medical School who are currently "crusading against over-testing and over-diagnosis of American patients".

And the book doesn’t stop with the medical profession. For Ehrenreich, the new obsession with health all turns on wider cultural issues, one of which she has covered in her work before – the destruction of secure middle-class professions. “It’s not just blue-collar people who were wiped out by deindustrialisation in the eighties,” she says. “The white-collar workforce [also have] no job security. So, what do you have control over instead? Your health.” She pauses. “Supposedly.”

The obsession with fitness and health has grown in parallel with job insecurity, she says, and exercise has now become a sort of generic defence mechanism. "I can't really control whether Trump nukes Iran or North Korea, but I can go to the gym and my quads are mighty."

She goes on to reference the work of the historian Christopher Lasch who contended that many of the radicals of the 1960s, people like Jerry Rubin and Jane Fonda, "turned inward by the mid-seventies and began trying to work on something they thought they could control, their diet and their exercise. Lasch's idea was that this was a retreat from politics."

An avid gym-goer herself (“You could say that for all these years I was doing field work”), her chapter on fitness utopianism and gym culture is a fascinating work of anthropology. “You see these people, the guys especially, who’ll have a notebook in one hand so that they’re making a record of exactly how many repetitions they’re doing and what weights they’re using,” she says. “It’s as if they were both the manual labourer and the supervisor all at once.” She laughs. “Anyway, it amuses me.”

The book is often amusing. "I'm not trying to make it humorous," she says. "It just happens to be funny." There's a darkly comic chapter, for example, that examines the lives and deaths of fitness gurus, including "public health big shot" John H Knowles, who argued that "you are responsible for your own health and if you in any way screw up and get sick it must have been something you were doing that you shouldn't have been doing . . . He died at age 52 of cancer."

She thinks that contemporary discussions of health have now, taking a cue from Knowles, turned into a form of moralising. Bad health is increasingly seen as a consequence of one’s own behaviour and lack of vigilance and not a consequence of public policy, poverty or bad luck. And at the core of Ehrenreich’s impatience with all this is her sense that the health and wellness obsession is ultimately selfish.

Dying just sounds like some super new kind of Ambien that means you don't wake up after four hours

“There are many things we could be doing in the years after 45 or 50 that would be more outgoing and helpful to others,” she says. “There is no shortage of causes to be swept up in and things to do other than monitoring your weight, your mood and your intake of coenzyme q. It becomes very striking when you read some of our wellness guru . . . I mean, you could spend all your time applying skin products or doing odd things like Gwyneth Paltrow’s idea about steaming your vagina. I find this stuff hilarious. You can spend a great deal of time and money and that then shows how much you love yourself and there’s nothing better than loving yourself in today’s pop psychology.”

She talks about the extremes taken by Silicon Valley multi-millionaire "immortalists" like the futurist and computer scientist Ray Kurzweil who hopes to cheat death by taking over two hundred different pills and supplements a day. "That must take up quite a bit of time," she says.

In her book she almost revels in explaining how little control we, or Ray Kurzweil, actually have over our lives. She delves into the ways in which our immune systems can inexplicably turn against us as we age and her final chapter amounts to a gleeful relinquishment of control and a refutation of self-absorption. She also discusses how psychedelic drugs are currently being used to help terminally ill people to see their place in a wider universe and to accept their impending deaths. Has she ever done such drugs herself? “No,” she says. Then she thinks for a moment. “Actually, we took something at college, I don’t even know what it was . . . but I think the resulting state of mind was one of self-loss which is, at first, terrifying, and then great . . . But I don’t know what the relationship is between that and what they’re using experimentally now . . . The philosophical point here is that it’s impossible to face death if you’re a narcissist. Because if you’re a narcissist you are the world and if you die the world dies.”

She is wary of panaceas and hates “sounding like a guru . . . ‘Here’s my idea for how to live’. . . But the more you can lose yourself in other things, whether it’s in your work or in some political cause that’s important to you or just in the beauty of the world, then you begin to see that your own death is quite incidental. It’s not true of other people’s deaths let me say. I can’t even let myself think for a second about losing anybody I love . . . but I don’t understand the huge fear of death. I have been an insomniac for most of my lifetime. So how could I possibly be afraid of dying? It just sounds like some super new kind of Ambien that means you don’t wake up after four hours. For me it’s just like a nothing. A light switch being turned off.”

Natural Causes: Life, Death and the Illusion of Control by Barbara Ehrenreich is published by Granta.