Natural Causes

Natural Causes Plot Summary

Introduction

The quest for control over our bodies has become a central obsession of modern life. From fitness regimens to medical screenings, wellness programs to mindfulness practices, we invest enormous resources trying to master our physical existence. We watch what we eat, monitor our steps, track our biomarkers, and submit to endless medical tests—all in pursuit of the promise that we can somehow overcome our biological limitations and achieve optimal health, longevity, and perhaps even immortality. Yet this drive for control contains a profound paradox. The more we learn about human biology, the more we discover that our bodies are not obedient machines responding reliably to conscious commands, but complex confederations of cells with their own agendas. Even our immune systems, supposedly dedicated to protecting us, sometimes betray us by abetting cancers or launching inflammatory attacks against our own tissues. This fundamental insight challenges our deepest assumptions about health, selfhood, and human nature. Through rigorous analysis of scientific evidence and philosophical inquiry, we encounter a radical reimagining of what it means to inhabit a body—one that finds liberation not in the futile struggle for complete control, but in recognizing our place within a dynamic, living universe where agency exists at every level of being.

Chapter 1: The Illusion of Body Control: Challenging Medical Surveillance

The culture of medical surveillance has become so normalized that we rarely question its underlying premises. Regular screenings, annual physical exams, and preventive testing are positioned as responsible behaviors for anyone with health insurance. The basic promise is compelling: early detection saves lives by identifying problems when they're most treatable. It seems like a simple matter of prudence. However, this narrative fails to acknowledge a troubling reality. When examined through the lens of evidence-based medicine, many routine medical procedures show little or no benefit while carrying significant risks. Mammograms frequently lead to false positives and unnecessary treatments; PSA tests for prostate cancer result in interventions for conditions that might never cause harm; and colonoscopies, though expensive and invasive, show no greater effectiveness than simpler screening methods. The annual physical exam itself, costing Americans about $10 billion annually, has been described by physicians as "basically worthless" despite its cultural entrenchment. What drives this system of excessive monitoring? Certainly profit plays a role in a privatized healthcare landscape. Medical facilities need to fill beds; equipment requires return on investment; pharmaceutical companies fund research that coincidentally creates new markets for their products. Even cancer screening protocols have been subsidized by drug manufacturers, transforming normal aspects of aging into treatable conditions requiring medication. More fundamentally, though, medical surveillance reflects our collective anxiety about mortality and our faith in technological intervention. The medical encounter has evolved into a ritual that provides psychological comfort while reinforcing social hierarchies. Physicians, armed with increasingly sophisticated monitoring equipment, assume positions of authority while patients surrender autonomy in exchange for the promise of safety and control. This illusion of control extends beyond medical settings into our daily lives. We've developed an entire cultural apparatus around the fiction that perfect health is achievable through vigilance and discipline. The result is a strange inversion: rather than medicine serving human needs, humans increasingly organize their lives around medical imperatives. What began as tools for healing have become instruments of ongoing surveillance, generating endless data but questionable improvements in wellbeing. Rethinking this relationship requires acknowledging a difficult truth: despite our best efforts, we cannot achieve perfect control over our bodies. At some point, each of us must recognize when the pursuit of medical certainty diminishes rather than enhances our limited time alive. This doesn't mean abandoning healthcare but approaching it with greater skepticism about which interventions truly contribute to meaningful wellbeing.

Chapter 2: Medical Rituals: The Ceremonial Nature of Healthcare

Healthcare interactions function as elaborate rituals in contemporary society, though we rarely recognize them as such. From the specialized clothing worn by medical professionals to the sanctified spaces where care occurs, from the prescribed positions patients must assume to the ceremonial tools used for examination—these elements create a theater of medicine that transforms ordinary human encounters into something sacred and separate from daily life. These rituals serve multiple purposes beyond their ostensible medical functions. For patients, the performance of submission—undressing on command, allowing strangers intimate access to one's body, answering deeply personal questions—marks a boundary crossing that temporarily suspends normal social conventions. For practitioners, the ritual components establish authority and distance, creating psychological protection from the emotional toll of constantly encountering human suffering. The white coat, stethoscope, and technical language serve as armor, maintaining the practitioner's position above the messy realities of bodily existence. Anthropologists have long recognized that healing rituals exist in all human societies. Indigenous healing ceremonies featuring drums, chants, and specialized practitioners were once dismissed by Western observers as primitive superstition. Yet medical anthropologists increasingly point out the striking parallels between these traditional practices and modern healthcare. Both involve specially designated healers, transgressive physical contact, specialized tools, and a shared belief system about causation and cure. The key difference lies not in efficacy but in cultural legitimation—science provides modern medicine's credibility in the same way spiritual beliefs validated traditional healing practices. This ritual perspective helps explain why many medical procedures persist despite limited evidence of their effectiveness. The annual physical exam, gynecological screenings, and various tests become valued not primarily for their medical benefits but for their symbolic reassurance. As one physician acknowledged, these procedures continue because "It's what I was taught and it's what patients have come to expect," not because scientific evidence justifies them. The ritual comfort often outweighs rational considerations of benefit and harm. The placebo effect further complicates this picture. Research shows that even when patients are told they're receiving an inert substance, the ritual context of medical care can produce measurable physiological improvements. The ceremonial aspects of healthcare—the caring attention, the touch, the expressions of concern—appear to activate healing responses independent of any specific treatment. This suggests that the ritual itself, rather than particular medical interventions, may constitute the most consistently effective aspect of healthcare. Understanding medicine as ritual raises profound questions about medical authority and the nature of healing. If ritual elements substantially contribute to positive outcomes, why have we constructed a healthcare system that systematically minimizes human connection while maximizing technological intervention? The challenge becomes how to preserve the beneficial aspects of medical ritual while discarding elements that humiliate patients or promote unnecessary procedures.

Chapter 3: When Science Fails: The Limits of Evidence-Based Medicine

Modern medicine derives its authority from its presumed scientific foundations. Unlike religious healing traditions that relied on faith and authority, scientific medicine presents itself as empirical, objective, and verifiable through systematic observation. This claim to scientific legitimacy distinguishes it from "pseudoscience" and alternative approaches, serving as the cornerstone of medical authority in contemporary society. Yet the relationship between medicine and science has always been tenuous. In the late twentieth century, mathematician-turned-physician David Eddy made a startling discovery when investigating the evidence behind common medical practices. When examining a 75-year-old treatment for ocular hypertension used on tens of millions of patients, he found only eight poorly designed controlled studies—and six of them showed recipients were worse off after treatment. As he expanded his investigation to other procedures, he encountered similar gaps, concluding that "medical decision making was not built on a bedrock of evidence or formal analysis, but was standing on Jell-O." This realization sparked the movement for "evidence-based medicine," which demanded statistical justification for medical interventions. The implications were profound, challenging the very foundation of modern healthcare. If medicine wasn't previously "evidence-based," what exactly was it based on? The uncomfortable answer appears to be a combination of tradition, intuition, anecdote, and institutional authority—precisely the elements scientific medicine claimed to have transcended. The gap between scientific ideals and medical practice appears throughout healthcare. Cancer screening programs like mammography were implemented widely before statistical evidence demonstrated their effectiveness—evidence that, when finally collected, often failed to show meaningful reductions in mortality. Similarly, routine PSA testing for prostate cancer detection, though intuitively appealing, leads primarily to overdiagnosis and harmful treatments without extending lives. Repeated international studies have failed to demonstrate that these screening programs achieve their stated purposes. Medical education itself reveals this disconnection. While pre-med students must master abstract scientific disciplines like organic chemistry, many physicians later acknowledge these subjects contribute little to their clinical practice. The scientific material serves less as practical knowledge than as a rite of passage—a "weed-out course" that limits access to the profession while establishing its intellectual credentials. Medicine's claim to scientific authority thus functions partly as a boundary-maintenance mechanism, distinguishing physicians from other healers. When evidence-based standards threaten established practices, the profession often resorts to protecting ritualistic elements of care. Some doctors defend unnecessary examinations as necessary for "cementing the doctor-patient relationship" or providing "emotional meaning that transcends the notion of a cure." While reasonable arguments exist against over-reliance on statistical evidence, the retreat into ritual suggests a discipline struggling with its scientific identity. This epistemological crisis reveals medicine not as applied science but as a complex social practice that incorporates scientific elements alongside ritual, tradition, and economic interests. Acknowledging these limitations doesn't mean abandoning medical care but approaching it with appropriate skepticism—recognizing that behind the veneer of scientific certainty lies a practice still navigating the fundamental mysteries of human embodiment.

Chapter 4: The Cellular Rebellion: How Immune Cells Betray Us

Our understanding of the immune system has traditionally cast it as the body's loyal defender—an intricate network of specialized cells and molecules protecting us from foreign invaders. This military metaphor permeates both scientific literature and popular understanding: immune cells as soldiers patrolling borders, mounting defenses, and sacrificing themselves in the body's service. Like any effective security force, the immune system supposedly distinguishes between "self" and "non-self," destroying dangerous outsiders while preserving the integrity of the organism it protects. This comforting narrative, however, has been profoundly disrupted by mounting evidence that immune cells frequently betray the very organism they supposedly defend. The most striking example concerns macrophages—large immune cells responsible for devouring microbes and clearing damaged tissue. Far from being loyal guardians, macrophages have been caught actively abetting the growth and spread of tumors. They supply cancer cells with growth factors, help build the blood vessels that feed tumors, and even escort cancer cells into the bloodstream, enabling metastasis to distant organs. The discovery left researchers "horrified." Macrophages can account for up to 50 percent of a tumor's mass, and their presence correlates with worse outcomes for patients. When cancerous mice are treated to eliminate macrophages, tumors stop metastasizing. Advanced microscopy reveals macrophages pairing with cancer cells to create openings in blood vessel walls—literally holding the door open for cancer cells to escape and colonize other parts of the body. This alliance between immune cells and cancer represents a profound betrayal of biological expectations. Yet cancer is merely one manifestation of a broader pattern of cellular rebellion. Autoimmune diseases like rheumatoid arthritis and multiple sclerosis—affecting 5 to 8 percent of the population—occur when immune cells attack the body's own tissues. Even seemingly non-immune conditions like coronary artery disease involve inflammatory processes driven by macrophages. The once-reliable distinction between "self" and "non-self" has collapsed under scientific scrutiny, revealing immune function as far more complex and contradictory than previously understood. Perhaps most disturbing is the role immune cells play in aging itself. The concept of "inflammaging" recognizes that many age-related conditions—from Alzheimer's to diabetes—represent active inflammatory processes driven by immune cells rather than simple deterioration. As we age, macrophages respond to accumulated cellular damage by initiating inflammatory responses that eventually destroy healthy tissue. The very system designed to protect us ultimately orchestrates our demise. These discoveries challenge our fundamental understanding of bodily integrity. Rather than viewing the body as a harmonious whole with parts working toward common goals, we must recognize it as a confederation of cells with potentially competing agendas. The immune system, far from being the body's loyal security force, operates with substantial autonomy and according to priorities that may conflict with the organism's survival. This perspective fundamentally changes how we understand health and disease—not as states of harmony versus dysfunction, but as ongoing negotiations between semi-autonomous cellular communities.

Chapter 5: Mindfulness Madness: Technology's Solution to Technology's Problem

As digital technology increasingly dominates modern life, an unexpected side effect has emerged: our minds are fragmenting. Studies show the average adult attention span has shrunk from twelve seconds to eight seconds over just a decade—shorter than a goldfish's attention capacity. This cognitive degradation manifests in rising diagnoses of attention disorders, multitasking compulsions, and a pervasive sense of mental scattering across all age groups. The culprit seems obvious: constant interruptions from smartphones, relentless social media notifications, and endless digital stimulation are rewiring neural pathways in ways that undermine sustained attention. Ironically, Silicon Valley—the epicenter producing these attention-fracturing technologies—has positioned itself as the source of the solution: mindfulness. What began as ancient Buddhist meditation practices has been repackaged as secular "attention training" through sleek apps and digital platforms. Corporations like Google and Facebook, whose business models depend on capturing and monetizing attention, simultaneously promote mindfulness programs to help employees manage the very distraction their products create. This represents a remarkable feat of cognitive dissonance—or perhaps marketing genius. The commercialization of mindfulness follows a predictable pattern of technological solutionism. Having identified fragmented attention as a problem, technologists propose to solve it through more technology—in this case, meditation apps that promise to strengthen attention through guided exercises in focus. The industry has exploded to include over 500 mindfulness applications with names like "Calm," "Headspace," and "Buddhify." The core proposition is that neuroplasticity—the brain's ability to reorganize itself—can be harnessed through meditation to counteract technology's harmful effects. This proposition contains several layers of contradiction. First, mindfulness apps themselves compete for the same scarce attention they claim to enhance. Second, they transform what was historically a practice of spiritual detachment into another monetized product for consumption. Third, and perhaps most fundamentally, they frame the problem of distraction as an individual failing rather than a systemic issue created by the attention economy's business model. Rather than questioning whether technology should be designed to fragment attention in the first place, mindfulness solutions place responsibility on individuals to build resistance against these effects. What scientific evidence supports digital mindfulness practices? Despite widespread claims about "neuroplasticity" and brain rewiring, the research remains remarkably thin. A comprehensive meta-analysis published in 2014 found that meditation programs showed no greater effectiveness for stress reduction than other interventions like relaxation techniques or even simple physical exercise. Specifically regarding mindfulness apps, researchers concluded there is "an almost complete lack of evidence supporting the usefulness of those applications." The mindfulness movement nonetheless flourishes because it offers a compelling narrative that flatters both consumers and producers of technology. It suggests we can have our digital cake and eat it too—remaining immersed in technology while developing immunity to its negative effects. More cynically, it transforms a problem created by technology companies into another profitable market opportunity. While attention continues to degrade across populations, Silicon Valley has successfully branded itself not as the source of digital distraction but as the enlightened provider of cognitive solutions.

Chapter 6: Aging, Death and Dignity: Rethinking Our Final Chapter

The pressure to maintain control over our bodies intensifies rather than diminishes with age. As physical decline becomes inevitable, the imperative to fight back only grows stronger. Health and fitness advice aimed at older adults often takes on a tone of military discipline: "Exercise six days a week for the rest of your life. Sorry, but that's it. No negotiations. No give. No excuses." The message is clear—aging itself represents a failure of discipline and willpower rather than a natural biological process. This perspective drives the concept of "successful aging," which emerged in the 1980s and has since become the dominant framework for approaching later life. Under this paradigm, the ideal is to maintain youthful levels of activity, appearance, and capability indefinitely. Aging successfully means essentially not aging at all—or at least concealing the evidence of aging through rigorous exercise, dietary restriction, and medical intervention. The elderly person who accepts physical limitations or slows down is seen as having surrendered prematurely. Yet this approach contains profound contradictions. Despite our best efforts at control, the risk of disability increases dramatically with age. Nearly 40 percent of people over sixty-five report at least one significant disability, with two-thirds experiencing difficulty walking or climbing. The goal of compression of morbidity—remaining healthy until a swift final decline—proves elusive for most people. The cruel irony is that our frantic efforts to maintain control might actually extend the period of disability rather than compress it. More fundamentally, the successful aging paradigm denies the distinctive value of later life as a unique developmental stage. While promoting physical maintenance, it ignores the potential for emotional, spiritual, and interpersonal growth that can accompany aging. The elderly person struggling to maintain youthful standards may miss the opportunity to develop qualities particularly available in later life—perspective, integration of experience, and acceptance of limitations. By defining success exclusively in terms of physical capacity, we devalue the wisdom that can emerge precisely from acknowledging mortality. The preoccupation with controlling aging ultimately reflects our deeper discomfort with death itself. In contemporary society, death has been medicalized and professionalized—removed from everyday experience and relegated to hospitals and funeral homes. The dying process, once integrated into community life, has become a series of medical interventions aimed at postponement rather than meaningful transition. Even when cure is impossible, the medical establishment often defaults to aggressive treatments that diminish quality of life without extending it meaningfully. Reimagining aging requires challenging the assumption that control is the highest value. What if instead we recognized aging as an invitation to develop a different relationship with our bodies—one based less on domination than on accommodation and grace? This would mean accepting that certain physical capacities will diminish while developing others like adaptability and presence. It would mean recognizing that dying is not a medical failure but a natural culmination of living, deserving dignity rather than desperate intervention.

Chapter 7: Beyond the Self: Embracing the Living Universe

Throughout human history, we have grappled with fundamental questions about our nature and place in the cosmos. What are we, beyond our physical bodies? What persists after death? The traditional answers—souls, spirits, or other immaterial essences—have increasingly struggled against scientific materialism, which portrays the universe as fundamentally lifeless matter governed by mechanical laws. This view positions humans as isolated consciousnesses in an otherwise dead cosmos, leading to our desperate attempts to preserve individual existence against inevitable dissolution. The self-concept that emerged in Western culture during the Renaissance and Enlightenment intensified this isolation. Unlike earlier conceptions that embedded individuals within communities and traditions, the modern self presents as autonomous, bounded, and separate—the center of experience and decision-making. This self demands constant attention and maintenance, generating endless self-help techniques, personal optimization strategies, and psychological interventions. Yet paradoxically, the more we focus on securing and enhancing this self, the more vulnerable we feel to its eventual disappearance. This existential anxiety manifests most dramatically when confronting mortality. The prospect of self-extinction seems almost logically impossible—how can I imagine a world without me in it when that very imagination requires my consciousness? As philosopher Herbert Fingarette wrote: "I can imagine a world without me in it as an inhabitant. But I can't imagine a world as unimagined by me." The terror of self-dissolution drives both religious conceptions of immortality and secular projects to extend life indefinitely. Yet recent scientific discoveries challenge these assumptions at a fundamental level. Far from being a dead mechanism, the natural world exhibits agency and decision-making at every level. Individual cells navigate complex environments making unpredictable choices; viruses determine whether to reproduce immediately or remain dormant; even subatomic particles display behavior that cannot be predetermined. The physicist Freeman Dyson suggested that "atoms have free will" in their fundamental unpredictability. Rather than finding ourselves alone in a dead universe, we inhabit a cosmos teeming with agency and potentiality. This perspective shifts our relationship to mortality. Death remains inevitable, but it no longer represents a fall into nothingness. Instead, it marks a transition where our particular configuration of matter and energy rejoins the ongoing creative processes of a living universe. Recent research with psychedelic substances offers glimpses of this understanding. In controlled studies, terminally ill patients given psilocybin frequently report profound experiences of connection with a living cosmos that dramatically reduces anxiety about dying. Brain scans reveal these substances temporarily suppress the default mode network associated with self-experience, allowing consciousness to perceive beyond the boundaries of individual identity. The German playwright Bertolt Brecht captured this insight in his final poem, written on his deathbed: "Already for some time / I had lost all fear of death. For nothing / Can be wrong with me if I myself / Am nothing. Now / I managed to enjoy / The song of every blackbird after me too." This isn't resignation but recognition—the self dissolves, but the living world continues its song. Our brief moment of consciousness represents not isolation but participation in the ongoing expression of a universe that was never dead to begin with.

Summary

The fundamental insight emerging from this exploration challenges our most basic assumptions about human existence. What we discover is not merely that complete control over our bodies remains elusive, but that the very framework of control—with its implicit separation between the controlling mind and the controlled body—fundamentally misrepresents reality. Our bodies are not machines to be commanded but complex ecologies where countless cellular agents make autonomous decisions that may align with or oppose our conscious intentions. Immune cells betray us, tissues rebel, and neurons fire in patterns we cannot dictate. This recognition calls for a profound reorientation in how we approach everything from healthcare to aging and death. This perspective ultimately points toward liberation rather than despair. When we release the exhausting obligation to achieve perfect control, we can recognize ourselves as participants in rather than masters of the living processes that constitute us. We exist as temporary configurations within a universe characterized not by dead matter but by agency at every level—from quantum fluctuations to cellular decisions to ecological relationships. Death no longer represents an absolute termination but a transition where our particular manifestation of consciousness rejoins the ongoing creative processes of a living cosmos. The truly rational response to mortality isn't desperate control but appreciative engagement with the remarkable world we briefly inhabit, acknowledging that "nothing can be wrong with me if I myself am nothing."

About Author

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Barbara Ehrenreich

Barbara Ehrenreich was an American author and political activist. During the 1980s and early 1990s, she was a prominent figure in the Democratic Socialists of America. She was a widely read and award-winning columnist and essayist and the author of 21 books. Ehrenreich was best known for her 2001 book Nickel and Dimed: On (Not) Getting By in America, a memoir of her three-month experiment surviving on a series of minimum-wage jobs. She was a recipient of a Lannan Literary Award and the Erasmus Prize.

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