Barbara Ehrenreich
CONTENTS
INTRODUCTION Ix
Chapter One: Midlife Revolt 1
Chapter Two: Rituals of Humiliation 14
Chapter Three: The Veneer of Science 32
Chapter Four: Crushing the Body 51
Chapter Five: The Madness of Mindfulness 71
Chapter Six: Death in Social Context 91
Chapter Seven: The War Between Conflict and Harmony 112
Chapter Eight: Cellular Treason 137
Chapter Nine: Tiny Minds 151
Chapter Ten: "Successful Aging" 162
Chapter Eleven: The Invention of the Self 181
Chapter Twelve: Killing the Self, Rejoicing in a Living World 197
NOTES 213
ABOUT THE AUTHOR 235
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CHAPTER TEN "Successful Aging"
The pressure to remain fit, slim, and in control of one's body does not end with old age—in fact, it only grows more insistent. Friends, family members, and doctors start nagging the aging person to join a gym, "eat healthy," or, at the very least, go for daily walks. You may have imagined a reclining chair or a hammock awaiting you after decades of stress and, in the case of manual laborers, physical exertion. But no, your future more likely holds a treadmill and a lat pull, at least if you can afford to access these devices. One of the bossier self-help books for seniors commands:
Exercise six days a week for the rest ofyour life. Sorry, but that's it. No negotiations. No give. No excuses. Six days, serious exercise, until you die.'
The reason for this draconian regime is that "once you pass the age of fifty, exercise is no longer optional. You have to exercise or get old." You may have retired from paid work, but you have a new job, going to the gym. "Think of it as a great job, which it is."2
People over fifty-five are now the fastest-growing demographic for gym membership. A few gyms, like the Silver Sneakers chain, deliberately target the elderly, in some cases even to the point of discouraging those who are younger—on the theory that older folks don't want to be intimidated by meatballs or spandexed sylphs. If the mere presence of white-haired gym-goers isn't enough to repel the young, some gyms don't offer free weights, partly because the sound of falling weights is supposedly annoying to older people and partly because older people, who are more likely to use exercise machines, may see them as a reproach. In the mixed-age gym I go to, membership tilts toward the over-fifty crowd, where "exercise is no longer optional." The more dedicated may use the gym as only part of their fitness regimen; they run in the morning or bike several miles to get there. Mark, a fifty-eight-year-old white-collar worker, does a 6 a.m. workout before going to work, then another one after work. His goal? "To keep going." The price of survival is endless toil.
For an exemplar of healthy aging, we are often referred to Jeanne Louise Calment, a Frenchwoman who died in 1997 at the age of 122—the longest confirmed human life span.3
Calment never worked in her life, but it could be said she "worked out" While he was still alive, she and her wealthy
husband enjoyed tennis, swimming, fencing, hunting, and mountaineering. She took up fencing when she was 85, and even at 111, when she was in a nursing home, started the morning with gymnastics performed in her wheelchair.
164 NATURAL CAUSES "SUCCESSFUL AGING" 165
Anyone looking for dietary tips will be disappointed; she liked beef, fried foods, chocolates, and pound cake. Unthinkably, by today's standards, she smoked cigarettes and sometimes cigars, though antismoking advocates should be relieved to know that she suffered from a persistent cough in her final years.
This is "successful aging," which, except for the huge investment of time it can require, is almost indistinguishable from not aging at all. Anthropologist Sarah Lamb and her coauthors of a book on the subject4 date the concept of successful aging to the 1980s and locate it throughout the Western world, where it also goes by such names as "active aging," "healthy aging," "productive aging," "vital aging," "anti.aging," and "aging well."5 Lamb reports that
the WHO dedicated World Health Day 2012 to Healthy Ageing, and the European Union designated 2012 as the European Year for Active Ageing.6 In North America and Western Europe, centers for Healthy Aging, Active Aging and Successful Aging abound. Popular cultural and self-help books on the topic are flourishing.7
Among the titles now available on Amazon are: Successful and Healthy Aging: 101 Best Ways to Feel Younger and Live Longer; Live Long, Die Short: A Guide to Authentic Health and Successful Aging, Do Not Go Gentle: Successful Agingfor Baby Boomers andAll Generations; AgingBackwards: Reverse the Aging Process and Look 10 Years Younger in 30 Minutes a Day; and of course Healthy Agingfor Dummies. A major theme is that aging itself is abnormal and unacceptable. As the physician coauthor of Younger Next Year wrote, under the subhead "Normal Aging' Isn't Normal":
The more I looked at the science, the more it became clear to me that such ailments and deterioration [heart attacks, strokes, the common cancers, diabetes, most falls, fractures] are not a normal part of growing old. They are an outrage.8
And who is responsible for this outrage? Well, each of us is individually responsible. All of the books in the successful‑
aging literature insist that along and healthy life is within the reach of anyone who will submit to the required discipline. It's up to you and you alone, never mind what scars—from overexertion, genetic defects, or poverty—may be left from your prior existence. Nor is there much or any concern for the material factors that influence the health of an older person, such as personal wealth or access to transportation and social support. Except for your fitness trainer or successful-aging guru, you're on your own.
Unfortunately, the gurus' instructions are far from unanimous or easy to follow. On the dietary front there's no more clarity than can be found in the general dietary advice for adults. Should you go with a Paleo diet or one heavy in complex carbohydrates? Should you eliminate all fats that do not originate in avocados or olives? We are widely advised to follow a "Mediterranean diet," but does that include Greek gyros and Italian charcuterie? Or perhaps we should refrain from eating anything at all. Numerous studies have shown that caloric restriction or intermittent fasting can prolong the lives of rats and other animals, but
166 NATURAL CAUSES "SUCCESSFUL AGING" 167
the debate over its effectiveness in humans goes on,9 despite the fact that most of us would find a semi-starved life not
worth living. If I can discern a general rule, it is governed by deprivation: Anything you like to eat—because it is, for example, fatty, salty, or sweet—should probably be put aside now in the interests of successful aging.
As for exercise, here too we find no precise instructions. Some sources, like the book quoted above, specify the
rough amount of exercise, such as six days a week for about
forty-five minutes per session, and how it should be divided between cardiovascular work and muscle training. But overall, a disturbing vagueness prevails. Often, we are urged
simply to "get active" or "get moving," on the grounds that even the smallest motion can be life-prolonging. "And even if you can't run a four-minute mile, keep running. If you can't run, walk—but keep moving, "10 For the sedentary, fidgeting at one's desk can help, along with parking a block or so from one's destination. A middle-aged woman reports that "I keep maniacally active because if there's any down time I sit there feeling guilty I'm not doing anything." Not doing anything is the same as aging; health and longevity must be earned through constant activity. Even the tremors of Parkinson's disease can be seen, optimistically, as a form of health-giving exercise, since they do, after all, burn calories. The one thing you should not be doing is sitting around and, say, reading a book about healthy aging.
There are bright sides to aging, such as declines in ambition, competitiveness, and lust. In her seventies, Betty Friedan turned her attention from gender to aging, writing a book called The Fountain ofAging and telling an interviewer that as they age, people become "more and more authentically themselves. They didn't care anymore what other people thought of them, you know, keeping up with the Joneses and
'Am I going to make a fool of "12 Another noted
feminist, the Australian-born Englishwoman Lynne Segal, found artists often doing their best work in old age, and titled her balanced and richly documented book Out of Time: The Pleasures and Perils ofAgeing. I can add from my own experience that aging also comes along with a refreshing refusal to strive, to take on every potential obligation and opportunity that comes my way.
But as even the most ebullient of the elderly eventually comes to realize aging is above all an accumulation of disabilities, often beginning well before Medicare eligibility or the arrival of the first Social Security check. Vision loss typically begins in one's forties, bringing the need for reading glasses. Menopause strikes in a woman's early fifties, along with the hollowing out of bones. Knee and lower back pain arise in the forties and fifties, compromising the mobility required for "successful aging." As we older people mutter to each other in the gym, "It's just one damn thing after another," most of these things are too commonplace and boring even to serve as small talk. The U.S. Census Bureau
reports that nearly 40 percent of people age sixty-five and older suffer from at least one disability, with two-thirds of
them saying they have difficulty walking or climbing.13 Yet
we soldier along, making occasional concessions to arthritic joints or torn muscles but always aware that any major ces‑
sation of effort, say for two weeks or more, could lead to catastrophic collapse. "You don't become inactive because
168 NATURAL CAUSES "SUCCESSFUL AGING" 169
you age," we've been told over and over. "You age because you've become inactive."
No doubt immortality would be a more alluring goal ifwe could imagine surviving without disability, but hardly any‑
one, outside of the narrow demographic slice represented
by Silicon Valley billionaires, is interested in an extended life of being fed and "toileted" by caretakers until the next
biomedical breakthrough comes along. More modestly, the
goal of "successful aging" is often described as a "compression of morbidity" into one's last few years. In other words,
a healthy, active life followed by a swift descent into death.
The latter goal may help account for the rise of "extreme" and dangerous sports in recent years, at least among those
who can afford ski resorts, snowboarding, or a trip to Nepal.
While the poor are chided for unhealthy lifestyles, the rich are applauded for summiting Everest, an enterprise with a
6.5 percent mortality rate14 and costing a minimum of about $100,000, not counting equipment or airfare—although fitness enthusiasts will be happy to know that both gluten-free and vegan diets are now available to climbers. 15
But the goals of a healthy, active life followed by a fairly quick death may not even be compatible without the intervention of avalanches and altitude sickness. The truly sinister possibility is that for many of us, all the little measures we take to remain fit—all the deprivations and exertions—will only lead to a longer chance to live with crippling and humiliating disabilities. As a New York Times columnist observed, "The price we're paying for extended life spans is a high rate of late-life disability-"16 There are no guarantees.
But where there are no guarantees, there are plenty of promises of which "younger next year" is far from the most extravagant. Skincare products, once content to be "age-defying," are increasingly claimed to be "age-reversing," and, we are told by the wellness coaches and websites, a youthful appearance is part of "feeling good about yourself," which is deemed essential to wellness at any chronological age. Credit for adding beauty—or at least a simulacrum of youthfulness—to the wellness package should go to the new "celebrity wellness" entrepreneurs, starting with actor Gwyneth Paltrow, whose digital company Goop has been dispensing tips on beauty, health, recipes, and shopping since 2008. Actor Blake Lively launched her own "lifestyle company" in 2013, which is about "living a very one-of-a-kind, curated life," and included home decorating tips. 17
The general assumption is that the customers have plenty of time and money on their hands for, among many other things, a $60 "skin-rejuvenating pillowcase with patented Copper technology," or a $5,000 "radiofrequency" skin-tightening treatment. If you have enough money for such gadgets and interventions, you can presumably buy your way out of the strenuous "younger next year" approach to aging and take a more sybaritic path, one designed not to challenge but to pamper. The celebrity wellness entrepreneur du jour, Amanda Bacon, who is a celebrity only by virtue of her Moon Juice wellness products, offers, instead of exercise regimens, a line of ointments and drinks, heavy on the kinds of exotic and expensive substances that Bacon herself likes to consume: "ho shou wu, silver needle tea, pearl, reishi, cordyceps, quinton shots, bee pollen and chaga." The theme here is self-nurturance, as reflected in the
170 NATURAL CAUSES
cost of the items consumed, as well as the time that goes into "curating" and procuring them. As New York Times reporter Molly Young comments:
What Goop (and acolytes like Moon Juice) sell is the notion that it's not only excusable but worthy for a person to spend hours a day focused on her tiniest mood shifts, food choices, beauty rituals, exercise habits, bathing routines and sleep schedule. What they sell is self-absorption as the ultimate luxury product. 18
Not surprisingly, these celebrity-endorsed wellness techniques are not exactly evidence-based, although of course there may be some large-scale double-blind randomized studies of, say, the salubrious effects of pearl consumption, that I am not aware of. But there are other equally passive and sweat-free wellness techniques that claim slightly more scientific credibility, such as "touch therapy." It is known that human infants and probably those of many other mammals only thrive when held and touched. Extrapolating from that, some wellness purveyors surmise that even adults in modern societies suffer from "touch deprivation"—most of all the elderly ones, who may have lost, or lost interest in, their partners and simply aged out of the dating pool.
Fortunately, touch is easy enough to commoditize in the form of massages or "healing touch" therapies that can be offered by spas, hospitals, and senior care centers. An assisted living center excitedly tells us that touch reduces blood pressure and glucose and increases alertness, while all-out hugs "strengthen the immune system, relieve pain
"SUCCESSFUL AGING" 171
and depressions elevate mood, reduce stress, decrease the heart rate, and may prevent Parkinson's disease. "9 The hugs can be dispensed by care providers or acquired from the fledgling "cuddling industry," which offers asexual cuddles for a price. 20
Inflammaging
In the twentieth century, medical science began to think of aging as a kind of disease as opposed to a normal stage of the life cycle. Women were used to having their lives "med-icalized" from puberty to menopause, with pregnancy and childbirth as acute episodes requiring intense medical monitoring and often intervention. But since there was no cure for aging, the elderly were pretty much left to their own devices, once meaning tonics and elixirs rich in alcohol or cocaine, which may have been, at least in the short term, highly effective. Not until the 1960s and '70s did a researcher come up with a theory of aging at the sub-cellular level, which in the reductionist biology of the time was the only level that counted as interesting. This was the "telomere theory": Every time a cell divides, the tips of its chromosomes (telomeres) grow shorter until further cell
divisions become impossible.
The theory had its problems—many types of cells, such as cardiac cells and neurons, do not reproduce or do not do so very often, yet they somehow manage to age. But it also presented a tempting commercial opportunity in the form of drugs that might lengthen and fortify telomeres, al‑
172 NATURAL CAUSES "SUCCESSFUL AGING" 173
though their pharmaceutical promise has not been fulfilled. A host of other chemical agents in the aging process have
been identified, each with its own proposed nostrum. Free
radicals were popular culprits in the 1980s and '90s, leading to a brief fad of consuming antioxidants like vitamin E and
selenium—to no effect, as it turned out. Methylation, the
addition of a methyl group to a protein or nucleic acid, is required for cellular health and is thought to be encouraged
by B vitamins such as folate. But the effect of B vitamins on aging is murky at best. 21 Or, it has been proposed, mutations can occur in a cell's DNA, leading to accumulated intracellular damage, and there is no known cure for that.
All of these proposed chemical pathways of aging occur within individual cells, and all are suggestive of the kind of deep trends one might associate with aging—decay and entropy. The analogy is often made to the kind of "wear and tear" that eventually disables a machine or at least its moving parts, except that cells are not machines and their moving parts are molecules or clusters of molecules that are subject to perpetual destruction and renewal. Proteins, the fundamental chemical ingredient of cells, are constantly being torn apart by intracellular digestive enzymes and replaced by freshly constructed ones. Some of the key protein players in cellular metabolism have half-lives only minutes long, meaning that there are plenty of opportunities for errors, as well as opportunities for correcting them. Over time, though, with advancing age, the errors accumulate until the integrity of the cell is compromised. And it is then that things get interesting.
Damaged cells attract immune cells, or, more precisely, damaged cells send out chemical signals that attract the immune cells, which proceed to devour the ailing cells. Some of the immune cells are messy eaters, leaving behind debris or the equivalent of crumbs, which in turn attracts more immune cells. Macrophages in particular are drawn to damaged cells; in fact, their chief "function" in the body, in addition to fighting microbes, is the removal of such compromised cells. Thus the site of cell damage becomes a site of inflammation, where macrophages pile up and attract more macrophages to share in the meal. Inflammation is of course lifesaving when provoked by microbes, but when the target is the body's own cells or damaged versions thereof, it can lead, however gradually, to death.
In 2000, the Italian immunologist Claudio Franceschi proposed the neologism "inflammaging" to describe the entire organism-wide process of aging. Far from being a simple process of decay originating in individual cells, aging involves the active mobilization of macrophages to deal with proliferating sites of cellular damage. Today Franceschi's theory is widely accepted, with inflammaging being described, ominously enough, as "chronic smoldering oxidative and inflammatory Stress?'22 The hallmark disorders of aging—such as atherosclerosis, arthritis, Alzheimer's disease, diabetes, and osteoporosis—are all inflammatory diseases, characterized by a local buildup of macrophages. In atherosclerosis, for example, macrophages settle in the arteries leading to the heart, where they gorge themselves with lipids until the arteries are eventually blocked. In Type 2 diabetes macrophages accumulate in the pancreas, where they destroy the cells that produce insulin. Osteoporosis involves
174 NATURAL CAUSES "SUCCESSFUL AGING" 175
the activation of bone-dwelling macrophages, called osteo-cytes, that kill normal bone cells. The inflammation associated with Alzheimer's disease was first thought to represent macrophages' attempts to control the beta-amyloid plaques that clog up the Alzheimer's brain. But the most recent research suggests that the macrophages, which may indeed be activated by the plaques, actually drive the progression of the disease. 23
These are not "degenerative" diseases, not just accumulations of "errors" and cobwebs. They are active and seeming‑
ly purposeful attacks by the immune system on the body
itself. Why should this happen? Perhaps a better question
is: Why shouldn't it happen? The survival of an older person is of no evolutionary consequence since that person can no longer reproduce—unless one wants to argue for the role of grandparents in prolonging the lives of their descendants. It might even, in a Darwinian sense, be better to remove the elderly before they can use up any more resources that might otherwise go to the young. In that case, you could say that there is something almost altruistic about the diseases of aging. Just as programmed cell death, apoptosis, cleanly eliminates damaged cells from the body, so do the diseases of aging clear up the clutter of biologically useless older people—only not quite so cleanly. And this perspective may be particularly attractive at a time, like now, when the dominant discourse on aging focuses on the deleterious economic effects of largely aging populations. If we didn't have inflammatory diseases to get the job done, we might have to turn to euthanasia.
But however benevolent the diseases of aging might ulti mately be—at least from a social or economic perspective—they are experienced by the individual as a betrayal. In one of his last novels, Everyman, Philip Roth's protagonist, who is essentially the same Rothlike, sex-obsessed character who has starred in most of his novels, must face his own physical deterioration. Well into his seventies, retired and largely estranged from his family, he is still hitting on women at least
a half century younger than himself. Mostly though, he is aging—tormented by his increasingly unreliable penis and
by atherosclerosis, which comes to require heart surgery ev‑
ery year. The setting is increasingly claustrophobic as it moves among waiting rooms and hospitals before returning
to the cemetery where the story started, at a family funeral,
and where his own body will eventually rest. It is unlikely that Roth knew anything about inflammaging or the cel‑
lular basis of atherosclerosis, but he accurately summed up the biological situation when he wrote that "old age isn't a battle; old age is a massacre.724
So whatever good deeds immune cells may accomplish in the young, such as fending off microbial infections, their job—or perhaps we should say, their effect in the elderly—is to destroy the organism. The question of why they do
these things might be simplified into a more childish form: Are the immune cells "good" or are they "bad"? Friends or foes? For the most part, scientists dodge this question with
mumblings about "paradoxical" effects or a "double-edged sword." Macrophages can save our lives or promote deadly
tumors. Neutrophils, which are among the first immune cells to arrive at a site of infection, can slay intruders or start a spiral into chronic inflammation. Scientists sometimes fall
176 NATURAL CAUSES "SUCCESSFUL AGING" 177
back on the language of moral judgment, of "good" and "bad." For example, a researcher who has contributed to several papers on inflammation attempts to exonerate neu-trophils by blaming their occasional bad behavior on other cell types they are in contact with, which are typically other immune cells:
Although neutrophils may often appear to be the "bad" guy in certain inflammatory conditions this is typically due to the influence of other molecules released from surrounding cells. Without this influence the primary aim of the neutrophil is to resolve inflammation, making them overall the "good" guys of the inflammatory process.25
It would take a lengthy trial to determine the guilt or innocence of the immune system or of any cell type within it. In the case of macrophages their contributions to the wellbeing of the organism are well known: They help sculpt the embryo into a human fetus; they defend the body against microbial invasions; they participate in the process of antigen presentation; they keep the body clear of dead and damaged cells. On the destructive side, they encourage the growth and spread of tumors; they launch the catastrophe of inflammaging; they are frontline killers in autoimmune diseases. If I were a prosecutor in the trial of macrophages I might wind up my case with the autoimmune diseases, which may not prove active malice on the macrophages' part, but certainly make a case for homicidal negligence. In their defense, macrophages could argue that whatever the deleterious consequences, they are simply doing the kind of things they are expected to do—removing damaged cells, for example. To which the prosecution might counter that macrophages have way too much discretion in determining which cells are damaged enough to die, and may even have caused the initial harm themselves.
Early in his massive work on the history and philosophy of immunology, The Immune Se Theory or Metaphor, Alfred Tauber states that "the immune self has come to be viewed analogously to a living entity."26 His use of the passive voice conceals who has come to see the "immune self" in this way—he himself or immunologists in general? But the larger question is, what does it mean to say that some part or parts of the body act as a "living entity"? Certainly the cells of the immune system are in constant communication, and are capable of rather dramatic forms of cooperation. For example, if a macrophage needs to expand its supply of cell-killing digestive enzymes, all it has to do is gobble up a neutrophil and add the neutrophil's stockpile of enzymes to its own. So the immune system seems to qualify as a "system," but does it possess the autonomy we expect to find in a "living entity"? If so, we should probably call the nervous system a kind of living entity too, since it is capable of plotting and carrying out the death of the organism—in the form of suicide by gunshot or poison—on its own.
But what kind of an entity is it? Is it a second, shadow self, assuming the word "self" has not been so degraded by
its metaphorical uses as to be meaningless? The best analogy I can come up with would be that it is a symbiont—living in a symbiotic relationship within us, sometimes saving our lives and sometimes destroying us. All we can say
178 NATURAL CAUSES "SUCCESSFUL AGING" 179
for sure is that its agenda does not always concur with ours, and there does not seem to be any command-and-control
center within the organism to bring these agendas reliably into harmony. There are many small measures, to be sure—checks and balances, anti- and pro-inflammatory chemical messages—but there is ultimately no one in charge.
The danger is that the inflammatory forays of the immune system can easily tilt into lethal cascades. A plaque composed of macrophages can suddenly block a coronary artery. Alzheimer's disease, which is an inflammatory disease of the brain, can cut off the neuronal circuits controlling breathing. Where there is an inflammation, body cells are damaged, and the damage lures more inflammatory cells to the site. Macrophages get less efficient with age, slower and less effective as phagocytes and defenders against microbial invasions. But the effect may be to make them even messier eaters than they were in their youth, and hence more prone to inadvertently call for more macrophages as backup. Chronic, "smoldering" inflammations can easily ignite into conflagrations.
We all know how this ends, though for the most part we prefer not to think about it. When the organism dies, as signaled by the cessation of the heartbeat and respiration, not all body cells die simultaneously, though many begin to ail within minutes or hours. Their mitochondria swell, their disabled proteins are not replaced, their cell membranes start to leak. Macrophages and other phagocytes, which are not wholly dependent on the bloodstream for nutrients, may last slightly longer and perhaps enjoy a brief orgy as they rush around devouring damaged cells, but they too soon succumb to the lack of oxygen from circulating blood. Bacteria from the gut—collectively known as the microbiome—find their way through leaky membranes to the rest of the body and begin the process of putrefaction. Next come the insects, including beetles, flies, and, should they be in the neighborhood, butterflies. Maggots are the hallmark of decomposition; Shakespeare remarked that "we fat [fatten] ourselves for maggots" and was amused by the fact that even kings are eventually eaten by these little worms. Mercifully perhaps, the corpse may be attacked at some point by larger scavengers—crows vultures, rats, hyenas, jackals, and dogs—which at least serve to clean up the mess. To the heroes of the Iliad, this was the ultimate humiliation they could wish on their enemies—to be eaten by dogs and crows, to descend from the status of warriors and predators into prey.
So much, then, for the hours—and years—you may have devoted to fitness. The muscles that have been so carefully sculpted and toned stiffen when calcium from the dead body leaks into them, causing rigor mortis, and loosening only when decomposition sets in. The organs we nurtured with supplements and superfoods abandon their appointed functions. The brain we have tamed with mindfulness exercises goes awry within minutes after the heart stops beating. Soon after, reports a forensic anthropologist, "the brain liquefies very quickly. It just pours out the ears and bubbles out the mouth ."27 Everything devolves into a stinking pool or, what may sound even worse, a morsel in a rat's digestive system.
If this sounds offensive, let me remind you that we in‑
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habit an entertainment culture that is thickly populated with the "undead," the "walking dead," and other borderline creatures that resemble decaying corpses. Their mouths, always open to expose rotting teeth, are bloody gashes, their eyes are set deep in their sockets, their jowls may be beginning to melt down toward their necks, and of course, they are lurching toward us in search of a meal. This obsession is odd, given how meticulous our society is about the disposal of corpses. We are unlikely to trip over dead bodies on the sidewalk, but it is hard not to encounter them while relaxing in front of movies—as if we needed reminders of the postmortem future of the flesh.
CHAPTER ELEVEN
The Invention of the Self
We return now to a question raised earlier in this book. Who is in charge? We seek control over our bodies, our minds, and our lives, but who or what will be doing the controlling? The body can be ruled out because of its tendency to liquefy—or turn into dust—without artful embalming. So the entity we wish to enthrone must be invisible and perhaps immaterial—the mind, the spirit, the self, or perhaps some ineffable amalgam, as suggested by the phrase "mind, body, spirit" or the neologism "mindbody."
The spectacle of decomposition provides a powerful incentive to posit some sort of immaterial human essence that survives the body. Certainly there is very little talk of "mind-body unity" in the presence of a rotting corpse. In fact, the conversation is likely to take a different turn, to
an emphasis on the existence of an immortal essence, or soul, that somehow carries on without the body. Medieval
Catholic artists and clerics deployed images of decomposing bodies—sometimes with maggots wiggling in the nos‑
182 NATURAL CAUSES THE INVENTION OF THE SELF 183
trils and eye sockets—to underscore the urgency of preparing the soul for the disembodied life that awaits it. Buddhist monks practice "corpse meditation" in the presence of corpses, both fresh and rotting, to impress on themselves the impermanence of life The soul, m both Christian and Islamic philosophy, is the perfect vessel for the immortality that eludes us as fleshly creatures: It's immortal by virtue of the fact it somehow participates in, or overlaps with, an immortal deity. Even nonbelievers today are likely to comfort themselves with the thought of a "soul," or spirit, or vague "legacy" that renders them impervious to decay. As Longfellow famously wrote, "Dust thou art, to dust turnest, was not spoken of the soul."
But no one has detected this entity. There is in fact much firmer evidence for the existence of "dark matter," the hypothesized substance that is invoked to explain the shape of galaxies, than there is for any spirit or soul. At least dark matter can be detected indirectly through its gravitational effects. We can talk about someone's soul and whether it is capacious or shriveled, but we realize that we are speaking metaphorically. Various locations for an immaterial individual essence have been proposed—the heart, the brain, and the liver—but autopsies yield no trace of it, leading some to speculate that it is delocalized like the Chinese qi. In 1901, an American physician reported that the human body loses three-quarters of an ounce, or twenty-one grams, at the moment of death, arguing that this meant the soul is a material substance. But his experiment could not be replicated, suggesting that the soul, if it exists, possesses neither location nor mass. One can't even find the concept of the "immortal soul" in the Bible. It was grafted onto Christian teachings from the pagan Greeks long after the Bible was written.2
The idea of an immortal soul did not survive the Enlightenment unscathed. The soul depended on God to pro‑
vide its immortality, and as his existence—or at least his
attentiveness—was called into question, the immortal soul gave way to the far more secular notion of the self. While
the soul was probably "discovered" by Christians (and Jews)
reading Plato, the self was never discovered; it simply grew by accretion, apparently starting in Renaissance Europe.
Scholars can argue endlessly about when exactly the idea of
the self—or any other historical innovation—arose; precedents can always be claimed. But historians have generally
agreed on the vague proposition that nothing like either
the soul or the self existed in the ancient world. Ego, yes, and pride and ambition, but not the capacity for introspec‑
tion and internal questioning that we associate with the self. Achilles wanted his name and his deeds remembered forever; he did not agonize over his motives or conflicted allegiances. That sort of thinking came later.
Lionel Trilling wrote that "in the late 16th and early 17th centuries, something like a mutation in human nature took
place," which he took to be the requirement for what his‑
torian Frances Yates called "the emergence of modern European and American man."' As awareness of the individual
self took hold, the bourgeoisie bought mirrors, commis‑
sioned portraits, wrote autobiographies, and increasingly honored the mission of trying to "find" oneself among the
buzz of thought engendered by a crowded urban social world. Today we take it for granted that inside the self we
184 NATURAL CAUSES THE INVENTION OF THE SELF 185
present to others, there lies another, truer self, but the idea was still fresh in the 1780s when Jean-Jacques Rousseau announced triumphantly:
I am forming an undertaking which has no precedent, and the execution of which will have no imitator whatsoever. I wish to show my fellows a man in all the truth of nature; and this man will be myself.
Myself alone. I feel my heart and I know men. I am not made like any of the ones I have seen; I dare to believe that I am not made like any that exist. If I am worth no more, at least I am different.4
Megalomania, or the proud claim of a rebellious political thinker? Contemporary thought has leaned toward the latter; after all, Rousseau was a major intellectual influence on the French Revolution, which, whatever its bloody outcome, was probably the first mass movement to demand both individual "Liberté" and "Fraternité," or solidarity within the collective. There is something bracing about Rousseau's assertion of his individual self, but the important thing to remember is that it was an assertion—no evidence was offered, not that it is easy to imagine what kind of evidence that might be. As historian John 0. Lyons put it, the self was "invented."5
Another slippery abstraction was taking hold at around the same time as the self, and this was the notion of "society." Like the self, society is not something you can point to or measure, it is a concept that has to be taught or shared, a ghostly entity that arises from an aggregate of individual selves. In material terms, you can imagine a "super-being" composed of numerous subunits clumsily trying to coordinate their movements. It is no coincidence that the concept of society arose along with that of the self, if only because the newly self-centered individual seemed to be mostly concerned with the opinion of others: How do I fit in? How do I compare to them? What impression am I making? We do not look into mirrors, for example, to see our "true" selves, but to see what others are seeing, and what passes for inner reflection is often an agonizing assessment of how others are judging us.
A psychological "mutation" of this magnitude cries out for a historic explanation. Here, historians have generally invoked the social and economic changes accompanying the increasing dominance of a market economy. As fixed feudal roles and obligations lost their grip, it became easier for people to imagine themselves as individuals capable of self-initiated change, including upward mobility. You might be an artisan and learn to dress and speak like a merchant, or a merchant who takes on the airs of an aristocrat. Traditional bonds of community and faith loosened, even making it possible to assume the identity of another person, as in the famous case of the sixteenth-century adventurer who managed to convince the inhabitants of a village that he was their missing neighbor Martin Guerre. He took over the family inheritance and moved in with the real Guerre's wife, at least until the ruse was uncovered three years later.6 If you could move from village to village, from village to city, from one social class to another—and surely the disruptions of intra-European wars played a part in the new
186 NATURAL CAUSES THE INVENTION OF THE SELF 187
mobility—you have to constantly monitor the impression you are making on others. At the same time, those others are becoming less trustworthy; you cannot be sure what true "self" lies behind the façade.
Related to the rise of capitalism—though how related has long been a subject of debate—was the religious innovation represented by Protestantism, which midwifed the soul's transformation into the modern notion of the self Pre-Reformation Catholics could ensure a blissful postmortem existence by participating in the sacraments or donating large sums to the church, but Protestants and especially Calvinists were assigned to perpetual introspection in an attempt to make their souls acceptable to God. Every transient thought and inclination had to be monitored for the slightest sinful impulse. As science and secularism chipped away at the notion of God, the habit of introspection remained. Psychoanalyst Garth Amundson writes:
People continued to look inward, into the private life of the mind, so as to locate essential truths about their lives, though without the additional notion that these truths are the fruit of a dialogue with God's presence within the self Hence, the Deity that Augustine thought that we discover by looking within the self was dethroned, and replaced by an invigorating confrontation with powerful private emotional states, fantasies, hopes, and needs. An authentic and immediate awareness of one's affective experience became the new center around which to create a life lived truthfully and "fully." In this way, the development of the private life of the self became something of an object of worship.7
Or, as somewhat more simply put by a Spanish historian, "the modern Rousseauist self, which feels and creates its own existence, would appear to be the heir to attributes previously assigned to God."8
In our own time, the language of self-regard has taken on a definite religious quality. We are instructed to "believe" in ourselves, "esteem" ourselves, be true to ourselves, and, above all, "love" ourselves, because otherwise how could anyone else love us? The endless cornucopia of "self-help" advice that began to overflow in the twentieth century enjoins us to be our own "best friends," to indulge ourselves, make time for ourselves, and often celebrate ourselves. If words like "believe" do not sufficiently suggest a religious stance, one site even urges us to "worship ourselves" by creating a shrine to oneself, which might include photos (probably "selfies"), favorite items of jewelry, and "nice smelling things such as perfume, candles or incense"' The self may seem like a patently false deity to worship, but it is no more—and no less—false than the God enshrined in recognized religions. Neither the self nor God is demonstrably present to everyone. Both require the exertion of
belief
In today's capitalist culture the self has been further objectified into a kind of commodity demanding continual effort to maintain—a "brand:' Celebrities clearly have well-defined "brands," composed of their talents, if any, their "personalities," and their physical images, all of which can be monetized and sold. Even lowly aspirants toward wealth and fame are encouraged to develop a brand and project it confidently into the world, and never mind if it is indistin‑
188 NATURAL CAUSES THE INVENTION OF THE SELF 189
guishable from that of millions of other people—cheerful, upbeat, and "positive-thinking" has been a favorite since the 1950s, both for office workers and CEOs. If some darker self, containing fears, resentments, and doubts, remains under your carefully constructed exterior, it is up to you to keep it under wraps. Internal "affirmations"—"i am confident, I am lovable, and I will be successful"—are thought to do the trick.
What could go wrong? Of course, with the introduction of "self-knowledge" and "self-love," one enters an endless hail of mirrors: How can the self be known to the self, and who is doing the knowing? If we love ourselves, who is doing the loving? This is the inescapable paradox of self-reflection: How can the self be both the knower and the content of what is known, both the subject and the object, the lover and that which is loved? Other people can be annoying, as Sartre famously suggested, but true hell is perpetual imprisonment in the self. Many historians have argued that the rise of self-awareness starting in roughly the seventeenth century was associated with the outbreak of an epidemic of
"melancholy" in Europe at about the same time, and subjective accounts of that disorder correspond very closely with
what we now call "depression." ° Chronic anxiety, taking the form of "neurasthenia" in the nineteenth century, seems to be another disease of modernism. The self that we love and nurture turns out to be a fragile, untrustworthy thing.
Unlike the "soul" that preceded it, the self is mortal. When we are advised to "come to terms with" our mortal‑
ity, we are not only meant to ponder our decaying corpses, but the almost unthinkable prospect of a world without us
in it, or more precisely, a world without me in it, since I can, unfortunately, imagine a world without other people, even those I love most. A world without me, without a conscious "subject" to behold it, seems inherently paradoxical. As philosopher Herbert Fingarette writes:
Could I imagine this familiar world continuing in existence even though I no longer exist? If I tried, it would be a world imagined by me.... Yes, I can imagine a world without me in it as an inhabitant. But I can't imagine a world as unimagined by me. My consciousness of that world is in-eliminable, and so, too, therefore, is my reaction to it. But this falsifies the meaning of my death, since its distinctive feature is that there won't be consciousness of, or reaction to, anything whatsoever. 11
We are, most of the time, so deeply invested in the idea of an individual conscious self that it becomes both logically and emotionally impossible to think of a world without it. A physician who had narrowly escaped death more than once writes:
Whenever I've tried wrapping my mind around the concept of my own demise—truly envisioned the world continuing on without me, the essence of what I am utterly gone forever—I've unearthed a fear so overwhelming my mind has been turned aside as if my imagination and the idea of my own end were two magnets of identical polarity, unwilling to meet no matter how hard I tried to make
i 12
tnem.
190 NATURAL CAUSES THE INVENTION OF THE SELF 191
We may all imagine that some trace of ourselves will persist in the form of children and others whom we have influenced, or through the artifacts and intellectual products we leave behind. At the same time I know, though, that the particular constellation of memories, fantasies, and ambitions that is, for example, me will be gone. The unique—or so I like to imagine—thrum of my consciousness will be silenced, never to sound again. "All too often," wrote philosopher Robert C. Solomon, "we approach death with the self-indulgent thought that my death is a bad thing because it deprives the universe ofme" (italics in the original).13 Yet if we think about it, the universe survives the deaths of about fifty-five million unique individuals a year quite nicely.
In the face of death, secular people often scramble to expand their experiences or memorialize themselves in some lasting form. They may work their way through a "bucket list" of adventures and destinations or struggle to complete a cherished project. Or if they are at all rich or famous, they may dedicate their final years and months to the creation of
a legacy, such as a charitable foundation, in the same spirit as an emperor might plan his mausoleum. One well-known
public figure of my acquaintance devoted some of his last months to planning a celebration of his life featuring adulatory speeches by numerous dignitaries including himself. Sadly, a couple of decades later, his name requires some explanation.
So the self becomes an obstacle to what we might call, in the fullest sense, "successful aging." I have seen accomplished people consumed in their final years with jockeying for one last promotion or other mark of recognition, or crankily defending their reputation against critics and potential critics. This is all that we in the modern world have learned how to do. And when we acquire painful neuroses from our efforts to promote and protect ourselves, we often turn to forms of therapy that require us to burrow even more deeply into ourselves. As Amundson writes, "the psychotherapy patient looks within for the truth, and comes away, not with anything that is considered universally valid or absolute in a metaphysical sense, but with a heightened and intensified devotion to such individualistic creeds as 'being true to oneself,' 'loving oneself,' and 'practicing self-care."' 14
There is one time-honored salve for the anxiety of approaching self-dissolution, and that is to submerge oneself into something "larger than oneself," some imagined super-being that will live on without us. The religious martyr dies for God, the soldier for the nation or, if his mind cannot encompass something as large as the nation, at least for the regiment or platoon. War is one of the oldest and most widespread human activities, and warriors are expected to face death willingly in battle, hoping to be memorialized in epics like the Iliad or the Mahabharata or in one of the war monuments that have sprung up since the nineteenth century. For frightened soldiers or, later, their grieving survivors, dying is reconfigured as a "sacrifice"—the "ultimate
sacrifice"—with all the ancient religious connotations of an offering to the gods. And in case thoughts of eventual glory
are not enough to banish fear, the US military is increasingly adopting the tools of alternative medicine, including
192 NATURAL CAUSES THE INVENTION OF THE SELF 193
meditation, dietary supplements, and reiki.'5 The expecta From San Diego up to Maine
tion, though, is that true soldiers die calmly and without In every mine and mill
regret. As Winston Churchill said of poet and World War I Where workers strike and organize
recruit Rupert Brooke: Says he, You'llfindJoe Hill 17
He expected to die: he was willing to die for the dear England whose beauty and majesty he knew: and he advanced towards the brink in perfect serenity, with absolute conviction of the rightness of his country's cause and a heart devoid of hate for fellow-men. 16
But you don't have to be a warrior to face death with equanimity. Anyone who lives for a cause like "the revolution" is entitled to imagine that cause being carried on by fresh generations, so that one's own death becomes a temporary interruption in a great chain of endeavor. Some stumble and fall or simply age out, but others will come along to carry on the work. As an old labor song about Joe Hill, a labor activist who was framed for murder and executed in 1915, tells us, it's as if death never happened at all:
I dreamed lsaw Joe Hill last night Alive as you or me
Says I, But Joe, you're ten years dead I never died, says he
In ever died, says he...
Where working men are out on strike .Joe Hill is at their side
Joe Hill is at their side
The revolutionary lives and dies for her people, secure in her belief that someone else will pick up the banner when she falls. To the true believer, individual death is incidental. A luta continua.
The idea of a super-being that will outlive us as individuals is not entirely delusional. Human beings are among the most sociable of living creatures. Studies of orphaned infants in World War II showed that even if kept warm and adequately fed, infants who were not held and touched "failed to thrive" and eventually died.18 Socially isolated adults are less likely to survive trauma and disease than those embedded in family and community. We delight in occasions for unified, collective expression, whether in the form of dancing, singing, or chanting for a demagogue. Even our most private thoughts are shaped by the structure of language, which is of course also our usual medium of interaction with others. And as many have argued, we are ever more tightly entangled by the Internet into a single global mind—although in a culture as self-centric as ours, the Internet can also be used as a mirror, or a way to rate ourselves by the amount of attention we are getting from others, the number of likes.
It is the idea of a continuous chain of human experience and endeavor that has kept me going through an unexpectedly long life. I will stumble and fall; in fact, I already stum‑
194 NATURAL CAUSES THE INVENTION OF THE SELF 195
ble a lot, but others will pick up the torch and continue the race. It's not only "my work"—forgive the pompous phrase—that I bequeath to my survivors but all the mental and sensual pleasures that come with being a living human: sitting in the spring sunshine, feeling the warmth of friends, solving a difficult equation. All that will go on without me. I am content, in the time that remains, to be a transient cell in the larger human super-being.
But there are flaws in this philosophic perspective. For one thing, it is entirely anthropocentric. Why shouldn't our "great chain of being" include the other creatures with which we have shared the planet, the creatures we have martyred in service to us or driven out of their homes to make way for our expansion? Surely we have some emotional attachment to them, even if it is hard to imagine passing the figurative torch to dogs or, in one of the worst scenarios, insects and microbes.
Then there is a deeper, more existential problem with my effort to derive some comfort from the notion of an ongoing human super-being: Our species itself appears to be mortal and, in many accounts, imminently doomed, most likely to die by our own hand, through global warming or nuclear war. Some scientists put the chance of a "near extinction event," in which up to 10 percent of our species is wiped out, at a little over 9 percent within a hundred years.19 Others doubt our species will survive the current century. As environmentalist Daniel Drumright writes—and I can only hope he is an alarmist—with the growing awareness of extinction, "We're dealing with a discovery of such epic proportion that it simply reduces everything in existence to nothing." He goes on to say that our emerging circumstances require "a diabolic consciousness to which no living human being has ever had to bear witness. It is an awareness which requires a degree of emotional maturity that's almost indistinguishable from insanity within western culture."20
If your imagination is vigorous enough, you may take comfort from the likely existence of other forms of life throughout the universe. Earth-sized planets abound, potentially offering other habitats similar to our own, with reasonable temperatures and abundant water. In addition, sci-fi fans know that our vision of life based on carbon and water is likely to be far too provincial. There may be life forms based on other chemicals, or self-reproducing entities that do not even consist of conventional matter—patterns of energy bursts, oscillating currents, gluttonous black holes; already we have artificial life in the form of computer programs that can reproduce and evolve to meet changing circumstances. And—who knows?—some of these "life" forms may be suitable heirs for our species, capable of questing and loving.
But even here our yearning for immortality runs into a wall, because the universe itself will come to an end if current predictions are borne out, whether in 2.8 or 22 billion years from now, which of course still gives us plenty of time to get our things in order. In one scenario there will be a "big crunch" in which expansionist forces will rip even atoms apart. In another, the night sky will empty out, the huge void spaces now separating galaxies will grow until they swallow everything. Vacuum and perfect darkness will prevail. Both scenarios lead to the ultimate nightmare of a world "without us in it," and it is infinitely bleaker than a
196 NATURAL CAUSES
world without our individual selves—a world, if you can call it that, without anything in it, not the tiniest spark of consciousness or wisp of energy or matter. To cruelly paraphrase Martin Luther King, the arc of history is long, but it bends toward catastrophic annihilation.
214 ENDNOTES ENDNOTES 215
CHAPTER TEN: "SUCCESSFUL AGING"
1. Chris Crowley and Henry S. Lodge, Younger Next Year: Live Strong, Fit, and Sexy—Until You're 80 and Beyond (New York: Workman, 2004), 49.
2. Ibid., 111.
3. "Jeanne Calment," Wikipedia, https://en.wikipedia.org/wiki/ Jeanne_Calment.
4. Sarah Lamb et aL,SuccessfulAgingasa Contemporary Obsession: Global Perspectives. (New Brunswick, NJ: Rutgers University Press, 2017).
2. The Gerontologist published its February 2015 edition as a "Special Issue on Successful Aging," reflecting on the concept's past and future. Beyond gerontology proper, see also the Spring 2015 issue of Daedalus: Journal ofthe American Academy ofthe Arts and Sciences, dedicated to the "Successful Aging of Societies." See also John W. Rowe and Robert L. Kahn, "Successful Aging 2.0: Conceptual Expansions for the 21st Century,"Journals of Gerontology, Series B: Psychological Sciences and Social Sciences 70, no.4 (2015): 593-96.
1. The full name of this conference was "European Year for Active Aging and Solidarity Between Generations." See http://ec.europa.eu/archives/ey2012/.
4. Sarah Lamb, "Permanent Personhood or Meaningful Decline? Toward a Critical Anthropology of Successful Aging"JournalofAging Studies 29(2014): 41-52, https://medschool.vanderbilt.edu/ psychiatry-geriatric-fellowship/ftles/psychiatry-geriatric-fellowshjp/ public_files/Aging%20-%20meaningfui%20decline.pdf.
5. Crowley and Lodge, Younger Next Year, 29.
6. Richard Conniff, "The Hunger Gains: Extreme Calorie-Restriction Diet Shows Anti-Aging Results," ScientficAmerican, February 16, 2016, wwwscientificamerican.com/article/the-hunger-gains-extreme-calorie-restriction-diet-shows-anti-aging-results!.
7. Roger Landry, "The Person Who Will Live to Be 150 Is Alive Today—Could He Be You?," US. News & World Report, August 19,2015, via Yahoo News, www.yahoo.com/news/person-live-i 50-alive-today-could-i 1000011 5.html?ref=gs.
ii. Quoted in Lynne Segal, Out of Time: The Pleasures and the Perils of
Ageing (New York: Verso, 2014), 178.
12. Deirdre Carmody, "At Lunch With: Betty Friedan; Trying to Dispel 'The Mystique ofAge' at 72," New York Times, September 15, 1993, wwwnytimes.com!books!99!05!09!specials!friedan-lunch.html.
13. U.S. Census Bureau, "Mobility Is Most Common Disability Among Older Americans, Census Bureau Reports," press release, December 2, 2014, www.census.gov!newsroom!press-releases! 2014,/cbl4-218.html.
14. Stewart Green, "Death on Mount Everest," ThoughtCo., March 2, 2017, www.thoughtco.com/death-on-mount-everest-755907.
15. See, for example, International Mountain Guides, www.mountainguides.com!everest-south.shtml.
16. Paula Span, "High Disability Rates Persist in Old Age," New York Times, July 8, 2013, http:!!newoldage.blogs.nytimes.com!2013! 07!08!high-disability-rates-persist-in-old-age!?_r=0.
17. Cavan Sieczkowski, "Blake Lively Announces Lifestyle Company Similar to Gwyneth Paltrow's GOOP," Huffing-ton Post, September 26,2013, www.huffingtonpost.com!2013!09!26!blake-lively-lifestyle-company_n_3997565.html.
18. Molly Young, "How Amanda Chantal Bacon Perfected the Celebrity Wellness Business," New York Times Magazine, May 25, 2017, www.nytimes.com!2017!05!25!magazine!how-amanda-chantal-bacon-perfected-the-celebrity-wellness-business.html.
19. "The Importance of Touch for Seniors," TheArborsBlog, March 23, 2017, http:!!blog.arborsassistedliving.com!importance-of-touch-for-seniors.
232 ENDNOTES
20. Siyi Chen, "Intimacy for Rent: Inside the Business of Paid Cuddling," Quartz, October 6, 2016, https://qz.com/779547/ intimacy-for-rent-inside-the-business-of-paid-cuddling!.
21. Martha Savaria Morris, "The Role of B Vitamins in Preventing and Treating Cognitive Impairment and Decline ," Advances in Nutrition 3 (2012): 801-12, http://advances.nutrition.org/content/3!6/801.ftill.
22. Katarzyna Szarc yel Szic, Ken Declerck, Melita Vidakovi, and Wim Vanden Berghe, "From Ilillammaging to Healthy Aging by Dietary Lifestyle Choices: Is Epigenetics the Key to Personalized Nutrition?," Clinical Epigen etics 7, no. 1 (2015): 33, www.ncbi.nlm.nih.gov/pmc!articles!PMC4389409/.
23. "Blocking Brain Inflammation 'Halts Alzheimer's Disease," BBC News, January 8, 2016, www.bbc.com!news!health-35254649.
24. Philip Roth, Everyman (Boston: Houghton Muffin Harcourt, 2006), 155.
25. Kathryn Higgins, "The Immune Cell, the Neutrophil—The Good, the Bad, or the Ugly?," Brainwaves, February 21, 2012, wwwsciencebrainwaves.com/the-immune-cell-the-neutrophiF the-good-the-bad-or-the-ugly!.
26. Alfred I. Tauber, The Immune Self, 8.
21. Quoted in Mary Roach, Stiff. The Curious Lives ofHuman Cadavers (New York: W. W. Norton, 2003), 68.
CHAPTER ELEVEN: THE INVENTION OF THE SELF
1. Henry Wadsworth Longfellow, "A Psalm of Life," Poetry Foundation, wwwpoetryfoundation.org!poems-and-poets/poems/detail/44644.
2. Gary Petty, "What Does the Bible Say About the 'Immortal Soul,'" Beyond Today, July 15, 1999, www.ucg.org!the-good-news! what-does-the-bible-say-about-the-immortal-soul.
3. Lionel Trilling, Sincerity andAuthenticity (Cambridge, MA: Harvard University Press, 1973), 19.
4. Jean-Jacques Rousseau, The Confessions and Correspondence, Including the Letters toMalesherbes, trans. Christopher Kelly (Hanover, NH: University Press of New England, 1995), ebook, location 693.
2. John 0. Lyons, The Invention of the Se'f: The Hinge of Consciousness in the Eighteenth Century (Carbondale: Southern Illinois University Press, 1978).
3. "Martin Guerre," Wikipedia, https:!/en.wikIpediaorj/ Martin-Guerre.
4. Garth Amundson, "Psychotherapy, Religion, and the Invention of the Self," Therapy View: Musings on the Work and Play ofPsy-chotherapy, November 1, 2015, https://'therapyviews.com,/2015/ 1 1/01!do-psychiatric-drugs-offer-a-meaningful-resolutionof. human-suffering!.
5. Marino Perez-Alvarez, "Hyperreflexivity as a Condition of Mental Disorder: A Clinical and Historical Perspective," Psi cothema 20, no.2 (2008):181-87.
6. "Worshiping Yourself," The Twisted Rope, March 6, 2014, https:/!thetwistedrope.wordpress.com/2014/03/06,'worshiping yourself!.
4. Barbara Ehrenreich, Dancing in the Streets:A History of Collective Joy (New York: Metropolitan Books, 2006).
5. Herbert Fingarette, Death: Philosophical Soundings (Chicago: Open Court, 1999),34-35.
6. Alex Lickerman, "Overcoming the Fear of Death," Psychology Today, October 8, 2009, ww'psychologytoday.com!blog!happiness-in-world!200910!overcoming-the-fear-death.
6. Robert C. Solomon, Spiritualityfor the Skeptic: The Thoughtful Love ofLfi' (Oxford: Oxford University Press, 2006), 120.
7. Amundson, "Psychotherapy, Religion, and the Invention of the Self."
8. Noah Shachtman, "Troops Use 'Samurai' Meditation to Soothe PTSD," Wired, October 8, 2008, www.wired.com/2008/10/ samurai-soldier!.
9. "Rupert Brooke's Obituary in The Times,"
http:!!exhibits.lib.byu.edu/wwi!poets/rbobituary.html.
8. "Joe Hill," Union Songs, http:!!unionsong.com/u017.html.
9. Daniel Goleman, "The Experience of Touch: Research Points of a Critical Role," New York Times, February 2, 1988, www.nytimes.com/l 988!02!02!science!the-experience-of-touch-research-points-to-a-critical-role.html ?pagewanted=all.
10. Robinson Meyer, "Human Extinction Isn't That Unlikely," Atlantic, April 29, 2016, www.theatlantic.com!technology!archive! 2016!04!a-human-extinction-isnt-that-unlikely!480444!.
11. "The Irreconcilable Acceptance of Near-Term Extinction," Nature Bats Last, April 28, 2013, https:!!guymcpherson.com,'2013/04! the-irreconcilable-acceptance-of-near-term-extinction!.
234 ENDNOTES
CHAPTER TWELVE: KILLING THE SELF, REJOICING IN A
LIVING WORLD
1. "Jacques Monod," Today in Science History,
https : //todayinsci.com/M/Monodjacques/MonodJacques-Quotations.htm.
1. "The Triumph of Abrahamic Monotheism?," Religion Today, November 2, 2011, http://religion-today.blogspot.com/201 1/11/ triumph-of-abrahamic-monotheism.html.
3. Jessica Riskin, The Restless Clock: A History ofthe Centuries-Long Argument over What Makes Things Tick (Chicago: University of Chicago Press, 2016), 3.
1. Jackson Lears, "Material Issue," The Baffler, no. 32 (September 2016), https://thebaffler.com/salvos/material-issue-lears.
George Dvorsky; "Prominent Scientists Sign Declaration That Animals Have Conscious Awareness, Just Like Us," Gizmodo, August 23, 2012, http://io9.gizmodo.com/5937356/prominent-scientists-sign-declaration-that-animals-have-conscious-awareness-just-like-us.
Stephen Hawking, "The Origin of the Universe," Hawking.org.uk, wwhawking.org.uk/the-origin-of-the-universe.html.
Rolf Ent, Thomas Ullrich, and Raju Venugopalan, "The Glue That Binds Us," ScientficAmeri can, May 2015, www.bnLgov/physics/ NTG/linkablejiles/pdf/SciAm-Glue-Final.pdf.
5. David Rieff, Swimming in a Sea ofDeath: A Son's Memoir (New York, Simon & Schuster, 2008), 167.
6. Ibid.
1. Michael Pollan, "The Trip Treatment," New Yorker, February 9, 2015, www.newyorker.com/magazine/2015/02/09/trip-treatment.
Ibid.
8. Ibid.
1. Simon G. Powell, Magic Mushroom Explorer: Psilocybin and the AwakeningEarth (South Paris, ME: Park Street Press, 2015), 30.
Pollan, "The Trip Treatment."
"Bertolt Brecht: When in My White Room at the Charité," reproduced at Tom Clark Beyond the Pale, January 12, 2012, http://tomclarkblog.blogspot.com/2012/01/bertolt-brecht-when-in-my-white-room-at.html.
ABOUT THE AUTHOR
Barbara Ehrenreich is the author of more than a dozen books, including the New York Times bestseller Nickel and Dimed. She has a PhD in cellular immunology from Rockefeller University and writes frequently about health care and medical science, among many other subjects. She lives in Virginia.
Natural
Causes
Life, Death
and the Illusion
of Control
Barbara Ehrenreich
GRANTA
