B Ehrenreich NATURAL CAUSES CH 6 Death in Social Context
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 SIX Death in Social Context
any of the people who got caught up in the health "craze" of the late twentieth century—people who exercised, watched what they ate, abstained from smoking and heavy drinking—have nevertheless died. Lucille Roberts, owner of the chain of women's gyms that introduced me to the fitness culture, died incongruously from lung cancer at the age of fifty-nine, even though she was a "self-described exercise nut" who, the New York Times reported, "wouldn't touch a French fry, much less smoke a cigarette." Jerry Rubin, who devoted his later years to trying every supposedly health-promoting diet fad, therapy, and meditation system he could find, jaywalked into Wilshire Boulevard at the age of fifty-six and died of his injuries two weeks later. If this trend were to continue, everyone who participated in the fitness culture—as well as everyone who sat it out—will at some point be dead.
Some of these deaths were genuinely shocking. Jerome Rodale, the founder ofPrevention magazine and an early promoter of organic food, died of a heart attack at age seventy‑
Image
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two, while taping The Dick Cavett Show—a death made particularly memorable by Rodale's off-camera statement that he had "decided to live to be a hundred?'2 Jim Fixx, author of the bestselling The Complete Book ofRunning, believed he could outwit the cardiac problems that had carried his father off to an early death by running at least ten miles a day and restricting himself to a diet consisting mostly of pasta, salads, and fruit. But he was found dead on the side of a Vermont road in 1984, at the age of only fifty-two. In 2017, Henry S. Lodge, coauthor of the bestselling Younger Next Year: Live Strong, Fit, and Sexy— Until You're 80 and Beyond, died of pancreatic cancer at the still-youthful age of fifty-eight. In an obituary, his coauthor Chris Crowley wrote:
I suppose the question may arise: doesn't his premature death undercut the premise of the book? No, not for one minute. We always said that the life-style we were promoting—and which Harry followed carefully—would reduce the risk of death from cancers and heart disease, among other things, by half, but not entirely. You could catch a lousy break, "ski into a tree" or "grow a tangerine in your brain pan," as [our] book puts it.3
Even more disturbing, to those who knew about it, was the untimely demise of John H. Knowles, director of the Rockefeller Foundation and promulgator of what became known as the "doctrine of personal responsibility" for one's health. Most illnesses are self-inflicted, he argued—the result of "gluttony, alcoholic intemperance, reckless driving, sexual frenzy, and smoking,"4 as well as other bad choices. The "idea of a 'right' to health," he wrote, "should be replaced by the idea of an individual moral obligation to preserve one's own health?' But he died of pancreatic cancer at the age of fifty-two, prompting one physician commentator to observe that "clearly we can't always be held responsible for our health."'
Still, we persist in subjecting anyone who dies at a seemingly untimely age to a kind of bio-moral autopsy: Did she smoke? Drink excessively? Eat too much fat and not enough fiber? Can she, in other words, be blamed for her own death? When two British entertainers, David Bowie and Alan Rickman, both died in early 2016 of what major US newspapers described only as "cancer," some readers complained that it is the responsibility of obituaries to reveal what kind of cancer.6 Ostensibly this information would help promote "awareness" of the particular cancers involved, as Betty Ford's openness about her breast cancer diagnosis helped to destigmatize that disease. It would also, of course, prompt judgments about the victim's "lifestyle?' Would David Bowie have died—at, we should note, the quite respectable age of sixty-nine—if he hadn't been a smoker?
Apple cofounder Steve Jobs's 2011 death from pancreatic cancer continues to spark debate. He was a food faddist, specifically a consumer only of raw vegan foods, especially fruit, refusing to deviate from that plan even when doctors recommended a diet high in protein and fat to help compensate for his failing pancreas. His office refrigerator was filled with Odwalla juices; he antagonized nonvegan associates by attempting to proselytize among them, as biographer Walter Isaacson has reported:
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At a meal with Mitch Kapor, the chairman of Lotus software, Jobs was horrified to see Kapor slathering butter on his bread, and asked, "Have you ever heard of serum cholesterol?" Kapor responded, "I'll make you a deal. You stay away from commenting on my dietary habits and I will stay away from the subject of your personality. "7
Defenders of veganism argue that his cancer could be attributed to his occasional forays into protein-eating (a meal of eel sushi has been reported), or perhaps to exposures to toxic metals as a young man tinkering with computers. A case could be made, however, that it was the fruitar-ian diet that killed him: Metabolically speaking, a diet of fruit is equivalent to a diet of candy, only with fructose instead of glucose, with the effect that the pancreas is strained to constantly produce more insulin. As for the personality issues—the almost manic-depressive mood swings—they could not unreasonably be traced to frequent bouts of hypoglycemia. Incidentally, the sixty-seven-year-old Mitch Kapor is alive and well at the time of this writing.
Similarly, with sufficient ingenuity—or malicious intent—almost any death can be blamed on some failure or mistake of the deceased. Surely Jim Fixx had failed to "listen to his body" when he first felt chest pains and tightness while running, and maybe if Jerry Rubin had been less self-absorbed, he would have looked both ways before crossing the street. Maybe it's just the way the human mind works, but when bad things happen or someone dies, we seek an explanation, and preferably one that features a conscious agency—a deity or spirit, an evildoer or envious acquaintance, even the victim him- or herself We don't read detective novels to find out that the universe is meaningless, but that, with sufficient information, it all makes sense.
Mass disasters afflicting hundreds or thousands of people of varying degrees of virtue or sinfulness have often required massive supernatural explanations. One of the most confounding disasters in European history was the great earthquake that leveled Lisbon in 1755. The first tremors struck on the morning of All Saints' Day, demolishing many of the city's buildings. After the tremors, a thirty-nine-foot-high tsunami swept up streets full of frantic quake survivors, and this in turn was followed by a huge fire originating in household hearths, which had been left unattended during church services. Altogether, somewhere between thirty thousand and sixty thousand lives were lost, this vast range reflecting the fact that there were no serious efforts to count the dead.
An earlier city-destroying disaster, the 79 CE eruption of Mount Vesuvius, which left the Roman city of Pompeii buried in lava, had occasioned no moralizing, if only because the prevailing deities were not known to be moral exemplars. Jupiter, Juno, and the rest of the pantheon were vain, capricious, and generally indifferent to human suffering. But by the eighteenth century, the pagan gods had all been replaced by a single monotheistic deity who had the double responsibility of being both all-powerful and all-good. This was a tricky combination at best, and the root of the theological puzzle of "theodicy": If God is perfectly good, how can he let bad things happen? True believers rushed in to assert that if he flattened Lisbon, that must be because Lisbon was wicked, which may have been a fair
96 NATURAL CAUSES DEATH IN SOCIAL CONTEXT 97
assessment. AS one historian observes, in pre-quake Lisbon, the convents usually doubled as brothels'— althoughthe moral reckoning is a little complicated by the fact that cathedrals and the local headquarters of the Inquisition toppled or burned along with the dens of iniquity.
Historians can discern a bright side to the Lisbon earthquake: It helped instigate the new intellectual era known as the Enlightenment. While the faithful debated whether it was even worthwhile to try to rebuild the city God had so clearly marked for destruction, when it might be better to devote oneself to prayer and acts of penitence, the French philosopher Voltaire published a lengthy poem refuting the entire idea of a good God:
And can you then impute a sinful deed To babes who on their mothers' bosoms bleed? Was then more vice in fallen Lisbon found, Than Paris, where voluptuousfoys abound? Was less debauchery to London known, Where opulence luxurious holds the throne?9
Voltaire, who dabbled in chemistry and physics in his own home laboratory, proposed that the earthquake was the result of "natural causes," which would eventually be understandable through patient observation. It would not be until the twentieth century that the theory of plate tectonics arose, and with it the notion of an unstable planetary surface composed of shifting puzzle pieces. But Voltaire helped establish that there were no moral lessons to be derived from the carnage of 1755. It was an accident.
But nearly three hundred years after the Lisbon earthquake and the philosophical debates that followed it, we have returned to the habit of dissecting the dead for the moral failings that undid them. Had they neglected important religious rituals and prohibitions, or, in the contemporary version, had they smoked cigarettes and ingested fatty meats? Can we learn anything from their lives and deaths that will help us avoid the same fate?
There is of course a major difference between the intellectual groundwork of the eighteenth century and that of the twenty-first: Our predecessors proceeded from an assumption of human helplessness in the face of a judgmental and all-powerful God who could swoop down and kill tens of thousands at will, while today's assumption is one of almost unlimited human power. We can, or think we can, understand the causes of disease in cellular and chemical terms, so we should be able to avoid it by following the rules laid down by medical science: avoiding tobacco, exercising, undergoing routine medical screening, and eating only foods currently considered healthy. Anyone who fails to do so is inviting an early death. Or to put it another way, every death can now be understood as suicide.
Liberal commentators countered that this view represented a kind of "victim-blaming:' In her books Illness as Metaphor and AIDS and Its Metaphors, Susan Sontag argued against the oppressive moralizing of disease, which was increasingly portrayed as an individual problem. The lesson, she said, was "Watch your appetites. Take care of yourself. Don't let yourself go710 Even breast cancer, she noted, which has no clear lifestyle correlates, could be blamed on a "cancer
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personality," sometimes defined in terms of repressed anger, which presumably one could have sought therapy to cure. Little or nothing was said, even by the major breast, cancer advocacy groups, about possible environmental carcinogens or carcinogenic medical regimes like hormone replacement therapy. A 1998 official UK "Green Paper" on health summarized that "it is finally up to the individual to choose whether to change their behaviour to a healthier one:"
While the affluent struggled dutifully to conform to the latest prescriptions for healthy living—adding whole grains and gym time to their daily plans—the less affluent remained for the most part mired in the old comfortable, unhealthy ways of the past, smoking cigarettes and eating foods they found tasty and affordable. There are some obvious reasons why the poor and the working class resisted the health craze: Gym memberships can be expensive; "health foods" usually cost more than "junk food." But as the classes diverged, the new stereotype of the lower classes as willfully unhealthy quickly fused with their old stereotype as semiliterate louts. I confront this directly in my work as an advocate for a higher minimum wage. Affluent audiences may cluck sympathetically over the miserably low wages offered to blue-collar workers, but they often want to know "why these people don't take better care of themselves," why, for example, do they smoke or eat fast food? Concern for the poor usually comes tinged with criticism.
And contempt. In the 2000s, British celebrity chef Jamie Oliver took it on himself to reform the eating habits of the masses, starting with school lunches. Pizza and burgers were replaced with menu items one might expect to find in a moderately upscale restaurant—fresh greens, for example, and roast chicken. But the experiment was a mortifying failure. Both in the United States and the UK, schoolchildren dumped out their healthy new lunches or stamped them underfoot. Mothers passed burgers to their children through school fences. Administrators complained that the new meals were vastly over budget; nutritionists noted that they were cruelly deficient in calories. In Oliver's defense, it should be observed that ordinary "junk food" is chemically engineered to provide an addictive combination of salt, sugar, and fat. But it probably matters too that he didn't bother to study local eating habits before challenging them, nor did he seem to have given much thought to creatively modifying them. In West Virginia, he alienated parents by bringing a local mother to tears when he publicly announced that the food she normally gave her four children was "killing" them. 12
There can of course be unfortunate consequences from eating the wrong foods. But what are the "wrong" foods? In the 1980s and '90s, the educated classes turned against fat in all forms, advocating the low-fat diet that, journalist Gary Taubes argues, paved the way for an "epidemic of obesity" as health-seekers switched from cheese cubes to low-fat desserts.'3 The evidence linking dietary fat to poor health had always been shaky, but class prejudice prevailed: Fatty and greasy foods were for the poor and unenlightened; their betters stuck to bone-dry biscotti and fat-free milk. Other nutrients went in and out of style as medical opinion shifted: It turns out that high dietary cholesterol, as in oysters, is not a problem after all, and the doctors
have stopped pushing calcium on women over forty. Increasingly, the main villains appear to be sugar and refined carbohydrates, as in hamburger buns. Eat a burger and fries washed down with a large sugary drink, and you will probably be hungry again in a couple of hours, when the sugar rush subsides. If the only cure for that is more of the same, your blood sugar levels may permanently rise, causing the condition we call diabetes.100 101
Special opprobrium is attached to fast food, thought to be the food of the ignorant. Filmmaker Morgan Spurlock spent a month eating nothing but McDonald's offerings to create his famous Super Size Me, documenting his twenty-four-pound weight gain and soaring blood cholesterol. I have also spent many weeks eating fast food because it's cheap and filling, but in my case, to no perceptible ill effects. It should be pointed out, though, that I ate selectively, skipping the fries and sugary drinks to double down on the protein. When at a later point a notable food writer called to interview me on the subject of fast food, I started by mentioning my favorites (Wendy's and Popeyes), but it turned out that they were all indistinguishable to him. He wanted a comment on the general category, which was to me like asking what I thought about restaurants.
The Great White Die-Off
If food choices defined the class gap, smoking provided afire-wall between the classes. To be a smoker in almost any industrial country is to be a pariah, and most likely a sneak. I grew up in another world, the 1940s and '50s, when cigarettes served not only as a comfort for the lonely but a powerful social glue. People offered each other cigarettes, and lights, indoors as well as outdoors, in bars, restaurants, workplaces, and living rooms, to the point where tobacco smoke became synonymous with human habitation, and, for better or worse, the scent of home. In John Steinbeck's 1936 novel In Dubious Battle, a cynical older labor organizer offers a young migrant worker a fresh-rolled cigarette, along with some advice:
You ought to take up smoking. It's a nice social habit. You'll have to talk to a lot of strangers in your time. I don't know any quicker way to soften a stranger down than to offer him a smoke, or even to ask him for one. And lots of guys feel insulted if they offer you a cigarette and you don't take it. You better start. 14
My parents smoked; one of my grandfathers could roll a cigarette with one hand; my aunt, who was eventually to die of lung cancer, taught me how to smoke when I was a teenager. And the government seemed to approve. It wasn't till 1975 that the armed forces stopped including cigarettes along with food rations.
As more affluent people gave up the habit, the war on smoking—which was always presented as an entirely benevolent effort—began to look like a war against the working class. When the break rooms offered by employers banned smoking, workers were left to brave the elements outdoors, where you can see them leaning against walls to shelter their cigarettes from the wind. When working-class bars went
nonsmoking, their clienteles dispersed to drink and smoke in private, leaving few indoor sites for gatherings and conversations. Escalating cigarette taxes hurt the poor and the working class hardest.
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The way out is to buy single cigarettes on the streets, but strangely enough the sale of these "loosies" is largely illegal. In 2014 a Staten Island man, Eric Garner, was killed in a chokehold by city police for precisely this crime. 15
Why do people smoke? The most common explanation, reinforced by Steinbeck, is that peer pressure leads people to start smoking, after which the addictive power of nicotine leaves them without much choice. There has been little exploration of the inherent pleasures of smoking, as if the very mention of them would undercut the antismoking cause. An exception was a 2011 column in which a journalist boldly asserted:
I love smoking, I like the way it tastes after a meal or with a cocktail, I like the way it fends off boredom, I like it on a hot, sweaty summer day and I like it on a cold, crisp winter night.... In the end, the ritual and routine of smoking, not to mention the nicotine, puts me at ease and relaxes me. 16
Nicotine activates the brain's "reward pathways," so that reactivating them becomes a form of self-nurturance and a way of countering pressure and overwork as well as, sometimes, boredom. I once worked in a restaurant in the era when smoking was still permitted in break rooms, and many workers left their cigarettes burning in the common ashtray so that they could catch a puff whenever they had a chance to, without bothering to relight. Everything else they did was for the boss or the customers; smoking was the one thing they did for themselves. In one of the few studies of why people smoke, a British sociologist found that smoking among working-class women was associated with greater responsibilities for the care of family members—again suggesting a kind of defiant self-nurturance.'7
When the notion of "stress" was crafted in the mid twentieth century, the emphasis was on the health of executives, whose anxieties presumably outweighed those of a manual laborer who had no major decisions to make. It turns out, however, that the amount of stress one experiences—measured by blood levels of the stress hormone cortisol—increases as you move down the socioeconomic scale, with the most stress being inflicted on those who have the least control over their work. In the restaurant industry, stress is concentrated among the people responding to the minute-by-minute demands of customers, not those who sit in corporate offices discussing future menus. Add to these workplace stresses the challenges imposed by poverty and you get a combination that is highly resistant to, for example, antismoking propaganda—as Linda Tirado reported about her life as a low-wage worker with two jobs and two children:
I smoke. It's expensive. It's also the best option. You see, I am always, always exhausted. It's a stimulant. When I am too tired to walk one more step, I can smoke and go for another hour. When I am enraged and beaten down and incapable of accomplishing one more thing, I can smoke and I feel a little better, just for a minute. It is the only relaxation I am allowed. 18
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Nothing has happened to ease the pressures on low-wage workers. On the contrary, if the old paradigm of a blue-collar job was forty hours a week, an annual two-week vacation, and benefits such as a pension and health insurance, the new expectation is that one will work on demand,. as needed, without benefits or guarantees of any kind. Some surveys now find a majority of US retail workers working without regular schedules19—on call for when the employer wants them to come and unable to predict how much they will earn from week to week or even day to day. With the rise in "just in time" scheduling, it becomes impossible to plan ahead: Will you have enough money to pay the rent? Who will take care of the children? The consequences of employee "flexibility" can be just as damaging as a program of random electric shocks applied to caged laboratory animals.
Sometime in the first decade of the twenty-first century, demographers began to notice an unexpected uptick in the death rates of poor white Americans. This was not supposed to happen. For almost a century, the comforting American narrative was that better nutrition and medical care would guarantee longer lives for all. It was especially not supposed to happen to whites who, in relation to people of color, have long had the advantage of higher earnings, better access to health care, safer neighborhoods, and of course freedom from the daily insults and harms inflicted on the darker-skinned. But the gap between the life expectancies of blacks and whites has been narrowing. At first, some researchers found the rising mortality rates of poor whites less than surprising: Didn't the poor have worse health habits than the affluent? Didn't they smoke?
According to the New York Times, economist Adriana Lleras-Muney, one of the first to note the mortality gap, offered the explanation that "as a group, less educated [and thus on the whole, poorer] people are less able to plan for the future and to delay gratification. If true, that may, for example, explain the differences in smoking rates between more educated people and less educated ones."" Another researcher, economist James Smith at the Rand Corporation, amplified on this point a few years later: Poor people don't seem to realize that "a lot of things you might do don't have an immediate negative impact—excessive drinking, smoking, and doing drugs can [feel good in the short term] —but the fact is it's going to kill you in the future'21
Poor white Americans were, in other words, killing themselves, and this was not a mere blip in the data. In late 2015, the British economist Angus Deaton won the Nobel Prize for work he had done with fellow economist Anne Case, showing that the mortality gap between wealthy white men and poor ones was widening at a rate of one year each year, and slightly less for women. A couple of months later, "economists at the Brookings Institution found that for men born in 1920, there was a six-year difference in life expectancy between the top 10 percent of earners and the bottom 10 percent. For men born in 1950, that difference more than doubled, to 14 years."22 Smoking could account for only one-fifth to one-third of the excess deaths. The rest were apparently attributable to alcoholism, opioid addiction, and actual suicide—as opposed to metaphorically killing oneself through unwise lifestyle choices.
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But why the excess mortality among poor white Americans? In the last few decades, things have not been going well for working-class people of any color. I grew up in an America where a man with a strong back—and better yet, a strong union—could reasonably expect to support a family on his own without a college degree. By 2015, those jobs were long gone, leaving only the kind of work once relegated to women and people of color, in areas like retail, landscaping, and delivery-truck driving. This means that those in the bottom 20 percent of the white income distribution face material circumstances similar to those long familiar to poor blacks, including erratic employment and crowded, hazardous living spaces. When a member of my extended family needed a loan to pay her mortgage, I was surprised to discover that her home was not a house; it was a single-wide trailer she shared with two other family members. Poor whites had always had the comfort of knowing that someone was worse off and more despised than they were; racial subjugation was the ground under their feet, the rock they stood upon, even when their own situation was deteriorating. That slender reassurance is shrinking.
There are some practical reasons too why whites are likely to be more efficient than blacks at killing themselves. For one thing, they are more likely to be gun owners, and white men favor gunshots as a means of suicide. For another, doctors, undoubtedly acting in part on stereotypes of nonwhites as drug addicts, are more likely to prescribe powerful opioid painkillers to whites than to people of color. Pain is endemic among the blue-collar working class, from waitresses to construction workers, and few people make it past fifty without palpable damage to their knees, back, or rotator cuffs. In 2011, the Centers for Disease Control and Prevention declared an "epidemic" of opioid use, in which the victims are mostly white. 2' As opioids became more expensive and closely regulated, users often make the switch. to heroin, which varies in strength and can easily lead to accidental overdoses.
It's hard to find historical analogies to the current white-collar die-off in the United States. Perhaps the closest is the sudden drop in male life expectancy associated with the fall of communism in the Soviet Union. As jobs were lost and the old infrastructure of social welfare measures—free medical care and education—came apart in the 1990s, Russian male life expectancy fell from sixty-two to fifty-eight; women's hovered around seventy-four.24 Other post-communist countries did not suffer such a startling transition, in part because they did not undergo the same "shock therapy" that international financial institutions had prescribed for the Soviet Union. As in America, "lifestyle" factors are easy to invoke: The fall of communism led to an upsurge in alcoholism and alcohol-related deaths.
Or, for a more global and somber analogy, we could reach back to the deadly consequences of European expansionism in the sixteenth through the twentieth centuries, and still ongoing. The number of indigenous people killed in this "single, multi-century, planet-wide exterminatory pulse,"25 whether by bullets, disease, or mass deportations, has been estimated at fifty million. 26 But when the shooting stopped, the survivors were often left suffering from what could be a fatal malaise, characterized by alcoholism, depression, and suicide. This was the background for anthropologist Claude Levi-Strauss's 1955 Triste Tropiques: decimated native cultures, stripped of customs, rituals, or traditional means of subsistence, left listless and dispirited by their encounter with the West.
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The advocacy group Cultural Survival reports that throughout the Western Hemisphere, indigenous peoples suffer from high rates of alcoholism and suicide. The same can be said of the peoples of Oceania and northern Russia, as well as the aboriginal groups of Taiwan. Furthermore, we can safely conjecture that dislocation, epidemics, depopulation, and subjugation have put indigenous peoples everywhere at high risk of depression and anxiety. 27
Like twentieth-century Russian workers or nineteenth-century Polynesians, the American working class—or at least the white part of it—which could once hope for steady work at decent pay, has lost much of its way of life.
In current political conversations, the anomalous mortality of poor white Americans is often elided or confused with the larger problem of economic inequality. Until very recently, any shortcomings the United States experienced in the realm of health and mortality relative to other advanced countries, such as its embarrassingly high rate of infant mortality, could be chalked up to "diversity": The American numbers were being dragged down by the presence of a historically and relentlessly disadvantaged racial minority, or so we were told. But clearly race does not explain everything—poverty itself shortens life spans. What has happened is that the gap between the rich and the poor has widened abruptly in the last forty and even the last five years, to the point where the richest 1 percent of Americans now own 35 percent of the nation's net worth.28 The trailer parks, tenements, and tent cities of the poor coexist, however uneasily, with the penthouse-topped towers of the rich.
In fact, the gap between rich and poor—not only in the United States but in other highly unequal societies, such as the UK and Israel—has widened to such an extent that a single word, "health," no longer suffices to describe what was once a universally desirable biological status. The increasingly polarized economic situation demands the more nebulous and elastic concept of "wellness." At the lower end of the wealth and income spectrum, wellness presents itself in the form of the corporate wellness programs now offered by about half of employers. These range from in-house gyms to ambitious surveillance programs that subject employees to periodic measurements of quantities like blood pressure and body mass index. Failure to participate or to comply with weight loss goals can mean being forced to pay higher premiums for health insurance or even outright fines, although there is no evidence that such programs either improve employees' health or reduce employers' ex-penses.29
But aside from punitive corporate programs aimed at retail and midlevel white-collar employees, wellness is mainly the domain of the rich, described in the fitness industry as a "luxury pursuit." Vogue magazine's online site Style.com goes further, announcing that wellness is "the new luxury status symbol," which can be displayed simply by carrying a yoga tote bag and a bottle of green vegetable-based juice.
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An advantage of wellness as a status symbol is that it is less likely to incite the envy of the lower classes than, say, furs and diamonds, plus the practice of wellness goes on largely out of sight, in hard-to-access spaces like private gyms and spas There are hundreds if not thousands of luxury wellness resorts around the world (although some of them may be traditional resorts to which the word "wellness" has been appended for marketing purposes). At their most ambitious, these resorts offer something far more comprehensive than mere "health," which still carries the taint of its old definition as the "absence of disease." Every known modality of self-improvement is on hand: yoga, Rolfing, detoxification, tai chi, and meditation, plus more esoteric practices such as hot stone massages, "sound therapy," often involving Tibetan singing drums, and "phototherapy." At a "destination" wellness resort, the scenery and even the local indigenous people may be enlisted in the healing process:
Our private, customized wellness retreats will reconnect you to your mind, body, and spirit in some of the world's most breathtaking places. We invite you to partake in sacred rituals alongside the Kalahari's Shamans, rebalance your body with private yoga classes in ancient Indian temples, refocus your mind as you chant with monks in Bhutan, and partake in healing practices such as massage, Reiki, and soaking in hot springs at luxurious onsens throughout the Japanese countryside. Whether you find yourself meditating in the foothills of the Himalayas, or engulfed in the peaceful solitude of Botswana's saltpans, our
wellness vacations will take you on an adventure of purpose, power, and personal renewal.30
No unifying theory—or, of course, cultural source—undergirds the hodgepodge of practices and interventions offered in the name of wellness. But if you read enough of the advertising literature, a common theme emerges, in which the key terms are "harmony," "wholeness," and "balance." To the extent that there is a philosophy here, it is holism, the source of the familiar adjective, "holistic." Everything—mind, body, and spirit, diet and attitude—is connected and must be brought into alignment for maximum effectiveness, whether to achieve "power" and "personal renewal" or just to lose a few pounds. Conflict may be endemic to the human world, with all its jagged inequalities, but it must be abolished within the individual. To what end? To feel good, of course, which is the same as feeling powerful. Put in more mechanical terms, wellness is the means to remake oneself into an ever more perfect self-correcting machine capable of setting goals and moving toward them with smooth determination. As Soren Kierkegaard wrote in a famous devotional text, "purity of heart is to will one thing,"3' although he did not mean that one thing was stronger quadriceps.
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CHAPTER SIX: DEATH IN SOCIAL CONTEXT
1. Susan Dominus, "The Lives They Lived; Ladies of the Gym Unite!," New York Times Magazine, December 8, 2003, www.nytimes.com/2003/12/28/magazine/the-lives-they-lived Iadies-of-the-gym-unite.html.
2. Dick Cavett, "When That Guy Died on My Show," Opinionator (blog), New York Times, May 3, 2007, http:!/opinionator.blogs .nytimes.com/2007!05/03!when-that-guy-died-on-my-show!?r0.
3. Chris Crowley, "Harry Lodge: A Personal Memoir," Younger Next Year, March 16, 2017, wwyoungernextyear.com!harry-lodge-personal-memoir!.
4. Quoted in Howard M. Leichter, "Evil Habits' and 'Personal Choices': Assigning Responsibility for Health in the 20th Century," Milbank Quarterly 81, no.4 (December 2003): 603-26, www.ncbi.nlm.nih.gov!pmc!articles!PMC2690243!.
2. Raymond Downing, Biohealth: Beyond Medicalization: Imposing Health (Eugene, OR: Wipf and Stock Publishers, 2011).
1. Ian Shapira, "What Kind of Cancer Killed Them? Obituaries for David Bowie and Others Don't Say," Washington Post,January22, 2016, wwwwashingtonpost.com/local/what-kind-of-cancer-killed-them-eobituaries-for-david-bowie-and-others-dont-say!2016!01!21! b4ac24e8-bf9a-1 1e5-83d4-42e3bceea902storhtml.
Walter Isaacson, Steve Jobs (New York: Simon and Schuster, 2011), 224.
Mark Molesky, This GulfofFire: The Destruction ofLisbon, Or Apocalypse in the Age ofScience and Reason (New York: Alfred A. Knopf, 2015), 55.
4. "Poémesur/ed&isiredeLisbonne,"Wikipedia,https:!/en.wikipedia.org! wiki/Po%C3%A8mesurled%C30/oA9sastredeLisbonne
1. Quoted in Michael Fitzpatrick, The Tyranny ofHealth: Doctors and the Regulation ofLstyle (New York: Routledge, 2002), 9.
Quoted in ibid.
Arun Gupta, "How TV SuperchefJamie Oliver's 'Food Revolution' Flunked Out," AlterNet, April 7, 2010, wwwalternet.org/ story! 146354!how_tv_superchef_jamie_oliver's_'food -revolution'-flunked-out.
Gary Taubes, "What If It's All Been a Big Fat Lie?," New York Times Magazine,July 7,2002, wwwnytimes.com!2002/07!07/ magazine!what-if-it-s-all-been-a-big-fat-lie.html.
224 ENDNOTES ENDNOTES 225
14. John Steinbeck, In Dubious Battle (1936).
15. "Death of Eric Garner," Wikipedia, https://en.wikipedia.org/ wild/Death_of_ Eric _Garner.
16. Christopher Mathias, "I Love 'Loosies': In Defense of Black Market Cigarettes," Huffington Post, April 6, 2011, wwwhufiingtonpost corn/christopher mathias/i love loosies in defense_b_845698.html.
17. Hilary Graham, "Gender and Class as Dimensions of Smoking Behaviour in Britain: Insights from a Survey of Mothers," Social Science &Medicine 38 (1994): 691-98.
18. Linda Tirado, "This Is Why Poor People's Bad Decisions Make Perfect Sense," Huffington Post, November 22, 2013, www.huffingtonpost.com/linda-tirado/why-poor-peoples-bad-decisions-make-perfect-sense_b_4326233.html.
19. Aspen Institute Economic Opportunities Program, Working in America, "Retail Workforce, Employment and Job Quality," December 2015, https://assets.aspeninstitute.org/content/uploads/ files/content/upload/Shop%20Til%2OWho%20Drops%20-%20 Backgrounder%20-%20FINAL.pdf.
20. Gina Kolata, "A Surprising Secret to a Long Life: Stay in School," New York Times, January 3, 2007, www.nytimes.com/2007/01/03/ health/03aging.html?_r=0.
21. Kimberly Palmer, "Do Rich People Live Longer?," US. News & WorldReport, February 14,2012, http://money.usnews.com/ money/personal-flnance/articles/2012/02/14/do-rich-people-live-longer.
22. Sabrina Tavernise, "Disparity in Life Spans of the Rich and the Poor Is Growing," New York Times, February 12,2016, www.nytimes.com/2016/02/13/health/disparity-in-life-spans-of-the-rich-and-the-poor-is-growing.html?
23. "Prescription Painkiller Overdoses at Epidemic Levels," CDC Newsroom, November 1, 2011, wwwcdc.gov/media/releases/ 2011/pl 101_flu_pain_killer_overdose.html.
24. Eugen Tomiuc, "Low Life Expectancy Continues to Plague Former Soviet Countries," Radio Free Europe/Radio Liberty, April 2, 2013, wwwrferLorg/content/life-expectancy-cis-report/ 24946030.html.
25. Tom Engelhardt, quoted in Barbara Ehrenreich, Dancing in the Streets:A History of Collective Joy (New York: Metropolitan Books, 2006), 161.
26. Ibid., 162.
27. Alex Cohen, "The Mental Health of Indigenous Peoples: An International Overview," Cultural Survival Quarterly Magazine, June 1999, wwwculturalsurvival.org/ourpublications/csq/article/ the-mental-health-indigenous-peoples-an-international-overview.
28. G. William Domhoff, "Wealth, Income, and Power," WhoRulesAmerica.net, September 2005, updated April 2017, www2.ucsc.edu/whorulesamerica/power/wealth.html.
29. Judy Peres, "Workplace Wellness Programs Popular, but Do They Improve Health?," Chicago Tribune, December 12,2014, www.chicagotribune.com/news/ct-workplace-wellness-met-20141212-story.html.
30. Absolute Travel, http ://absolutetravel.com/special-interest-travel-tours/wellness-retreats/.
31. "Purity of Heart Is to Will One Thing by Sören [sic] Kierkegaard," www.religion-online.org/showbook.asp?title=2523.
