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 SEVEN The War Between Conflict and Harmony
If the body—or the "mindbody" or whatever we are individually comprised of—somehow "wants" to act as a unified whole, then it should be easy enough to bring it under our conscious control. All we have to do is use the mind to encourage this natural urge toward wholeness, and inevitably, with the help of meditation, yoga poses, and a mindfully abstemious diet, wellness will follow. It was that simple.
The concepts of wellness and wholeness first wafted into American culture in the 1970s along with the scent of patchouli—hence the later derogation of some nonstandard practices as "hippie bullshit." In matters related to health, the old paradigm had been scientific reductionism: To understand something, you first have to take it apart and, using techniques like dissection, microscopy, and the fractionation of tissue into subcellular fragments, study its constituent parts. But in the new paradigm, promoted by the counterculture of the 1960s but also traceable to Emerson and any number of Eastern and European mystics, the focus was on the interconnections between the parts, and hence on the whole, which was increasingly assumed to be "more than the sum of its parts." In some versions, the entire cosmos was depicted as a single entity containing each one of us, or at least our souls or spirits—a perspective that seems more consistent with Eastern mysticism and the emerging psychedelic drug culture than dreary old math-ridden, reductionist science. According to counterculture chronicler Theodore Roszak, the hippies and flower children aimed for nothing less than "the subversion of the scientific world view itself"'
We may think of the counterculture as a laid-back philosophical stance opposed to the very concept of control, but holism opened a new avenue of control—exercised by the mind over the body. Mind and body were disconnected in the reductionist scheme of things; it was not even clear that they belonged in the same sentence. From a holistic viewpoint, though, they were continuous, forming almost a single substance, the "mindbody," which could be accessed through conscious effort. How exactly the mind-body connection works can be comically difficult to explain, as in a passage from a book called Integrative Holistic Health, Healing, and Transformation:
When the mind is filled with negative imaginings, anxiety and depression producing neuropeptides are created. Additionally, the limbic system [of the brain] gets caught in a continuous negative feedback loop resulting in the amyg-dala affecting the sympathetic response from the autonomic nervous system affecting bodily changes reminding
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the individual of past trauma thus producing more anxiety and imaginings which affect the amygdala, etc.2
If you didn't understand that, don't worry. Aside from the syntactical disarray illustrated by this quote, it should be pointed out that there is no solid evidence that, aside from the effects of extreme stress, negative thoughts affect physical health, or that optimists live longer than pessimists.* Nevertheless, the author reassures us that "participating in a holistic health program or going to a practitioner often brings back a sense of control and hope, which, in and of itself can strengthen the body's capacity to fight disease and stay healthy."' An amulet would probably work just as well.
No new discoveries or scientific insights accompanied the new holistic paradigm. It was not based on a theory but on a sensibility that, by the late twentieth century, was gaining a measure of legitimacy from something that could not have been more temperamentally different from the counterculture. This was "systems analysis," a fad that first took hold in the world of corporate management. I would never have encountered it if I hadn't spent a few months working as a "program policy analyst" at the New York City budget bureau. What that title meant exactly was never explained to me, nor was "systems analysis," which was being installed in the city government by the Rand Corporation and seemed to involve making decisions based on
* See my book Bright-Sided: How the Relentless Promotion of Positive Thinking
Has Undermined America.
quantitative data and doing it as "systematically" as possible. (Although at any moment some new political priority could arise from the mayor's office to override the planners' logical and numerically sound recommendations.) The key insight was that human organizations such as armies, governments, and corporations, are "systems" or "complex systems," like the human body itself, in which all the parts need to be considered together.
Oddly enough, given the assumed countercultural lineage of all things holistic, the chief promoter of systems analysis was a man surely innocent of psychedelic or mystical experience—Robert McNamara, the secretary of defense under Presidents Kennedy and Johnson. When he was plucked from the Ford Motor Company for the defense job, McNamara was initially shocked by the unsys-temlike nature of the Pentagon, where the different services—army, navy, and so forth—competed for resources with little or no centralized control. His solution had been to introduce a "program policy budget system," the template for the one I later encountered in the New York City Budget Bureau. In the military, as in the budget bureau, it seems to have been largely interpreted as an emphasis on quantitative goals and metrics—most famously, "body counts." So, piling one irony on top of another, the effort to rationalize military planning found itself enlisted into the service of America's fundamentally irrational war in Vietnam, and that effort was vaguely in synch with coun-tercultural yearning for wholeness.
Perhaps the most spectacular, and most spectacularly wrong, application of systems analysis was the Gaia hypoth‑
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esis, advanced by chemist and atmospheric scientist James Lovelock in 1974. Influenced by the increasingly popular science of ecology and made intuitively plausible by the first photos of our planet from space, the hypothesis proposed that Earth and all that live on it comprise a single "system," in fact, a self-regulating, living system in which the parts (humans, for example, or algae) interact to make Earth habitable for living creatures. That majestic image of a blue planet in space came to symbolize all that was good and desirable—wholeness, unity, ecology, interconnectedness, peace, harmony. It also decorated the cover of the Whole Earth Catalog, which featured subsistence farming techniques, outdoor gear, and DIY technologies for hippies and geeks seeking self-sufficiency. Humans were subunits of that greater whole represented by the planet Earth, although unfortunately the smooth-running system that was Gaia has never figured out how to correct for the profligate human consumption of fossil fuels.
If systems analysis could not provide scientific backup for the new paradigm of wholeness, it at least helped reinforce its cultural legitimacy. As Encyclopedia.com tells us, in three sentences that are notable for containing the words "system" or "systems" nine times, the idea of systems was everywhere, and seemed to embrace wholeness in any form:
During the second half of the twentieth century amalgams of the terms system and systems became ubiquitous. Computer and operating systems were joined by biological, business, and political systems. Systems science and systems engineering were complemented by systems management,
systems medicine, and the practice of looking at the earth as a system. 4
At times the notion of a "system" and a "whole" were almost indistinguishable. For example, something called the "mindful economics movement" sought "to engage a holistic and systems analysis of economic problems associated with
capitalism 75 "Holistic"was good; anything i
ess was a capitulation to the Enlightenment, science, capitalism, or whatever other evil force was believed to have smashed the human world into antagonistic fragments. To be holistic was to be kind, peaceable, and inclusive, which of course is how every vendor of services seeks to be seen. You can even find "holistic dentists," although a focus on any particular part of the body seems like a violation of holism.
It can be hard to discern any possible common ground between the two paradigms. At the extreme of scientific reductionism we have the fabled doctor who is so lost in the "parts" that he or she can no longer see the whole human, and refers to a patient as "the gall bladder in room 302." As we have seen in earlier chapters, medical education—beginning with the first corpse dissection—seems intent on removing any emotional connection between the patient and the physician. The patient is objectified, her conscious participation being required only in the form of "compliance." At the other extreme of congeniality would be the massage therapist I went to for lymphedema following surgery. She was a chatty, empathetic young woman, who in a dimly lit room gently fingered my chest and arms to the accompaniment of recorded trance music. (Not surpris‑
118 NATURAL CAUSES THE WAR BETWEEN CONFLICT AND HARMONY 119
ingly, several sessions of this did nothing for the incipient swelling, which I insisted on measuring before and after.) To its critics, the scientific approach is cold, rationalist even, in the view of feminist theorist Vandana Shiva, "imperialistic," while alternative approaches are soothing, nurturing, and somehow aligned with the cosmos. The philosophical gap here is at least as great as the one thought to exist between science and religion—and wars have been fought over less.
Spats still breakout from time to time, as in 2005 when the Society for Neuroscience provoked protests by inviting the Dalai Lama to speak on meditation and mindfulness at its annual conference. But even by the late twentieth century a fertile area of overlap had opened up between science, particularly quantum physics, and what we might loosely call the counterculture. Timothy Leary, the LSD pioneer, and Werner Erhard, the founder of EST, were both attracted to quantum physics, which a layperson could readily sample at venues such as Big Sur and the Santa Fe Institute. Meanwhile, some scientists and historians of science were beginning to mutter about the need for a more holistic approach within science itself Philosopher of science Evelyn Fox critiqued reductionist biology's emphasis on "master molecules," such as DNA, at the expense of the whole organism. At a somewhat less respectable academic level, the physicist Fritjof Capra discerned a continuity between quantum mechanics and Eastern mysticism and asserted that the natural world was not made up of discrete subunits, but of interacting vibrations. The path was clear for the explosive growth of integrative medicine in the. twenty-first century, in which the philosophical contradictions between the different treatment modalities could be dismissed with a wave of a hand and a mumbled reference to quantum physics.
Holistic Biology
By the late twentieth century, there is no question that medical science needed some sort of paradigm shift, if only to accommodate the fact that a "whole person"—body in addition to mind—is not well represented by a cadaver. Not only do we think and feel, but we react to the world in microscopic ways that are not visible to our minds and not easily accessible to our willpower or control. We bleed when cut, and if we are lucky the blood clots without our conscious intervention. The "system". that is a whole person contains many levels and parts. Some are macroscopic and some are microscopic; some are material, such as an organ, others apparently immaterial, as in the case of thoughts. How they interact to create a stable, or at least briefly stable, system has been the ongoing challenge to biological science.
The assumption, which has been around long enough to be almost unquestioned, has been that all parts and layers of the body work in concert. When we talk about human biology we are of course talking about the biology of mul-ticellular beings composed of subunits like tissues and cells. All these tissues and cells are presumed to work in harmony, each selflessly performing its assigned function, like obedient citizens of a benign dictatorship. Heart cells beat
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in unison, liver cells store glucose, red blood cells carry oxygen. Anything else would be a disaster, right? Thus the
biology of multicellular beings is biased toward a holistic outlook. We aren't content to describe, say, a kidney; we want to know what its function is—what it does in service to the whole.
The assignment of functions to different parts or subunits of the body goes back at least to the seventeenth century, when the English physician William Harvey figured out that the beating of the heart keeps the blood circulating, although why circulation was important was still not clear at the time. Prior to this discovery, anatomists had been content to describe and locate the organs, leaving it to physiologists or metaphysicians to explain what the organs actually did and how they fit into the body as a whole. According to Harvey, the heart had a "function," and, as biologists quickly inferred, so must all other subunits and parts of the body. Pick up a contemporary biology textbook and you will find it thickly populated, by the word "function," sometimes applied even to molecules. A 2014 cell biology textbook finds various ways of describing the commitment of cells and tissues to their functions: They have the "responsibility" or "task" of performing these functions, or they are said to be "specialized" to perform them,6 much like soldiers in an army or professors in a university.
Harvey's discovery revealed the body to be a kind of machine, cleverly built up out of interconnecting, smoothly cooperating parts that had no volition of their own. As a seventeenth-century Italian anatomist proclaimed, "A human body, as to its natural actions. . . is truly nothing else but a complex of chymico-mechanical motions, depending on such principles as are purely mathematical."' This mechanical view, which still dominates biology today, in no way challenged religion: After all, an extraordinarily brilliant designer must be behind the whole thing, or must at least have breathed life into some inert prior substance. And indeed the more we learn about how the body works, the more supernaturally marvelous its working seems. Consider how the body heals its wounds. First, a cascade of chemical reactions closes the lesion by making blood clot. At the same time, cells rush in from the bone marrow and other sites to chase out microbes, remove damaged tissue, and replace it with fresh, intact cells and tissues, so that we are prepared for any future wounds.
If the body is a perfect clockwork mechanism, this was, according to a cheap and dirty form of Darwinism, because perfection was inevitable. Bodily parts that didn't work, or work optimally, would be eliminated by natural selection, leaving only the "fittest" organisms to survive and breed. In the sociobiology that thrived in the 1960s, there was an evolutionary rationale for everything, and any trait or physical characteristic that did not contribute to the survival of the species would be weeded out as a waste of energy. This led to a noxious defense of the status quo, often denounced by feminists as "determinism": We are the way we are—say, warlike or male supremacist—because to be any other way would be less "fit," and the sculptor that shaped us this way is not God but natural selection.
The trouble was that many things cannot be explained in terms of "fitness," including vestigial characteristics like
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male nipples and the appendix, as well as purely structural features that just seem to be required by the available "de‑
signs" in our genomes. Biologists Stephen Jay Gould and
Richard Lewontin deemed that such structural features are the analog of "spandrels" in the design of cathedrals: They
don't "do" anything except to fill in a preexisting pattern
of arches. Natural selection, Gould and Lewontin pointed out, is not the only force governing evolution, nor had
Darwin ever suggested that it was. Changes in the environment—climate changes or the sudden arrival of an asteroid—can cause the extinction of whole species that may have been supremely well adapted the moment before disaster struck. Meanwhile, apparently useless features like male nipples may be conserved over generations simply because the plan for them remains in our genetic material.
So the unacknowledged bias in biology is optimistic, even utopian. Our bodies are perfectly adapted to the environment—or at least to the environment our distant ancestors faced—and they are that way because they could be no other way. In their critique of evolutionary biology, Gould and Lewontin invoked Voltaire's insanely optimistic Professor Pangloss, who had declared that everything was for the best in this "best of all possible worlds." The same could be said of the "functional" view of the body, which carries with it the assumption that all the parts and subunits act in harmony, ever alert to the needs of the whole. This is how we are introduced to biology as students—as the study of ideally functioning complex systems in which disease and death are disappointing aberrations.
But all is not well in this best of all possible worlds, and the aberrations are too common, not to mention too dramatic, to dismiss. Consider cancer, which is one of the leading causes of death worldwide. Many cancers can be blamed on chemical agents or radiation from outside the body, such as cigarette smoke or occupational hazards like benzene, but so far only about 60 percent of cancers can be traced to particular carcinogens.' For example, no carcinogens have been discovered to explain cancers of the breast, colon, or prostate. All we know is that individual cells within these organs sometimes break ranks and start reproducing madly, creating tumors that can destroy the entire organism. Or consider autoimmune diseases, such as rheumatoid arthritis and multiple sclerosis, which afflict 5 to 8 percent of the population and arise when the immune system abandons its designated "function," which is to protect the body, and attacks the body itself 9 The body's own immune cells have also been implicated in the development of coronary artery disease, the greatest single cause of mortality in the United-States and Europe.
The functionalist view of the body is still immensely helpful, but only if we remember that it is an approximation. Most skin cells, for example, behave as we would expect them to if their functions are to serve as a protection against the outside world, to perspire, and to provide us with tactile experience. But some will become cancerous and attempt to take over the entire body—and what is the "function" of melanoma? We need to admit that instead of acting as a harmonious whole, the body can serve as a battleground where its own cells and tissues meet in mortal combat.
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The potential theoretical basis for intrabody conflict had been laid out by Rudolf Virchow in the late nineteenth
century, when he proposed that the smallest living subunit
of the body was the cell, and that all cells arose from other cells. It was the latter proposition, expressed as Omnis eel‑
lula e cellula, that tended to attract the most attention
because it implied that even the most ferocious cancer cell was the descendant of a peaceable, law-abiding healthy cell.
But in some ways it was the first proposition—that the cell was the smallest living subunit of the body—that perhaps should have generated more excitement. At the time
of Virchow's work, other biologists were beginning to succeed in cultivating body cells outside of the body—in what
came to be called "tissue cultures," bathed in a nutrient fluid such as a serum. The stage was set, by the beginning of the twentieth century, for a thorough study of these curious microscopic entities—cells—that make up living organisms.
But this was the road not taken. The middle of the twentieth century brought the stunning discovery of the struc‑
ture of DNA and its role in heredity. Almost overnight,
biology entered its extreme reductionist phase, zipping right past cells to get to the more glamorous molecular level,
where DNA, RNA, and proteins ruled. Cancer research
came to focus on the DNA mutations that predispose cells to a career of selfish reproduction. Immunology downplayed the cellular dynamics of the immune system in favor of an obsession with antibodies—the protein molecules that can mark a "foreign" cell, like a microbe, for destruction—although it is chiefly specialized immune cells called macrophages that do the destroying. My first thesis adviser at Rockefeller University won a Nobel Prize for elucidating the structure of antibody molecules. My second thesis adviser got far less recognition, and a much smaller lab, for his work on how macrophages kill and digest their prey.
Cancer is hard enough to explain: Why would a cell undertake a campaign of conquest that can only end in that cell's own death? But cancer is commonly traced to errors in cell division, and it is easy to imagine such errors leading a healthy cell to produce two cancerous daughter cells. Autoimmune diseases, like rheumatoid arthritis and multi-pie sclerosis, in which the immune system attacks healthy tissue within the body, pose a more vexing philosophical problem for biology. It is possible to imagine a single cell producing cancerous offspring, but it is not so easy to see how the many delicate mechanisms making up the immune response—which involve interactions between multiple types of cells—could be mobilized against the body's own tissues. Posed with the possibility of such an attack, biologist Paul Ehrlich simply postulated the existence of a built-in horror autotoxicus, or "horror of self-poisoning," that would somehow prevent such hideous mistakes. How could there not be such a thing, since "life cannot harm itself," as the "dogma" of horror autotoxicus put it? For an organism to undermine itself would be, in Ehrlich's words, "dysteleological in the highest degree,"° meaning that it would serve no purpose.
Fifty years later, in the middle of the twentieth century, the Australian immunologist Frank Macfarlane Burnet took Ehrlich's dictum about the impossibility of auto‑
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immune disorders a little further when he proclaimed that the true function of the immune system was a meta‑
physical one: to distinguish "self" and "non-self"—the
latter being foreign material such as microbes and the former being one's own tissues. These are terms drawn
from psychology or philosophy; they are "nebulous," as philosopher of science Alfred I. Tauber has pointed out, adding that "the self can hardly be viewed as a scientific concept."" In fact, it was barely even a concept at all until about the seventeenth century, when languages such as English and German began to use the word "self" as something other than an intensifier (as in "I did it myself"). Then, as we shall see in a later chapter, the "self" began to replace the "soul" as a special kind of kernel within each individual, walled off in part from everyone else. Attention turned inward, as people were encouraged to know themselves through, for example, the widespread use of mirrors, the writing of journals and autobiographies, and the painting of portraits, often self-portraits. "Western individualism" was born, along, eventually, with psychoanalysis and any number of afflictions of the self.
So why did Burnet choose such a "nebulous" and patently unscientific concept to explain the work of the immune system? Some scholars have speculated that he was influenced, like so many people of his class, by Freud, and perhaps actually attracted by the aura of subjectivity that hovers around the notion of the self. He could, after all, have used some other term like "the organism" or "the individual" to describe what the immune system is trying to maintain. But if he was looking for a way to talk about the organism versus the "others," generally meaning foreign invaders like microbes, the self/non-self distinction was apt enough. At the heart of immunology is a military metaphor: Non-self is the enemy, usually represented by a bacterium or a virus, and has to be destroyed by the immune system, while "self," meaning the body's own tissues, of course has to be left alone. For example, a popular 1987 book, optimistically entitled The Body Victorious, described the immune system as
reminiscent of military defence, with regard to both weapon technology and strategy. Our internal army has at its disposal swift, highly mobile regiments, shock troops, snipers, and tanks. We have soldier cells which, on contact with the enemy, at once start producing homing missiles whose accuracy is overwhelming... [as well as] reconnaissance squads, an intelligence service and a defence staff which determines the location and strength of troops to be deployed.12
The military metaphor can even be tapped to help explain—or excuse—autoimmune diseases. Any human society within a spear's throw of potential enemies needs some kind of defensive force—minimally, an armed group who can defend against invaders. But there are risks to maintaining a garrison or, beyond that, a standing army: The warriors may get greedy and turn against their own people, demanding ever more food and other resources. Similarly, in the case of the body, without immune cells we would be helpless in
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the face of invading microbes. With them, we face the possibility of treasonous attacks on our "selves"—the autoimmune diseases that Burnet at one point likened to "a mutiny in the forces of a country.13
In fact, no compelling evolutionary explanation for the
existence of autoimmune disease has been offered—just the excuse that the immune cells, despite their supposed function of distinguishing self from non-self, sometimes make a "mistake." And why should that be? One popular hypothesis, proposed in 1989, is that the relatively hygienic environments of affluent societies do not give immune cells enough
practice in facing their "real" enemies from the microbial world. They grow up, in other words, soft and pampered. But today there is increasing acknowledgment that the link between lack of childhood exposure is not one of cause and effect. One possibility is that highly hygienic environments may simply allow more children to live long enough to develop an autoimmune disease. 14 As Burnet commented, "one cannot discuss autoimmune disease without getting into deep water philosophically, "15
We could say, in retrospect, that Burnet was torn between two paradigms: One, the holistic, utopian one, saw the body or organism as a well-ordered mechanism, evolutionarily ordained to be exactly as it is. In the other emerging paradigm, which could be called dystopian, the organism is a site of constant conflict—as between cancer cells and normal cells or between the immune system and the other tissues in the body. The conflict may result in some sort of compromise in which, for example, the disease settles into a chronic condition. Or it may end, sooner rather than later, in the death of the organism. These two paradigms, utopian and dystopian, may coexist in the same individual mind, Burnet's for example, but to my knowledge they have yet to square off in open combat. There however was a near collision in the early 1990s, for anyone who was paying attention, and it was not about autoimmune disease or cancer, but about something more normal and apparently healthy—menstruation.
Blood Feuds
The onset of menstruation can be appalling, even terrifying, to the young girl who experiences it. There may be painful cramps, leaky tampons or pads, bouts of anemia. Yet, at least among the affluent and educated, every effort is made to normalize this oddly violent occurrence, even to prettify it. A parenting website advises:
It's also important for parents to paint the process of menstruation in a positive light. If a mother refers to her period as "the curse," her daughter might get a negative impression of the whole experience. Instead, mothers can explain that monthly periods are a natural and wonderful part of being a woman. After all, without them, women couldn't become mothers. 16
Undeterred by the question of why a twelve-year-old girl should find it "wonderful" that she is now capable of becoming pregnant, the positive pro-menstrual propaganda goes on
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in its upbeat way. A writer for the American Psychological Association offers "another way to keep-it-positive":
Some parents have successfully put together a Welcome to Womanhood Basket that might include chocolate, a heating pad, hygiene supplies and perhaps a good book on the topic (or a novel from her favorite author), if she doesn't already have one. 17
Somehow, the gift of a heating pad and hygiene supplies may seem more ominous than welcoming.
In the "positive" view, menstruation has a serious biological function. Every month, at least in humans, the lining of the uterus grows thick, supposedly to provide a soft cushion for any fertilized eggs that find their way into it. If no embryo implants, the uterus sheds this lining, if only because it would be costly, in a caloric sense, to maintain it—hence the mess of blood and tissue fragments that make up the menstrual discharge. But repeated monthly over decades, the shedding of the uterine lining is itself very costly; women typically lose a pint of blood a year and sometimes several more, creating the risk of anemia. So, if natural selection prevails, and if it works to optimize a species' fitness, why do we menstruate so copiously? In particular, why do humans lose so much more blood than any other creature?
The answer—or at least an answer—came from an unlikely source. In 1993, Margie Profet, a thirty-five-year-old with no academic background in biology, proposed that the real function of menstruation is to cleanse the vagina of
pathogens that may have been introduced by an intruding penis.'8 I welcomed her hypothesis, which seemingly made the case that menstruation is not a result of female "uncleanness," as patriarchal religions had insisted. Catholic churches, for example, had barred menstruating women;
Jewish law required women to undergo a ritual bath after their periods. But according to Profet's theory, menstrua‑
tion, for all its messiness, was actually an effort to maintain
the naturally pristine condition of the female body—a sort of douche in reverse. Within a couple of years, Profet had
won a MacArthur "genius award" and been profiled in Sci‑
entfic American, Omni, Time, and People. She became the exemplar of the kind of optimistic biology in which every‑
thing "happens for a reason," that reason being to preserve the individual organism and propagate the species. There was still conflict in her model, but only the ancient conflict between humans (or other mammals) and their traditional enemy, microbes.
I tracked her down in the late 1990s to ask a question based on my years of study into the effect of animal preda‑
tors on human evolution and history, plus my own experi‑
ence of warnings you are likely to encounter in bear-ridden wild areas: Might not copious menstruation have been a
risk factor for predator attacks, especially in the carnivore-ridden "evolutionary environment"? Her terse answer—that "humans are not a cryptic species"—was biologically uninformed, since a "cryptic species" is not one that has to hide from predators but one that is morphologically identical to a species with a different genome. But mine was only one of a growing number of questions about her
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theory. Other critics brought up the lack of data on the cleansing effect of the menstrual flow and her failure to ex‑
plain the fact that human menstruation is so much more copious than that of any other mammal. In fact, very few mammals menstruate at all, and the few that do—other
"higher" primates, some bats, and the elephant shrew—lose far less blood than humans, although there is no evidence
that the semen of their males is any less germ-ridden than
that of human males. Profet's other much-heralded theoretical proposal—that the "morning sickness" characteristic
of human pregnancy served to protect the fetus from exposure to foods that might cause birth defects—was similarly assailed, and in about 2004, Margie Profet simply disappeared, only to resurface in 2012 and rejoin her family of origin after a period of poverty and illness.19
Today the emerging scientific consensus about menstruation hinges on conflict within our species—a possibility
that would until recently have been deeply disturbing to bi‑
ologists. In this view, the buildup of the uterine lining does not serve to entice embryos to implant, but to prevent all
but the most robust and agile embryos from ever having a
chance. I will not attempt to trace the lineage of this counterintuitive idea, except to say that another renegade scien‑
tist, Robert Trivers of Rutgers, had argued in the 1970s that
the father and mother have different genetic interests at stake. Put crudely, the father "wants"—or more accurately, his genes should want—the embryos he has fertilized to
implant and live; the mother's interest is in destroying any potentially defective embryos that might waste her energy on a fruitless pregnancy. Trivers, who is no less a fascinat‑
ing character than Profet, deserves a book of his own, and in fact has written one, Wild Life, that has less to say about science than about his adventurous career, including his membership in the Black Panther Party and long residency in Jamaica. Maybe these experiences gave him the moxie to challenge the more harmonious and utopian tendencies in biology. Not only did he find deadly competition between the sexes even in their most intimate moments, but he proposed that our genomes contain many stretches of DNA (often subsumed under the label "junk DNA") that are truly "selfish" in the sense that they
have discovered ways to spread and persist without contributing to organismal fitness. At times, this means encoding actions that are diametrically opposed to those of the majority of genes. As a consequence, most organisms are not completely harmonious wholes and the individual is, in fact, divisible. 20
Trivers's work seems to have emboldened his friend, Harvard biologist David Haig, to offer a far more dystopian view of reproduction than anything Profet and her admirers could have imagined. In 1993, the same year that Profet published her work on menstruation, Haig put forth the surprising view that pregnancy was shaped by "maternal-fetal competition:' The fetus and the placenta that attaches it to the maternal bloodstream strive to extract more nutrients from the mother, while maternal tissue fights to hold on to its nutrients—often to the detriment of the mother. For example, the fetus may interfere with maternal insulin
134 NATURAL CAUSES THE WAR BETWEEN CONFLICT AND HARMONY 135
production, leading to elevated blood sugar levels that are injurious to the mother but deliciously nourishing to the fetus. Or the fetus and placenta may release chemicals that raise the mother's blood pressure—apparently to guarantee a ready flow of nutrients to the fetus—although at some risk to the mother and ultimately to the fetus as well.
But the maternal/fetal battle begins before implantation, when the embryo and its placenta have to fight their way through endometrial lining to get access to the maternal bloodstream. As evolutionary biologist Suzanne Sadedin, who once studied with Haig, wrote:
Far from offering a nurturing embrace, the endometrium is a lethal testing-ground which only the toughest embryos survive. The longer the female can delay that placenta reaching her bloodstream, the longer she has to decide if she wants to dispose of this embryo without significant cost. The embryo, in contrast, wants to implant its placenta as quickly as possible, both to obtain access to its mother's rich blood, and to increase her stake in its survival. For this reason, the endometrium got thicker and tougher—and the fetal placenta got correspondingly more aggressive. 21
In other words, a kind of arms race has gone on between the human endometrium and the human embryo/placental combination. Human placentas are extraordinarily tough fighters compared to those of other species, and our en-dometria are correspondingly thick and forbidding. Hence the uniquely heavy flow that human females experience—the cramps, bloodstained panties, and perhaps also the
widespread cultural notion that women are peculiarly disabled versions of men.
Many phases of women's reproductive cycle, from menstruation to labor, resemble the kind of inflammatory response the human body usually mounts when invaded by pathogens, except that in the reproductive case the targets are not pathogens but human cells and tissues. Menstruation, for example, is not the gentle, autumnal-sounding process of "shedding" an endometrial lining that it is usually described as. When no embryo implants, the uterus releases chemical signals summoning immune cells to come in from the bloodstream and devour its thick endometrial lining, which quickly becomes a killing field, with the debris pouring out of the vagina. Fortunately, during most of human existence, thanks to frequent pregnancies and lengthy periods of lactation, human females probably endured very few menstrual periods during their lifetimes.
So far no adequate explanation has been found for the fact that among humans, about 80 percent of those who suffer from autoimmune diseases are female, suggesting that as holistic "systems," men are much better designed than women. Or it may be that we should see autoimmune diseases as just another part of the greater reproductive burden borne by women: All the inflammatory storms whipped up by menstruation and pregnancy may lead to a hazardous level of immune sensitivity, or, to put it in Burnet's vague philosophical terms, maybe pregnancy and the preparations for it inherently blur the distinction between self and non-self.
But the point is that intrabody conflict—between cells
136 NATURAL CAUSES
and their own sibling cells within the same organism—is not confined to pathological conditions like cancer and autoimmune diseases, where it can be traced to a mutation or described as a "mistake." Deadly combat among cells is part of how the body, and especially the human body, conducts its normal business, which certainly includes reproduction. If cells are alive and can seemingly act in their own interests against other parts of the body or even against the entire organism, then we may need to see ourselves less as smoothly running "wholes" that can be controlled by conscious human intervention, and more as confederations, or at least temporary alliances, of microscopic creatures.
It is disconcerting to think of the biological self, or body, as a collection of tiny selves. The image that comes to mind is the grotesque portrait of a super-sized king in the frontispiece of philosopher Thomas Hobbes's Leviathan: On close inspection, the king turns out to be composed of hundreds of little people crowded into his arms and torso. Hobbes's point was that human societies need autocratic leaders; otherwise they risk degenerating into a "war of all against all." But no "king" rules the community of cells that makes up the body. Despite, or sometimes because of, all the communications—chemical and electrical—that connect the cells of the body, disagreements and mixed signals can always occur. What we need is a paradigm that includes not only the marvelous harmony within living organisms, but the conflicts that routinely break out.
"SUCCESSFUL AGING" 163
CHAPTER SEVEN: THE WAR BETWEEN CONFLICT AND
HARMONY
1. Quoted in David Kaiser, How the Hippies Saved Physics: Science, Counterculture, and the Quantum Revival (New York: W. W. Norton, 2011), 266.
2. Penny Lewis, Integrative Holistic Health, Healing, and Transformation: A Guidefor Practitioners, Consultants, and Administrators (Springfield, IL: Charles C. Thomas, 2002), 20.
1. Ibid., 21.
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226 ENDNOTES
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9. DeLisa Fairweather and Noel R. Rose, "Women and Autoimmune Diseases," Emerging Infectious Diseases 10, no. 11(2004): 2005-1l,wwwnc.cdc.gov/eid/article/10/11/04-0367 article.
10. Quoted in Alfred I. Tauber, "Immunology and the Enigma of Selfhood," in Growing Explanations: Historical Perspective on Recent Science, ed. M. Norton Wise (Durham, NC: Duke University Press, 2004), 207.
10. Alfred I. Tauber, The Immune Se(fi Theory or Metaphor? (Cambridge: Cambridge University Press, 1994), 141.
9. Quoted in Emily Martin, "Toward an Anthropology of Immunology: The Body as Nation State," Medical Anthropology Quarterly, New Series, vol. 4, no.4 (December 1990): 410-26, quote on 411.
Quoted in Warwick Anderson and Ian R. Mackay, Intolerant Bodies: A Short History ofAutoimmunity (Baltimore: Johns Hopkins University Press, 2014), 89.
12. Lois N. Magner, A History ofinfectious Diseases and the Microbial World (Healing Society: Disease, Medicine, and History) (Westport, CT: Praeger, 2009), 205.
9. Quoted in Anderson and Mackay, Intolerant Bodies, 89.
"Talking to Your Child About Menstruation," KidsHealth, http:!/kidshealth.org!parent/positive/talk/ talk about menstruation.html#.
Karol Maybury, "A Positive Approach to Menarche and Menstruation," Society for the Psychology of Women, American Psychological Association, www.apadivisions.org!division-35! news-events!news/menstruation.aspx.
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Brendan Maher, "Missing Biologist Surfaces, Reunites with Family," Nature.com, May 31, 2012, http:!!blogs.nature.com!news!2012!05! missing-biologist-surfaces-reunites-with-family.html.
Austin Burt and Robert Trivers, Genes in Conflict: The Biology of Selfish Genetic Elements (Cambridge, MA: Harvard University Press, 2006), 3.
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