When someone dies, she often suffers a brutal moral autopsy, says Barbara Ehrenreich. Did she smoke? Drink overly? Eat too much fat?
I watched in consternation as most of my trained, middle-class friends began, at the onset of middle age, to obsess about their health and likely longevity. Even those who were at one point determined to change the world refocused on changing their own bodies. They undertook exert or yoga regimens; they filled their calendars with medical tests and exams; they boasted about their “good” and “bad” cholesterol counts, their heart rates and blood pressure.
Mostly they understood the task of ageing to be self-denial, especially in the realm of diet, where one medical fad, one study or the other, denounced fat and meat, carbs, gluten, dairy or all animal-derived products. In the health-conscious mindset that has predominated among the world’s affluent people for about four decades now, health is indistinguishable from virtue, tasty foods are” sinfully delicious”, while healthful foods may taste good enough to be advertised as “guilt-free”. Those seeking to compensate for a lapse undertake punitive measures such as hours-long cardio conferences, fasts, purgings or diets composed of different juices carefully sequenced throughout the day.
Of course I want to be healthy, too; I only don’t want to construct the pursuit of health into a major life project. I eat well, meaning I choose foods that savour good and will stave off hunger for as long as possible, such as protein, fibre and fats. But I refuse to overthink the potential hazards of blue cheese on my salad or pepperoni on my pizza. I also exert- not because it will make me live longer but because it feels good when I do. As for medical care, I will seek help for an urgent problem, but I am no longer interested in undergoing tests to uncover problems that remain undetectable to me. When friends berate me for my laxity, my heavy use of butter or habit of puffing( but not inhaling) on cigarettes, I gently remind them that I am, in most cases, older than they are.
So it was with a measure of schadenfreude that I began to record the cases of individuals whose healthy lifestyles failed to produce lasting health. It is about to change that many of the people who got caught up in the health “craze” of the last few decades- people who exercised, watched what they ate, abstained from smoking and heavy drinking- have nevertheless died. Lucille Roberts, proprietor of a chain of women’s gyms, died incongruously from lung cancer at the age of 59, although 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 56 and died of his injuries two weeks later.
Some of these demises were genuinely shocking. Jim Fixx, author of the bestselling The Complete Book Of Running, believed he could outwit the cardiac problems that had carried his father off to an early death by running at least 10 miles a day and restricting himself to a diet of pasta, salads and fruit. But he was found dead on the side of a Vermont road in 1984, aged merely 52.
Even more disturbing was the untimely demise of John H Knowles, director of the Rockefeller Foundation and promulgator of the” doctrine of personal responsibility” for one’s health. Most sickness are self-inflicted, he argued- the result of” gluttony, alcoholic intemperance, reckless driving, sex frenzy, smoking” and other bad options. 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 52, prompting one physician commentator to observe,” Clearly we can’t all be held responsible for our health .”
Still, we persist in subjecting anyone who dies at a apparently untimely age to a kind of bio-moral autopsy: did she smoke? Drink overly? Eat too much fat and not enough fibre? Can she, in other words, be blamed for her own demise? When 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 expose what kind of cancer. Ostensibly, this information would help promote ” awareness” of the particular cancers involved, as Betty Ford‘s openness about her breast cancer diagnosis helped to destigmatise that cancer. It would also, of course, prompt decisions about the victim’s “lifestyle”. Would Bowie going to die- at the quite respectable age of 69- if he hadn’t been a smoker?
Apple co-founder Steve Jobs‘ 2011 demise from pancreatic cancer continues to spark debate. He was a food faddist, eating merely raw vegan foods, especially fruit, and refusing to deviate from that scheme even when physicians recommended a high protein and fat diet to help compensate for his failing pancreas. His office refrigerator was filled with Odwalla juices; he antagonised non-vegan associates by attempting to proselytise among them, as biographer Walter Isaacson reported today: at a meal with Mitch Kapor, the chairman of Lotus software, Jobs was frightened to see Kapor slathering butter on his bread, and asked, “Have you ever heard of serum cholesterol?” Kapor reacted,” I’ll stimulate you a deal. You stay away from commenting on my dietary habits, and I will stay away from the subject of your personality .”
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 to exposure to toxic metals as a young man tinkering with computers. But a example could be made that it was the fruitarian diet that killed him: metabolically, 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 nearly manic-depressive mood sways- they could be traced to frequent bouts of hypoglycemia. Incidentally, 67 -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 blunder of the deceased. Surely Fixx had failed to” just listened to his body” when he first felt chest pains and tightness while operating, and maybe, if he had been less self-absorbed, Rubin would have seemed both styles before crossing the street. Maybe it’s just the way the human mind works, but when bad things happen or someone dies, we try an explanation, preferably one that features a conscious agent- a deity or spirit, an evil-doer or envious acquaintance, even the victim. We don’t read detective fictions to find out that the universe is meaningless, but that, with sufficient information, everything is constructs sense. 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 set it another way, every demise can now be understood as suicide.
Liberal commentators countered that this view represented a kind of ” victim-blaming “. In her volumes Illness As Metaphor and Aids And Its Metaphors, Susan Sontag argued against the oppressive moralising of cancer, which was increasingly portrayed as an individual problem. The lesson, she said, was,” Watch your appetites. Take care of yourself. Don’t let yourself run .” Even breast cancer, she noted, which had not yet been clear lifestyle correlateds, is likely to be blamed on a” cancer personality”, sometimes defined in terms of repressed indignation which, presumably, one could have sought therapy to cure. Little was said, even by the major breast cancer advocacy groups, about possible environmental carcinogens or carcinogenic medical regimes such as hormone replacing therapy.
While the affluent fought dutifully to conform to the latest prescriptions for healthy living- adding whole grains and gym time to their daily schemes- the less affluent remained mired in the old comfy, 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 defied the health furor: gym memberships can be expensive; “health foods” usually expense more than ” junk food “. But as the class diverged, the new stereotype of the lower classes as wilfully unhealthy quickly fused with their old stereotype as semi-literate louts. I confront this 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 employees, but they often want to know ” why these people don’t take better care of themselves “. Why do they smoke or eat fast food? Concern for the poorest of the poor usually comes tinged with pity. And contempt.
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