You’re Going to Die. Just Face It Already.

The most purely, proudly American genre of writing might be the to-do list. From Benjamin Franklin’s 13-week plan for self-optimization to young Gatsby’s daily routine (“practice elocution, poise and how to attain it”), nothing captures quite so well our essential optimism, mania for self-improvement and suspicion of leisure — not to mention the unapologetic grasping that so galled de Tocqueville.

All this striving is getting in the way of living, Barbara Ehrenreich argues in “Natural Causes” — and it’s making dying more painful and humiliating than it needs to be.

Her new book is blunt: Nothing in modern life prepares us for the leaving of it. We treat aging as an outrage or, worse, as a sin. In our addiction to betterment, we’ve replaced “health” — an absence of sickness — with the amorphous “wellness” and a flurry of overtesting, fad diets and pointless “alternative” treatments.

“Every death can now be understood as suicide,” she writes. “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?”

At 76 years old, Ehrenreich has decided that she is old enough to die. She forswears annual exams, cancer screenings and any other measure “expected of a responsible person with health insurance.” There will be no more mammograms, no more tedious lectures, no more pawing physicians. “Not only do I reject the torment of a medicalized death, but I refuse to accept a medicalized life.”

It’s reasonable, even honorable to so coolly make peace with the inevitable. But I confess wanting a bit more raging against the dying of the light. Ehrenreich is irreplaceable to the culture, with her rigor and skepticism, her allergy to comforting illusions. Only she would offer a grim riff on the Rev. Martin Luther King Jr. (“The arc of history is long,” she writes, “but it bends toward catastrophic annihilation”) as incentive to action not defeatism.

Ehrenreich has called herself a “mythbuster by trade.” In previous books, she’s assailed the positive-thinking movement (“Bright-sided”), and gone undercover to investigate low-wage work in the era of welfare reform (“Nickel and Dimed”) and middle-class job insecurity (“Bait and Switch”).

The wellness movement, as you might imagine, doesn’t stand a chance. She fillets it with ease and relish — revealing the paucity of research supporting the usefulness of everything from annual physical exams to meditation — and dismantles nostrums about the innate balance and wisdom of the body.

She introduces us to a world of dystopian “intrabody conflict.” (Ehrenreich has a doctorate in cellular immunology.) Our bodies are subject to randomness and even outright “conflict at the cellular level.” She cites a biologist who describes pregnancy as “maternal-fetal competition”: the fetus tries to siphon off the nutrients from the mother, whose body struggles to retain them for herself. Our immune system has been found to nourish cancer cells (“the fire department is indeed staffed by arsonists”).

“Natural Causes” is peevish, tender and deeply, distinctively odd — and often redeemed by its oddness. Ehrenreich is so offended by the American conflation of health with virtue and offers charming contrarian essays on the “defiant self-nurturance” of cigarette smoking, for example, and the dangers of eating fruit. The pleasures of her prose are often local, in the animated language, especially where scientific descriptions are concerned. Her description of cells rushing to staunch a wound is so full of wonder and delight that it recalls Italo Calvino.

There are, however, a few swan dives into near-nonsense. In arguing that the wellness epidemic seeks to prettify our body’s actual processes, she reveals a horror of menstruation — a “violent occurrence” that she claims can be “appalling, even terrifying, to the young girl who experiences it.” She rails against “pro-menstrual propaganda” that dares “normalize this.”

It’s a confusing moment of squeamishness and overstatement from a woman who was politicized as a young mother by the funky feminism of the 1970s. (There’s even a fond mention of a speculum in these pages.)

More surprising, Ehrenreich never really grapples with the obvious point that most Americans suffer from a lack — not excess — of access to basic health care. This is especially true for women of color, as the alarming rates of maternal mortality make clear.

Ehrenreich’s focus on relatively rarefied issues and pet preoccupations make it clear that this is a book born out of private not public concerns — despite masquerading as such. It possesses what the poet Helen Vendler described as “the strange binocular style” of late works, in which the writer is attentive to death’s encroaching shadow but also vividly alive to the present moment. There is a feeling of Ehrenreich getting her affairs in order, slaying a few final foes.

The wellness movement neatly dispatched, she sits in contemplation of death itself in the book’s concluding, very beautiful passages, bringing to it her characteristic curiosity and awe at the natural world.

“It is one thing to die into a dead world and, metaphorically speaking, leave one’s bones to bleach on a desert lit only by a dying star,” she writes. “It is another thing to die into the actual world, which seethes with life, with agency other than our own, and at the very least, with endless possibility.”

I’m reminded of a haiku by Mizuta Masahide, the 17th-century Japanese poet who commemorated the burning down of his barn, which left him homeless: “My storehouse burned down—/now nothing stands between me/and the moon above.”

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‘Natural Causes

An Epidemic of Wellness, the Certainty of Dying, and Killing Ourselves to Live Longer’

By Barbara Ehrenreich

234 pages. Twelve. $27.