SMILE OR DIE:
(London: Granta Books, 2009)
Reviewed by R.J. Stove
If any English-speakers still believe in either the inevitability or (worse still) the desirability of that "two cultures" chasm which generated so much anguished debate fifty years ago, Barbara Ehrenreich’s achievement should knock this belief into the proverbial cocked hat.
Dr Ehrenreich is a highly qualified scientist — she gained, in 1968, her PhD in cell biology from Rockefeller University, New York — best-known, nevertheless, for her investigative journalism. Her most famous book to date, Nickel and Dimed: On (Not) Getting By In America, appeared in 2001 and remains a distinguished (although not uniformly convincing) successor to Orwell’s Down and Out in Paris and London.
Smile Or Die is if anything still more tough-minded and personal. It arose from Dr Ehrenreich’s own battle against breast cancer, a battle painful enough in a purely physical sense, but made far more humiliating than it need have been by the culture of mindless lay happy-talk which has grown up in America — and has become increasingly widespread here — around the disease in question. The resultant testimony will seem moving, and often enough damning, whatever reservations one might have about Dr Ehrenreich’s own leftist faith. (Part of the cultural problem can be gleaned from the different titles her book has acquired on both sides of the Atlantic. The edition being discussed here is the British one; the US edition has the far blander, less convincing name Bright-Sided. From this we are forced to assume that the American public taboo against discussing anybody’s demise is as strong today as it was in the 1940s, when William Randolph Hearst ordered his tame media to reject syndication of Evelyn Waugh’s The Loved One, on the curious grounds that "Mr Hearst doesn’t like death mentioned.").
Sharp polemicist though Dr Ehrenreich is at her best, she scarcely needs to comment on her source material; all she has to do, for the most part, is quote it. The outcome resembles nothing so much as a collaboration in which Waugh and Nathanael West were determined to purge Louis-Ferdinand Céline of undue tastefulness. Except that this collaboration would perforce be fictional, whereas Dr Ehrenreich’s reportage has the full horror of actuality. She stresses, "I do not write this in a spirit of sourness or personal disappointment of any kind, nor do I have any romantic attachment to suffering as a source of insight or virtue. … But … we need to brace ourselves for a struggle against terrifying obstacles, both of our own making and imposed by the natural world. And the first step is to recover from the mass delusion that is positive thinking."
All too frequently this delusion, for breast cancer patients, takes the form of ... well, what? Bizarre religion? A devotion to high art? Unjustified career plans? None of the above. Instead, think teddy-bears. Yes, teddy-bears. This will be good practice for acquiring the "you couldn’t make this up" mentality which dominates America’s current breast-cancer sub-world. Among the toy bruins who are credited with almost shamanic powers, Dr Ehrenreich "identified four distinct lines, or species, of these creatures, including Carol, the Remembrance Bear; Hope, the Breast Cancer Research Bear, which wore a pink turban as if to conceal chemotherapy-induced baldness; and … the Nick and Nora Wish Upon A Star Bear".
As might be expected from this outbreak of ursophilia, a relentlessly upbeat mood rules. (It appears redolent of that nineteenth-century governess who, having frog-marched to a fun-fair the child in her charge, ordered him: "You were brought here to enjoy yourself, and enjoy yourself you shall.") Dr Ehrenreich complains: "Even the word ‘victim’ is proscribed, leaving no single noun to describe a woman with breast cancer. As in the AIDS movement, upon which breast cancer activism is partly modelled, the words ‘patient’ and ‘victim’ … have been ruled un-PC. … My support group seemed supportive enough, but some women have reported being expelled by their groups when their cancers metastasised and it became clear they would never graduate to the rank of ‘survivor’." When Dr Ehrenreich had the impudence to criticise, in a comment to an online message board, the whole shebang — not least its encouragement of "sappy pink ribbons" — she was bawled out. Condemnations (all from complete strangers, of course, and all, of course, signed only with Christian names) included these: "I really dislike saying you have a bad attitude towards all of this, but you do, and it’s not going to help you in the least." "You need to run, not walk, to some counselling. … Please, get yourself some help."
Perhaps the worst single element of such humbug is the fact that breast cancer treatment has hardly more success these days than it had three-quarters of a century back. "The death rate from breast cancer [has] changed very little between the 1930s, when mastectomy was the only treatment available, and 2000, when I received my diagnosis." Chemotherapy improves the actuarial chances of "younger, premenopausal women, who can gain a seven to eleven percentage point increase in ten-year survival rates". Yet Dr Ehrenreich was postmenopausal and almost sixty, which made her statistical outlook much worse. Fortunately, she is still very much alive and kicking, especially kicking. A point she emphasises over and over is how little scientific evidence can be found — and how problematic such evidence is even at its best — to justify allegations about the role of "positive thinking" either in preventing cancer to begin with, or in defeating it once it strikes.
Which leads Dr Ehrenreich to question not only such pseudo-scientific balderdash’s more grotesque manifestations, but the first principle behind them. She finds this principle, plausibly, in the "power of positive thinking" craze which underpinned the 1952 bestseller of that name by Norman Vincent Peale, and which had dominated the equally popular pre-war tract Think and Grow Rich by Napoleon Hill. Between them, Peale and Hill wrote the template for virtually every subsequent self-help fad of America’s publishing industry. Although Dr Ehrenreich does not actually quote Oprah Winfrey’s pernicious drivel to the effect that Ethiopians starve because they have been "thinking starving thoughts", she does mention possibly even more pernicious drivel formulated by Rhonda Byrne — Australian-reared, alas — in that near-plagiaristic (and, when not near-plagiaristic, more or less deranged) 2006 hit The Secret. Explaining the deaths of at least 230,000 in 2004’s Boxing Day tsunami, Miss Byrne announced that "By the law of attraction, they [the tsunami victims] had to be on the same frequency as the event." Presumably they brought it on themselves, via a process known to Miss Byrne alone. Presumably, also, the same suicidal mania motivated those who died on 9/11, in the Nazi extermination camps, in the Soviet and Chinese gulags, and so forth.
Dr Ehrenreich is on firm ground in diagnosing the ostensibly economics-based verbiage of Tony Robbins, Tom Peters, and suchlike business motivators as being little more than a pin-stripe-suited version of The Secret’s nonsense. (Even finance correspondents — a breed marked by almost incredible ex officio gullibility — might have wearied of Peters’s snake-oil, to judge by a delicious 2000 quotation from Fortune magazine which Dr Ehrenreich cites: "If you know one thing about Tom Peters, you know about his first book [Liberation Management], and if you know two things, the second is that he hasn’t written a book as good as that since, and if you know three things, the third is that sometime in the eighteen years since that first precious book, he’s gone bonkers.") She is on equally firm ground in analysing the connections between such cultic claptrap and Christian Science’s theology, which not only originated in America, but has flourished there more than anywhere else.
Where she convinces least is in blaming all these phenomena on Calvinism. To read her condemnations of that belief is to be reminded of Orwell’s acid comment about political terminology: "The word ‘fascism’ has now no meaning except in so far as it signifies ‘something not desirable’." (A resurrected Orwell would be forced to describe "racism", "anti-Semitism" and "homophobia" similarly.) For one thing, she never acknowledges the obvious truth that Calvinism depends to a quite exceptional extent on the national soil in which it has been planted, and that the syndromes which she laments have traditionally played little or no part in Calvinist societies outside America: such as Scotland, South Africa and Switzerland. For another thing, one of Calvinism’s most obvious features is a fastidious concern with Original Sin. By obvious contrast, mindless pap about "positive thinking" assumes that Original Sin does not occur; that, if it did occur, it would be harmful; and that no hereditary or sociological factors must be allowed to impede the striving Id’s progress towards "self-actualisation".
Indeed, the most puzzling problem with which the USA’s foreign well-wishers are confronted is the way in which the country’s public life usually seems to lurch between extremes of hyper-individualism and of hyper-determinism, with little room for mere sanity to prevail. American-style hyper-determinism represents a difficulty which hits outsiders in the face. Why, for example, do Americans lack the political resolve to crack down on Third World immigration in general, and on Third World illegal immigration specifically? Why is it beyond Americans’ talent, as it clearly is, to have a governmental schooling system which functions even one-tenth as well as its counterparts in Western Europe? Why has no White House occupant since Eisenhower — no, not even Nixon — defied Washington’s Israel lobby, a lobby much deplored within Israel itself, but one which no mainstream American media outlet dares reproach? Why America’s obesity plague, which could end tomorrow if the recommendations of books like French Women Don’t Get Fat were acted on?
Such national paralysis of will provides a strange contrast with those qualities which make so many Americans exceptionally pleasing: in particular, their sheer willingness to wish others well. (As one very gifted — and, regrettably, homosexual — British observer put it: "Americans want you to succeed because they feel you may drag them forward with you, while the British want you to fail because they fear you may leave them behind.") It just appears sad that this goodwill cannot be combined with an existential realism which, if more common Stateside, would have made it unnecessary for Dr Ehrenreich to produce Smile Or Die at all. America’s "positive thinking" mantra is by no means the sole, or the worst, instance of mistaking wishes for realities; but it has led to especially harrowing consequences in Dr Ehrenreich’s case, and she has eloquently shown why her readers — whether or not they have themselves endured the miseries of a cancer regimen — should be equally concerned.
R.J. Stove lives in Melbourne and is a writer and commentator on public affairs. He has had numerous articles published in Quadrant, National Observer and Chronicles. He is a contributing editor at The American Conservative. He is also the author of A Student's Guide to Music History (ISI Books, 2008).