The Chronicle Review

The Case Against Health

Marc Yankus for The Chronicle Review

November 21, 2010

In the United States, health has become a commodity and an industry. We spend vastly more than any other country on health care, and increasingly our health is our wealth. Even in our down economy, health-care spending continues to grow. In 2006, Americans spent about $35-billion on diets and diet services, in large part under the illusion that they were improving their health. Yet we consistently fall behind Britain, not to mention France, in every measure of public health. Some place American public health just ahead of that of Slovenia.

We may be nearing a point where institutions of public health and the commercial interests that surround it, including the media, do more harm than good to the nation's health. The official version of health peddled by our current system is not only venal but potentially noxious. In some instances, public health has been transformed into a kind of iatric disease, a medically induced assault on the health of society. Our minders trumpet the obesity epidemic even as epidemiological evidence suggests that "yo-yo dieting" (repeatedly losing and regaining weight over a period of several years) actively damages the immune system. At any given time, it is estimated that 50 percent of all women are on diets, and 95 percent of all diets fail. The more we diet, the fatter we seem to become.

To be "against health" is to utter a paradox, a sort of oxymoron in the Greek sense, from oxus, meaning "sharp," and moros, meaning "stupid." To be against health is to utter a sharp stupidity because, almost by definition, we cannot be against health. The very concept of health implies a positive value that one cannot but choose, as when Socrates argues that one can choose only the good. What is bad may be chosen only when it is a better evil, as in cutting off your arm to save your life. Indeed, how can the value of health be demeaned when Aristotle makes it the entelechy, the very aim of all medicine? If to be against health is therefore stupid, or moros, it is also oxus, shrewd and terribly sharp. If we cannot logically be against it, we must be against certain uses and misuses of the word "health."

To be against health is to be critical of the myths and lies concerning our health that are circulated by the media and paid for by large industries. It is to demystify their hidden moralizing and their political agenda. It also means expanding the idea of iatric disease to include the moral and physical harm that is done to the public by particular nostrums of public health, especially those that impose constraints and privations "for your own good," as the saying goes.

To be against health also means putting forth a different idea of health. My alternative approach takes its cue from a long line of Epicurean philosophers, beginning with the fourth-century-BC philosopher who founded his "Garden" in Athens, close by the Platonic Academy. The Garden of Epicurus has inspired many adherents to its teachings, including the poet Horace in Roman times and later Pierre Gassendi, François Bernier, Ninon de l'Enclos, Denis Diderot, Jeremy Bentham, and Friedrich Nietzsche. Thomas Jefferson referred to himself as an Epicurean.

You may not have heard of Ninon de l'Enclos. One of the greatest courtesans in the court of Louis XIII, she slept with royals and the most desirable men in the realm, conducted the most brilliant salon, and wrote the wittiest philosophical letters ever to speak about the nature of love. She was a great reader of Epicurus and his disciple Montaigne. In the eighth of her Letters to the Marquis de Sévigné, de l'Enclos writes:

What would vigorous youth be without love? A long illness—it would not be existence; it would be vegetating. Love is to our hearts what winds are to the sea. They grow into tempests, true; they are sometimes even the cause of shipwrecks. But the winds render the sea navigable, their constant agitation of its surface is the cause of its preservation, and if they are often dangerous, it is for the pilot to know how to navigate in safety.

According to de l'Enclos, if a life in the best of vigorous health is without love, it is no life at all, only a long illness. Even health is illness without love; conversely, there is no illness that love cannot cure or make tolerable. At the same time, love is trouble. Like wind, it troubles the surface of the sea, but it also makes navigation possible. The agitation of love preserves the self, keeps it healthy even when—especially when—it is sick. The risk of love, which so often ends in shipwreck, is what keeps a person healthy.

But there are other classic paths to health. Socrates believed in dancing every morning. We could do more for public health if the government spent a fraction of what it spends curbing smoking on promoting dancing. An Epicurean approach asks not what temptations need to be avoided in the name of health. Instead it asks, "What is health, and how do you get it?" Imagine a world in which public policy declared that pleasure is the principal means to health.

The very idea of pleasure, if one can speak of it in the singular and not the plural (is there something all pleasures have in common?), comprises the most diverse and even contradictory notions. Of these, the most clearly contradictory is the paradox of what Burke or Kant or Freud calls "negative pleasure," which is understood to underlie forms of masochism and the experience of the sublime. In Kant's Critique of Judgment, the sublime always entails a negative moment of shock or fearful awe as one component of its greater good feeling, its aesthetic pleasure. Leaving aside these antinomies, can we agree to call pleasure both the slow, economic accumulation of delicious tension and its abrupt and self-vacating explosion of release? This is the distinction the French make between plaisir and jouissance, between two different types of pleasure.

Bartolomeo Platina, the great 15th-century scholar, papal librarian, and Epicurean, wrote De honesta voluptate et valetudine ("On Honest Pleasure and Good Health") while imprisoned in the castle San Angelo in Rome, where a vengeful Pope Paul II had thrown him. Platina starts from the classical Epicurean premise that pleasure is not only a positive value but the highest value, and that health is its necessary supplement. A person cannot be sick and still feel good. She cannot be depressed, or physically debauched from alcohol and drugs, say, and still have pleasurable feelings. Following Platina and his master Epicurus, however, the corollary is also true. Not only is health the sine qua non of pleasure (that without which there is none), but pleasure improves your health. Put another way, if you inhibit the body's pleasure, you provoke disease.

Over the gates to his garden (it was not a school), Epicurus inscribed the hedonist creed: "Stranger, here you will do well to tarry; here our highest good is pleasure." With an eye to what was fitting and measured and moderate, Epicurus indulged his senses. After all, he believed that excessive pleasure, like stoic privation, ruins one's health and weakens the will. Thomas Jefferson, himself a hedonist, agreed. In 1819 he wrote to William Short, saying that "the doctrine of Epicurus ... is the most rational system remaining of the philosophy of the ancients, as frugal of vicious indulgence and fruitful of virtue as the hyperbolical extravagances of his rival sects."

In our time, it has become un-American to be Epicurean, to consider pleasure, even moderately indulged, to be the highest good. An old strain of American Puritanism to which Jefferson was immune, if not allergic, has become the new morality. Dressing itself up in the language of public health, this new morality views the least indulgence in adult pleasure as the sign of a nascent habit on the way to becoming a dangerous compulsion. In a sense, of course, that is precisely what distinguishes adult pleasures from childish ones: Adult pleasures can quickly become habitual. But without risk, there is no adult pleasure, and risk is what keeps us alive, not just living on. Perhaps that is why every single person I know has been addicted—habituated to something—at some time in life and has had a problem dealing with it. It is an all but inevitable consequence of the pleasures we seek, particularly in America, where we are publicly spurred on to consume by advertisements and stresses that excite desire. It is not all bad. Nietzsche says that nothing in life is better than our habits, as long as they don't perdure. "I love brief habits," he writes, "and consider them an inestimable means for getting to know many things and states, down to the bottom of their sweetness and bitternesses."

Each of us would like to know how to draw the fine line between the moderation Epicurus practiced and the intemperance he deplored. In "On Honest Pleasure and Good Health," Platina writes, "Not all foods suit all people. ... To my mind, no one eats what fills him with distaste, or harms, or pains, or kills." Platina is referring specifically to eating, but his suggestion can be taken more generally: We each consume what our body or spirit craves. You may require only one drink a day to ease your arteries, whereas I may need two or three. But when I start to need three or four a day, I'm probably getting into trouble. And if it isn't martinis at lunch that get me in trouble, it could be the cigarettes I sneak in the garage, or the poker game I lose twice a week, or the attractive babysitter, altar boys, or the alluring Congressional page. (What makes babysitters so irresistibly attractive, I have often thought, is their being simultaneously nubile children and caring mothers; the same may be true of Congressional pages—and altar boys.) It belongs to the very nature of adult pleasure that it has the potential for getting out of hand. If it did not entail the risk of being immoderate, the pleasure it procures would lose its intensity.

For many people, a life without the oil of drink becomes too much to bear. A little wine eases the vague and subcutaneous unease that stress puts on our muscles; a martini induces a moment of forgetfulness when the anxieties and fears of the day recede. In pursuit of happiness, Americans are insistently encouraged to consume vast quantities of anti-anxiety drugs and antidepressants, but booze is never publicly celebrated. Rarely do we hear about the charms and benefits of alcohol, or the sociability it has promoted from the dawn of time, or the pleasure and consolation it has infused into the lives of billions over the course of human history.

Even when epidemiology is not manipulated to serve special interests, it tells the truth of an aggregate. By definition, epidemiology says nothing about a particular person's mortal destiny or the health that accompanies it. An Epicurean view of health focuses not on what makes us identical to the scientists' cohort, but what makes each of us irreducible singularities. Each one of us is a throw of the genetic and historical dice, born into this world with peculiar strengths and weaknesses, and with the singular obligation to take responsibility for our individual health. In short, health for the Epicurean is more a matter of art than of science, more an aesthetic than a biological question. Each of us has to find his or her own road to health. This takes cunning and, these days, some scientific curiosity.

For an Epicurean, the first curiosity is about our body—how it works, how it responds to pleasure and pain. In The Physiology of Taste, the 19th-century Epicurean Jean Anthelme Brillat-Savarin writes: "When we eat, we receive a certain indefinable and peculiar impression of happiness originating in instinctive consciousness. When we eat, too, we repair our losses and prolong our lives." Pleasure may thus be a form of intelligence, an intuitive science as well as an art. Some nations have more of this intelligence than others. As M.F.K. Fisher writes in The Art of Eating, "France eats more consciously, more intelligently than any other nation." There are serious scientists who believe in the French paradox, that the gourmand's steady diet of foie gras and good red wine protects him from risk of heart disease. Michel Montignac, the French Dr. Atkins, believes in the healthful, slimming virtues of protein and fat but also recommends the purifying and invigorating powers of wine.

Whenever anyone asked Julia Child to name her guilty pleasures, she responded, "I don't have any guilt." Epicureanism not only absolves us of guilt but says that our guilty pleasures might actually be keeping us healthy—mentally, physically, or both. Like Proust, the doctor's son, we might even consider it perversely healthy to sacrifice our health in order to write the greatest novel of the century. Julia Child was vigorous into her 90s not despite slathering chickens with butter, but because of it. Only you can judge, however, what your body needs and what gives you pleasure. It may be vital to know that cigarettes are bad for your health, but you might at the same time feel, like Sartre, that life without cigarettes is not worth living.

In America, we have become strangely divorced from our bodies, counting calories on every product in the supermarket, watching blood pressure, measuring cholesterol, and sacrificing pleasure out of an excess of caution. These days we eat not for pleasure, but to lower our numbers. Yet we are one of the fattest nations in the world and growing every day more obese. But what do we stand to lose if we lose the enjoyment and pleasure that we derive from good eating and drinking? We may stand to lose everything. The epidemiologist cannot tell us what the Epicurean wants to know: What should I choose to love without guilt? What is good for me? What keeps me happy? What, in the best sense, keeps me healthy?

In certain European philosophical circles, there has been a recent spike of interest in Epicurus, and not only among Marxists. (Marx wrote his doctoral thesis on Epicurus.) Like every Greek, Epicurus was obliged to believe in the pantheon of Greek gods who lived on Mount Olympus; but he did so without having to suppose that these gods were even remotely interested in human affairs. As a result, Epicurus needed to find principles for living that were based not on theological but on materialist (or, we might say, scientific) conceptions of the world—those which explained all nature, including mind and spirit, with reference not to the supernatural but to harmonies and atomic processes.

Marx studied Epicurus because the Greek philosopher was the great ancient popularizer of the earlier materialist philosophers Leucippus and Democritus, who, in the fourth and fifth centuries BC, were the first to propound an atomistic doctrine. Epicurus in turn directly influenced the Roman Lucretius, whose De rerum natura became the authority for Renaissance materialism and the basis of the whole philosophical tradition that runs from Bacon to Locke to Hume and Hobbes and all the way to Feuerbach, who thought that "you are what you eat."

Neo-Epicureans argue that the entire philosophical tradition since Plato—perhaps philosophy itself—has always rejected materialism and has forever been in love with idealism. Even the so-called materialist philosophies exhibit forms of Platonic idealism; this idealism may be turned on its head, as it were, but its articulations are still in place. The new, radical Epicureanism, on the other hand, is nonphilosophical. It is a new way of articulating the relation between theory and practice; it is a praxis of thinking about pleasure and its value, in and of itself, as well as from the standpoint of health. Like Nietzsche, the Epicurean does not aspire to negate philosophy, for that would be only another way of affirming it. Philosophy is nothing but the history of its successive negations. Rather, Epicurus teaches us how to look away from the tradition. "Looking up and away shall be my only negation," Nietzsche asserts in The Gay Science. Like Nietzsche, neo-Epicureans start their thinking not with ideas but with what Epicurus insists is the origin of thought, the body.

Broadly put, neo-Epicureans suppose not only that you are what you eat, but that you think what you eat. Take German idealism, says Nietzsche. It has the leaden consistency and gaseous redolence of a diet thick with potatoes. Italian thought, one might add, is marked by the slippery texture and doughy blandness of pasta. Jewish metaphysics has the astringency and smoky intensity of briny pickles and cured fish. The indistinctness of Buddhist thought resembles white rice. Neo-Epicureans aim to discover not just a philosophy of being but a hygiene for living; not a universal system but a way of thinking about good health in terms of the peculiar proclivities of the individual body.

In the historical debate between mind and matter, mind won and silenced the voice of the body; it interpreted the body in terms of mind and considered it a mute machine that only reason could discover. It is time to recover that corporeal voice, to recast the Epicurean thinking that puts pleasure in the place of thought, that imagines bodily pleasure to be a kind of thinking. Good health will then be understood as a consequence of good pleasure, and adult pleasure will be prized, not tabooed; moderated, not censored; indulged, not feared.

Richard Klein is a professor of French literature at Cornell University. This essay is adapted from his chapter in the collection of essays Against Health: How Health Became the New Morality, edited by Jonathan M. Metzl and Anna Kirkland, published this month by New York University Press.