Sometime in my fifties I lost faith in conventional medicine, which, I had come to see, is more a collection of rituals than anything evidence-based. Alternative medicine did not attract me, since it is even goofier than the regular kind; I wanted an alternative to medicine. I began to work out, to systematically use my body in what could be described as fairly useless ways that had nothing to do with working or getting from one place to another. Early in the 1980s, a friend got me going with her to an unchallenging women’s-only gym in a nearby shopping center. She wanted to lose weight; my lower backaches had forced me to realize I could no longer treat my body as mere scaffolding for keeping my head upright. It needed some work.

And I needed some play. Except for brief bursts of housework, adult life, it turned out in my case, was conducted in the sitting position—in meetings or at a desk. The gym offered an enticing regressiveness, a chance, I wrote at the time, to reclaim “the lost muscular license of youth.” We waved our arms, crunched our abs, or lay on the floor and raised our legs to the beat of Billy Idol’s version of “Mony Mony.” After a day spent manipulating words and trying to coax paragraphs into an orderly sequence, forty-five minutes of zoned-out, militaristic obedience to the fitness instructor in front of the class seemed almost like freedom.

In fact, there is something almost utopian about the social spaces created by the fitness culture. Forget about the people who don’t have the money or the time to participate. Ignore the low-paid janitors, maintenance workers, and front-desk clerks, whose jobs don’t even offer health insurance. Just focus on the entitled inhabitants of the gym (or running or rowing group), who are encouraged to make themselves healthier and more attractive in a leisurely, carefully designed way, stopping for an occasional juice drink or chat. In this world, the sexes are more or less equal, people of all skin colors and sexual orientations mingle freely without the need to drink and dress up, and bodies are displayed with a minimum of self-consciousness, there’s free Wi-Fi and, in the locker rooms, free shampoo and moisturizer.

The Heavy Bear, Domesticated

Despite the pulsing pop music and comfortable clothes, gyms are not sites of spontaneity and play. There are rules beamed out from video monitors, mostly innocuous ones, like no cursing, “staring” at others, or expressing effort in audible form such as grunts or panting. Once, in a Key West gym, which you might imagine to be a somewhat permissive environment, I saw the manager chastise a young woman for moving too freely and rhythmically. “No dancing in the gym,” he announced, nonsensically, as if to underscore the seriousness of our undertaking. A regimented dancelike experience, as in aerobics or Zumba, is fine, but unsupervised dance moves reek of hedonism, and working out is supposed to be a form of work. Most people come with a plan like “legs and shoulders today” or “forty-five minutes of cardio and fifteen minutes of abs,” usually preceded by a warm-up and topped off with several minutes of stretching on a mat.

Despite the pulsing pop music and comfortable clothes, gyms are not sites of spontaneity and play.

Working out very much resembles work, or a curious blend of physical labor and office work. Members not only lift weights, for example; they often carry clipboards on which to record the number of reps and sets and the amount of weight lifted for each workout, like a supervisor monitoring a factory worker’s performance. Socializing is rare, if only because gym members are increasingly plugged into their iPods and can be alerted to an attempted communication (such as “May I work in?” or “Are you done with this now?”) only by frantic waving and gestures.

The major interaction that goes on in gyms is not between members or between members and staff, but between the fitness devotee and his or her body. The body must be trained, disciplined, and put to ever more demanding tests, all administered and evaluated by the devotee’s conscious mind. Compared to the mind, the body can be thought of as an animal, usually a domesticated or partially domesticated animal—capable of reflex and habit, though not of course conscious decision-making. The poet Delmore Schwartz described his body as a “heavy bear”: “Breathing at my side, that heavy animal, / That heavy bear who sleeps with me.” We learn from coaches and fitness class instructors that, like any other beast of burden, the body is always inclined to take the path of least resistance unless we can “trick” it with a sudden variation in the work-out routine. Western philosophy has long separated body from mind; fitness culture takes this dualism further—to an adversarial relationship in which mind struggles for control over the lazy, recalcitrant body. I plan to work out today, but I will not tell you exactly what I’ll do, lest my body find out.

And why should the mind want to subdue the body systematically, repeatedly, day after day? Many gym-goers will tell you cheerfully that it makes them feel better, at least when the workout is over. But there’s a darker, more menacing side to the preoccupation with fitness, and this is the widespread suspicion that if you can’t control your own body, you’re not fit, in any sense, to control anyone else, and in their work lives that is a large part of what typical gym-goers do. We are talking here about a relative elite of people who are more likely to give orders than to take them—managers and professionals. In this class, there are steep penalties for being overweight or in any other way apparently unhealthy. Flabby people are less likely to be hired or promoted; they may even be reprimanded and obliged to undergo the company’s “wellness” program, probably consisting of exercise (on- or off-site), nutritional counseling to promote weight loss, and, if indicated, lessons in smoking cessation.

Employee wellness is not a traditional concern of large capitalist enterprises, which are historically better known for imposing unhealthy conditions on their workers—exposure to hazardous substances in the case of blue-collar workers, punishing workloads and unholy levels of stress for workers of all collar colors. At some point in the 1970s and 1980s, though, companies got the idea that promoting individual health might reduce their expenditures on employee health insurance, an insight that eventually led to what is now a $6 billion industry in creating and managing corporate wellness programs. Participation in these is not entirely optional. Some employers will raise the workers’ contribution to their health insurance by $500 or so and then “waive” the price increase for employees who undergo a health assessment and then submit to the follow-up regimen, typically involving weight-loss goals. Many workers complain—at least to outside researchers—that corporate wellness programs are coercive and overly intrusive, just one more source of workplace-related stress. Promoters of corporate wellness programs claim that they reduce employer health insurance expenditures by a hefty percentage, but a massive 2013 study by the RAND Corporation found that they have “little if any immediate effects on the amount employers spend on health care.”

Fit for the Journey

It was the existence of widespread health insurance that turned fitness into a moral imperative. Insurance involves risk sharing, with those in need of care being indirectly subsidized by those who are healthier, so that if you are sick, or overweight, or just guilty of insufficient attention to personal wellness, you are a drag on your company, if not your nation. As the famed physician and Rockefeller Foundation president John H. Knowles put it in 1977:

[The] cost of sloth, gluttony, alcoholic intemperance, reckless driving, sexual frenzy, and smoking is now a national, and not an individual, responsibility. . . . One man’s freedom [in health] is another man’s shackle in taxes and insurance premiums.

Or, in the words of former secretary of Health, Education, and Welfare Joseph Califano, “We have met the enemy and they are us.” Never mind that poverty, race, and occupation play a huge role in determining one’s health status, the doctrine of individual responsibility means that the less-than-fit person is a suitable source not only of revulsion but resentment. The objection raised over and over to any proposed expansion of health insurance was, in so many words: Why should I contribute to the care of those degenerates who choose to smoke and eat cheeseburgers?

The idea that we are each individually responsible for our own health is perhaps most significant for what it omits: not only environmental and socioeconomic factors, but doctors and health care providers of all sorts, who were by and large unprepared for the fitness revolution. A 2014 “white paper” from the Bipartisan Policy Center reported that 75 percent of U.S. physicians felt that their medical training in nutrition and exercise was insufficient for counseling patients with obesity-related problems. In fact, doctors and fitness gurus seem to occupy non-overlapping worlds. Doctors’ offices do not, at least in my experience, offer literature or advice on exercise programs, nor do they encourage clients to be environmentally responsible. A doctor may inquire as to whether you “exercise,” but in most cases he or she is satisfied with a simple “yes.” The exception is the rare celebrity doctor, like the scientifically discredited “Dr. Oz,” who ministers to millions of TV viewers at a time, offering a mix of nutritional and exercise tips along with alternative and “natural” remedies such as aromatherapy and mud baths.

It’s tempting to invest one’s daily workout with a kind of dwarfish heroism.

Besides, the fitness movement’s core ideology of self-improvement and self-responsibility tends to render physicians irrelevant. Why ask a possibly flaccid medical doctor for diet and exercise tips that you can readily find on TV or the internet? Why waste precious time sitting in a doctor’s waiting room when you could be working out? Jerry Rubin credited yuppies—the identity he embraced after growing out of the Yippies—with bringing about “America’s health revolution,” explaining that “yuppies don’t wait to get sick and then let a doctor do the rest with pills and surgery; they work to avoid getting sick in the first place. From this has emerged the nation’s new awareness of self-responsibility for fitness and nutrition.”

One way for the medical profession to maintain its grip in a world of increasingly do-it-yourself health care was to establish the doctor’s office as a kind of way station along the patient’s “fitness journey,” a place to check in periodically on one’s blood pressure, cholesterol levels, and other markers of fitness success. And for years in the 1980s and 1990s, fitness devotees were content with this arrangement, carefully managing their diets and exercise regimens, and reporting to the physician now and then for a pat on the back. But then, almost without warning, the job of monitoring people’s health underwent a sudden burst of automation. There had always been a degree of self-monitoring—weighing oneself and, in the case of diabetics, checking blood sugar levels throughout the day. In the twenty-first century, technologies arose to enable continuous, convenient, unobtrusive self-monitoring of dozens of variables, including blood pressure, heart rate, calorie intake, number of steps taken in a day, even mood. Epileptics can wear devices that will warn them of oncoming seizures; asthmatics can be alerted to incipient attacks. In 2014, Forbes reported that the market for devices was “red hot,” and indeed, a year later, that one-third of American consumers were using at least some kind of wearable health monitoring device.

Executing with Intent

It’s tempting to invest one’s daily workout with a kind of dwarfish heroism. It may look like I’m just doggedly repeating the same routine with slight variations from day to day, but the real drama lies in the invisible confrontation between mind and muscle, in which I am the only conscious participant. Can I increase the load on my quads, and by how much? Are the lats getting a little lazy, and what will it take to shake them up? In the course of my own fitness “journey,” I have gone from being an embarrassed weakling to something of a show-off—taking over a machine from a young, strong man and ostentatiously increasing the weight on it, preferably while he is still watching. At my zenith, I could draw spectators for my leg presses at 270 pounds. None of this has had much effect on my daily life, other than to make me cackle contemptuously when a supermarket clerk asks if I need help getting my groceries to the car.

Then, in the last few years, I began to hit a wall. I developed temporarily disabling knee problems, which X-rays showed were attributable to overexertion rather than, as was to be expected at my age, arthritis. My lower back easily clenched into knots. I had to try to develop a less adversarial stance toward my body, or at least learn how to “listen” to it. The ideology of fitness, which had so far encouraged me to treat my body as a recalcitrant mass I was carrying around with me everywhere, showed a softer side, emphasizing the “wisdom of the body” and the need to develop some sort of détente with it. For a moment I even toyed with the idea of a yoga class, possibly including meditation, before deciding I’m not quite old enough for that.

If anything, the culture of fitness has grown more combative than when I first got involved. It is no longer enough to “have a good workout,” as the receptionist at the gym advises every day; you should “crush your workout.” Health and strength are tedious goals compared to my gym’s new theme of “explosive strength,” achieved, as far I can see, through repeated whole-body swinging of a kettleball. If your gym isn’t sufficiently challenging, you might want to try an “ultra-extreme warrior workout” or buy a “home fitness system” from P90X, which in 2016 tweeted a poster of an ultra-cut male upper body, head bowed as if in prayer, with the caption “A moment of silence please for my body has no idea of what I’m about to put it through.” Or you could join CrossFit, the fastest-growing type of gym in the world, and also allegedly the most physically punishing. The program “prepares trainees for any physical contingency,” the company boasts, “not only for the unknown, but for the unknowable, too. Our specialty is not specializing,” and the latter category includes the zombie apocalypse. The mind’s stuggle for mastery over the body has become a kind of mortal combat.

The South African runner Oscar Pistorius, who is now serving a sentence for the 2013 murder of his girlfriend, had more to overcome than most athletes: His legs had been amputated below the knees when he was a toddler. He managed to become a Paralympic champion and competed against able-bodied athletes in the 2012 London Olympics. Tattooed on his back is a modified verse from 1 Corinthians:

I do not run like a man running aimlessly I do not fight like a man beating the air; I execute each stride with intent; I beat my body and make it my slave I bring it under complete subjection . . .

An excerpt from the book Natural Causes: An Epidemic of Wellness, the Certainty of Dying, and Killing Ourselves to Live Longer © 2018 by Barbara Ehrenreich, forthcoming from Twelve on April 10, 2018.