One afternoon five years ago, my face swelled up like a helium balloon. My lips became tire-like, so thick I could no longer speak. At the ER, after deflating me with a cocktail of epinephrine, a steroid and an antihistamine, the doctors scolded me for not coming in more quickly: I could have died of asphyxiation.
It was a bizarre episode, unrelated to any discernible exposure, but it wasn’t isolated. In the time since, mounds have formed beneath my skin and ping-ponged up and down my limbs. Golf ball-sized lumps appear on my wrists, grapefruit on my hips. My fingers fatten into sausages; my labia distend. I’ve grown accustomed to bailing on dinners, bowing out of meetings, postponing travel. My kids try to mask their horror by making light of it, puffing up their cheeks, just like “mommy’s monster face”.
It’s hard to find help for a condition that has no name, but I’ve made the rounds of allergists, immunologists, rheumatologists and gastroenterologists. I’ve filled vials with blood and canisters with shit. But each expert reached the end of their expertise and, unable to confer a diagnosis, punted me on to the next.
And that is how I found myself tripping down the garden path of wellness.
Where conventional medicine shrugs its shoulders, the wellness industry brims with answers.
Once I glanced up from the narrow list of hospital-affiliated physicians at least partially covered by my insurance, I found a world of solutions waiting in the form of functional medicine, somatic therapies, boutique institutes and diet coaches. What they offered put traditional healthcare to shame. They weren’t just going to relieve my symptoms, they promised root cause treatment and complete remission.
From these sources, I learned I suffered from toxic inflammation, histamine intolerance, mold exposure, sensitivities to chicken, clams and chocolate, dormant Lyme disease, heavy metal poisoning, motherhood, hidden but newly awakened traumas, over-stress, under-sleep and nutrient deficits. But! With these pills and powders and out-of-pocket consultations – along with exacting combinations of vegetables, broth and, of course, mindfulness – I would become well.
The wellness industry “really gathers the masses with certainty”, says Rina Raphael, journalist and author of The Gospel of Wellness. “They say, ‘I can definitely help you. This supplement is definitely going to cure your symptoms. You should try this diet. It’ll get rid of all your pain.’ This is what gets people and hooks them in.”
Today, wellness represents a vast and amorphous industry, encompassing everything from diet and fitness to workplace resilience programs, bespoke IV drips and CBD-infused skin creams. It’s filled with practices borrowed from the world’s traditions, like yoga and plant medicine, that have been repackaged for affluent consumers. Fariha Róisín, the author of Who is Wellness For?, says such practices have become commodities and are often rebranded to obscure their roots in brown, Black and Indigenous cultures. The industry flaunts terms like authenticity, truth and meaning but, she argues, these are at odds with the extractive activities it depends on. (For instance, one rarely hears of the culture behind your morning meditation ritual and almost never of the labor behind the turmeric brightening your latte.)
The industry’s size depends on which sectors you think fair to include, but a look at the field indicates that there’s room enough for just about everything. At this year’s Global Wellness Summit, held in November in Qatar, topics include the usual suspects like spas and spirituality, but also tourism, technology, real estate and design. According to a 2019 report by the Global Wellness Institute, a non-profit advocacy organization, the industry represents a $4.4tn market. A 2021 NielsenIQ report declared health and wellness “THE single most powerful consumer force”.
The industry’s offerings run the gamut from the tried and true (walking) to the benignly absurd (crystal dildos) to the predatory and dangerous (castor oil for cancerous tumors). Raphael writes that being healthy once meant dutiful visits to the doctor, but now entails a never-ending quest to overcome sickness, sadness, stress and even death. “Wellness,” she writes, “is almost an aspirational obsession for some and close to religious dogma for others.”
And yet, she points to an underlying tension.
For all that we pursue and financially tether ourselves to wellness, indices of good health flag behind. Even though healthcare spending in the US amounts to more than 18% of GDP, Americans have a lower life expectancy at birth and die more often from avoidable or treatable conditions than people in other high-income nations. More than one in five US adults live with mental illness, and research suggests US workers are among the most stressed in the world.
“We have become a self-care nation,” Raphael writes. “Though arguably one that still lacks the fundamentals of wellbeing.”
So how did we end up in this predicament? One answer lies in the demands of modern life, which, in Raphael’s assessment, land with particular force on women, and mete out further burdens depending on race, class and sexuality.
American women, which are the focus of her reporting, are by most counts stretched thin. Compared with men, they report higher levels of stress, anxiety, depression and burnout, while also performing the lion’s share of care work. They feed their families while food costs soar and there is cadmium in the cocoa powder.
Running alongside this imbalance are the familiar pressures to enhance the body, radiate poise, master impulses (hunger, rage) and perfect the contortions required of the double standard. It is no wonder, in this field of outsized expectations, that wellness has found a ready market among women.
Raphael takes her reasoning a step further and argues that wellness has become a new form of faith. As organized religion has retreated from everyday life, she argues, wellness has rushed in to fill the void. “It’s providing belonging, identity, meaning, community. These are all the things that people used to find in their neighborhood church or synagogue. Wellness offers some sort of salvation on the horizon.” It also offers the illusion of control and empowerment. “If you work hard enough and you buy the right things, you’ll be saved from disease and ageing and anything bad happening to you,” Raphael says.
To believe that you are at the helm can offer respite from the constant deluge of technology, screaming children and a burning planet. But an illusion it remains. Even the best laid plan of diet, exercise and sobriety will dictate only a small portion of health outcomes, because it simply pales in comparison to systemic factors, including the spillage of work into all waking hours, the orange haze that consumes the skies, and the lopsided hazards and opportunities that hew to how much you earn, or the color of your skin.
According to one well-trafficked statistic, the social determinants of health – factors like air quality, domestic safety, community support and education access – account for as much as 80% of health outcomes. But these realities are neatly erased from most wellness marketing.
“Wellness is ever present in lives increasingly lived in crisis,” Colleen Derkatch writes in her book Why Wellness Sells. Wellness, she argues, presents collective social ills as problems for the individual to solve through some alchemy of consumer behavior. Joining a union would arguably deliver greater benefit than downloading another meditation app, but the wellness market presents the latter as a logical solution to work-related stress and deteriorating mental health.
“We’re sedating women with consumerist self-care,” Raphael says. “You’re not stressed because you’re not doing enough yoga or taking enough bubble baths. There are other, bigger reasons why you feel stressed out. Maybe it’s because you don’t have maternity benefits. Maybe it’s because your boss is emailing you after 6pm. Maybe it’s because your partner doesn’t help you with the workload at home. These are the things that get shoved under the rug and instead you’re told that you yourself, alone, have to take care of the issues.”
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Another reason wellness has mushroomed into its current behemoth is that we are not passive consumers, but active players in our self-optimization. Derkatch, a professor of rhetoric at Toronto Metropolitan University, has analyzed how the language and ideas of wellness have come to permeate our lives.
From social media and magazines at the check-out line to the emails lobbed from HR, we’re bombarded with messages that enjoin us to “take care”, to honor our wellbeing, but also to use “hacks” to boost our languishing productivity and mood. (Case in point, the text on a plastic baggie filled stool sample containers I just received from the GI doc, urges me to “celebrate each day” and “cultivate cheerfulness”.) Derkatch maintains we’ve been recruited into a hamster wheel of constant self-monitoring and surveillance, chasing a past where we were young and spry, while trying to outpace the vulnerabilities lurking in the future.
We might feel healthy in the present, but debility looms ahead in the form of creeping age, microbiome imbalances and hormonal dips and drops. We will be visited by decrements to our mobility, hair luster, muscle tone and libido – as well as the mirage that all can be regained.
“Everything about the language of wellness is designed to push the goal lines further and further out of reach,” she says. “You never arrive at a point to go like, ‘Oh, I’m well now.’ There’s always something else we could be doing.” As a result, there is no resting place because we can never fully restore what’s been lost, and there is always a greater state of enhancement to attain.
In my own tour of the wellness world, the most commonly cited enemy to my health was stress. If I could just get a handle on my inner tumult, it would not erupt with such unpredictable violence across my skin.
Accordingly, I was told again and again to incorporate more mindful practices into my routines. Yoga was one vaunted ally to my wellbeing, as was meditation. And at face value, spending time on the mat or cultivating a practice of inward reflection sound like great ideas. But few wellness practices are presented as good unto themselves. Diet, for instance, is not about balanced nutrition, but almost always code for becoming more slender and thus, it is implied, more socially acceptable. Psychedelics are for transcendence – as well as conjuring the next tech venture. Even orgasm is not simply an end to pleasure, but a way to improve complexion, enhance confidence and energetically manifest financial abundance.
In their book, The Wellness Syndrome, Carl Cederström and André Spicer observe that wellness has become a moral obligation. “As consumers, we are required to curate a lifestyle aimed at maximizing our wellbeing,” they write. “When we engage in boring activities, such as washing up at home, we should think of them as improving our mindfulness. Even baking a loaf of bread is now recast as a way of nurturing our wellbeing.”
The underlying implication is that it is not sufficient to simply feel good – we could always be accomplishing more.
The late social critic Barbara Ehrenreich wrote a sendup of what she saw as an “epidemic of wellness” in her book, Natural Causes. Our obligation to the self had become, in her opinion, an endless gauntlet of obligations. Our commitment to augmenting and bettering ourselves threatens to overtake, rather than improve, our minds and bodies. “You can think of death bitterly or with resignation … and take every possible measure to postpone it,” she wrote. “Or, more realistically, you can think of life as an interruption of an eternity of personal nonexistence, and seize it as a brief opportunity to observe and interact with the living, ever-surprising world around us.”
If we were to take the obligation to wellness seriously, wouldn’t it, ultimately, center on that possibility?
Wellness might be a landscape dotted with scammers, snake oil peddlers and influencers glowing from the force of their own sincerity, but what many of them are offering caters to needs that are both real and urgent. Americans, sick and stressed and isolated, are trying to navigate precariousness, the sense that at any moment their private lives and the global order might be snowed under.
Derkatch says that real wellness does not require an extensive menu of goods and services. It does not mean we swap out pharmaceuticals for natural products, or screen our tap water for hidden poisons, or sign up for resilience workshops. “Real wellness means having conditions under which we can flourish,” she says. It means social support, medical care that is accessible and empathetic, decent working conditions and ready sources of affordable and nutritious foods.
Genuine wellness might also require that we question deeper assumptions about what it means to live a good life. Today, if we are unhappy, something is amiss. But this idea, in addition to being a fairly recent social invention, does not necessarily make us feel better. Instead we’re troubled by standard lapses in contentment. Carl Cederström says: “We used to be better equipped culturally to deal with different forms of setbacks. We are now forced to think about every setback as a way to quickly get back into the saddle.”
Perhaps wellness, if we are to embrace its full potential, should dispense with the fantasy that we should always be fit and chipper, or strive to be. Perhaps it is far healthier to agitate against the circumstances making us sick and miserable than it is to latch our hopes to another glossy promise.
In recent months, I’ve taken a new approach to my own nameless malady. I’ve left the fancy pills and powders to molder in a bottom drawer, I’ve found a new board-certified specialist who takes the time to talk me through the data and help establish reasonable expectations, and I’ve connected with a small number of other people who, in sharing their own experiences of weird swelling bouts, help ease the sense of isolated helplessness.
Personally, and I say this as someone who has the privilege and suffers a desperation sufficient to throw thousands of dollars toward illusory cures, I have benefited from a loss of faith in what the industry has to offer, and a renewed conviction that the fix lies often beyond ourselves.