Medical Nemesis: Compulsory survival in a planned and engineered Hell

 

Ivan Illich‘s central theme of his 1970‘s writing revolved around the counter-intuitive development of modern societies based on the Western industrial model: The fact that the more effort and energy get invested in making things more efficient, the more they tend to become ineffective. Beyond a certain threshold, applying more of the same has destructive effects even, to which there is no remedy. In his book Deschooling Society”, for instance,he showed that schooling prohibits learning; in “Energy and Equity” he did the same for the traffic sector: faster transportation results in more time spent on transiting. Further publications of his, such as “H2O and the Waters of Forgetfulness”, “Gender”, or“Tools for Conviviality” – give many more examples of that malignant rebound effect which pervades all areas of civilized life; in fact every institution of Modernity, from church to academia, from military to administration, from agriculture to architecture.

 

Nemesis, pic:Yair Haklai CC by-sa 2.5 Generic


With
“Medical Nemesis”he produced another landmark publication in 1976 that continues to be reprinted by the title “Limits to Medicine: The Expropriation of Health”. Though Illich felt that, ten years after his book, the situation had taken another step to the worse, the quality of his socio-historical analysis still provides us with valuable insights into the behaviours currently enacted. Let’s jump right in to look at some of his theses. [all quotes from Illich: Medical Nemesis, unless otherwise sated; emphases mine.]

The medical establishment has become a major threat to health. The disabling impact of professional control over medicine has reached the proportions of an epidemic. Iatrogenesis, the name for this new epidemic, comes from iatros, the Greek word for “physician,” and genesis, meaning “origin.”

Illich identified three types of Iatrogenesis – clinical, social, and cultural – which he summed up as follows:

Increasing and irreparable damage accompanies present industrial expansion in all sectors. In medicine this damage appears as iatrogenesis. Iatrogenesis is clinical when pain, sickness, and death result from medical care; it is social when health policies reinforce an industrial organization that generates ill-health; it is cultural and symbolic when medically sponsored behavior and delusions restrict the vital autonomy of people by undermining their competence in growing up, caring for each other, and aging, or when medical intervention cripples personal responses to pain, disability, impairment, anguish, and death.

In other words, when people’s reliance on external sources of healing becomes the rule rather than the exception, healing turns into the institution of medicine – with negative effects on health. The individual’s abilities to, within its social context, heal itself atrophies like an underused muscle. With the expansion of the medical sector, ordinary healthy expressions of life such as birth, immunization, metabolizing, sorrow, grief, rage, confusion, aging and death become defined as requiring medical improvement, prevention, or treatment.

Beyond a critical level of intensity, institutional health care—no matter if it takes the form of cure, prevention, or environmental engineering—is equivalent to systematic health denial.

The mechanistic approach of the modern health trade reduces living humans to biological machines whose ailments fall into distinct pre-defined categories of illness and repair. These are quite different categories from the state of health every living being normally enjoys. People become “cases,” examples of broken hypothetic perfection, and cases enter statistics of generic classes of items: so many born, so many infected, so many dead, figures of potential danger to public health.

By equating statistical man with biologically unique men, an insatiable demand for finite resources is created. The individual is subordinated to the greater “needs” of the whole, preventive procedures become compulsory.

With dwindling autonomy, dependence on professionals rises even further. Soon enough the liberty to seek professional help becomes the right to treatment, which in turn becomes a duty to surrender to therapy, including legal sanctions for failure or refusal to undergo prevention, improvement and repair.

Welcome to the year 2020 in which desisting from wearing face masks or keeping distance to your own family members not only become criminalized but socially battled.

Unsick people have come to depend on professional care for the sake of their future health. The result is a morbid society that demands universal medicalization and a medical establishment that certifies universal morbidity.

And that is considered “the new normal.” Ivan Illich foresaw it back then, though he was by far not the first to notice where the professionalization of medicine was heading. More often in history than not the healer was a figure on the margins of society. Despite the progressive expropriation of every woman’s medical skills our grandparents still held remnants of the ability to heal themselves and each other. During the 70’s and 80’s most of the world’s more traditional cultures then underwent the destruction of their knowledge. It came upon them by way of “developmental aid”.

Suffering, healing, and dying, which are essentially intransitive activities that culture taught each man, are now claimed by technocracy as new areas of policy-making and are treated as malfunctions from which populations ought to be institutionally relieved. The goals of metropolitan medical civilization are thus in opposition to every single cultural health program they encounter in the process of progressive colonization.

Cognitive injustice is what the failure to acknowledge other ways of knowing – and healing – is called. Another word for the destruction of those knowledge systems is epistemicide eventually genocide by imperialistic scientism. Cognitive injustice denies livelihood and lives to whole classes or peoples. One cannot overstate the difference between traditional-cultural and industrial views on health and healing:

Cultures are systems of meanings, cosmopolitan civilization a system of techniques. Culture makes pain tolerable by integrating it into a meaningful setting; cosmopolitan civilization detaches pain from any subjective or intersubjective context in order to annihilate it. Culture makes pain tolerable by interpreting its necessity; only pain perceived as curable is intolerable.

 

Bantam 1976 ed.

Insufferable pain that cannot be relieved must inevitably lead to the end of any society, Illich proclaimed. Does that apply as well to an epidemic which can never be stopped? Can democracy survive the wholesale suspension of the division of power, of civil liberties and of human rights? Are the hostilities between the followers of different health paradigms harbingers of civil wars to come?

Among the many ways our civilization could have undergone collapse the one we are following right now surprises me. That an unpolitical caste like the medical doctors would play such a central role could not have been forseen… or could it?

The chief function of the physician becomes that of an umpire. He is the agent or representative of the social body, with the duty to make sure that everyone plays the game according to the rules. The rules, of course, forbid leaving the game and dying in any fashion that has not been specified by the umpire.

Dying of (or with, it seems in most cases) CoVid-19, especially doing so at home, does not constitute a permissible exit. Dying, Illich remarks, might be a consumer’s last act of resistance. But what is this CoVid-19, really, when its symptoms can be almost anything? What are those invisible entities called viruses? What is an infection and how do you know you are sick? The answers to these questions are not as obvious as streamlined media outlets would have us believe:

All disease is a socially created reality. Its meaning and the response it has evoked have a history. The study of this history will make us understand the degree to which we are prisoners of the medical ideology in which we were brought up.

In other cultures, what is sick and what is healthy can be quite different from what Western-industrial medicine assumes to be so. One must also admit that numerous elements of what constitutes the totality of the human experience – humour, relationship, belief, meaning, intuition, spirit… the list goes on and on and on – has no place in the scientific worldview at all, which means it gets overlooked deliberately. And even within the materialistic-mechanistic paradigm science can only show us the things it is looking for. Therefore its understanding of health fundamentally changed various times. Illich found, for instance, that,

As the doctor’s interest shifted from the sick to sickness, the hospital became a museum of disease.

It is important to see that nowaday’s medicine’s preoccupation with germs (and their killing) constitutes a gross exception among the healing traditions worldwide, including the tradition of our own culture until only recently. It limits the ability to approach health in a more holistic form, or from different angles, and it effectively dehumanizes us in many ways. Can you imagine a better symbol for the rendering of humans into controllable objects than the mandatory masking of the face? Considering that we are social animals, can you imagine a worse violation of human nature than the avoidance of closeness?

On the one hand, one may argue that this is the necessary price for staying alive and healthy. On the other, Illich points at research which seems to show that modern medicine neither helped to increase public health significantly – it had nothing to do with the extension of lifespans either – nor has it been more effective than other ways of healing. With relish he quotes from Oliver Wendell Holmet’s Medical Essays (Boston, 1883):

“I firmly believe that if the whole materia medica, as now used, could be sunk to the bottom of the sea, it would be all the better for mankind—and all the worse for the fishes,”

and he proposes his vision that,

no services are to be forcibly imposed on an individual against his will: no man, without his consent, shall be seized, imprisoned, hospitalized, treated, or otherwise molested in the name of health.

Illich’s conclusion as published in the last paragraph of Medical Nemesis reads like a prophet’s message from half a century ago, transmitted to an age gone insane over the war on micro-organisms waged by obsessive science, unleashed corporation sand amoral politics, in which ordinary people, the sick and the healthy alike, get consumed as cannon fodder. The enemy, though, is invisible, invincible and indestructible; which is good, for without it we could not be who we are. It could be that we could not be at all.

Man’s consciously lived fragility, individuality, and relatedness make the experience of pain, of sickness, and of death an integral part of his life. The ability to cope with this trio autonomously is fundamental to his health. As he becomes dependent on the management of his intimacy, he renounces his autonomy and his health must decline. The true miracle of modern medicine is diabolical. It consists in making not only individuals but whole populations survive on inhumanly low levels of personal health. Medical nemesis is the negative feedback of a social organization that set out to improve and equalize the opportunity for each man to cope in autonomy and ended by destroying it.

His idea is, of course, neither the abolishment of the institutional, professional medicine, nor the total surrender to curable sickness that some Christian sects practice, but a change of the mindset which lies at its foundation: from dependency on, and obedience to, faceless institutions towards interdependent freedom in the spirit of the Samaritan. According to Illich, professional health care would complement autonomous forms of staying in balanced condition, and the various ways of healing the human body and mind would be available in parallel.

In a 1974 Lancet essay anticipating his upcoming book Illich clarified the choices left to us:

The sickening technical and non-technical consequences of the institutionalisation of medicine coalesce to generate a new kind of suffering—anaesthetised and solitary survival in a world-wide hospital ward. […] Either the natural boundaries of human endeavour are estimated, recognised, and translated into politically determined limits, or the alternative to extinction is compulsory survival in a planned and engineered Hell. [Lancet 1974; i:918–21]

 

Post scriptum

Ivan Illich used to observe that, from the mid-1980’s on, the health sector has deteriorated even further than described in Medical Nemesis”. He said:

By reducing each person to ‘a life’, bioethics is helpless to prevent total management of the person, now transformed into a system. [Pathogenesis, Immunity and the Quality of Public Health. A lecture given in Hershey, PA, June 13th, 1994]

 

»Nobody has the right to obey.«

Poster to the exhibition
“Hannah Arendt & the 20th century
March 27th – October 18th 2020.

 


He meant to say that the processes of institutionalization and professionalization have reached a new stage in which the tool and its user can no longer be separated. People have become integral parts of systems. The next step, though, the machine-man-merger commonly know as transhumanism, already begins to establish itself as the successor. As progressive dehumanization visibly picks up speed, clearly, the time has arrived when resistance to oppression, medical or otherwise, can no longer remain limited to soap-box oratory. The cognitive dissonance that many of the intellectuals fell prey to – visiting a Hannah Arendt exposition in Berlin that has been advertised with her famous words, “Nobody has a right to obedience,” while following orders to wear masks in that Museum’s halls, not questioning the demand that “the Corona measures must never be questioned” (veterinarian Lothar Wieler, head of the German centre for disease control, the Robert Koch Institut) is a clear sign of historical lessons not learnt. Totalitarian rule will not return with a mustache and Caesar’s salute, but return it must to a society that succumbs to fear. Those who are aware of the folly need to stand up to end the umpires’ game right now. The alternative to the war on germs – healthy food, fresh air, clean water, loving community, positive attitude, autonomous posture, virtuous meaningful worldview – can be had for no price at all.

Instead, while – and because – a majority of people in industrialized areas surrender to the Corona regime, those critical of the anti-pandemic measures consciously live through that planned hell of a globalized hospital ward Illich was talking about. An increasing number seek refuge in voluntary death as permanent exposure to ordinary-folks-turned-soap-police makes life miserable to the point where the naked-faced cannot visit doctors, shops, temples, therapy, friends, family, work places, and administrative bodies any longer and life becomes a never-ending meaningless waiting game for relief. Most critics simply ask that their alternative, more autonomous ways of healing be respected – which is the one thing that the medical juggernaut can never allow.

 

Non-scientism: Rejecting Knowledge-as-Power

When, after the inauguration in January 2017 in D.C., Kellyanne Conway coined the term “alternate facts”, the resulting public outcry rightfully banned it into the realm of deception and falsehood. Facts are facts, as far as objective truths go. We may doubt the accuracy of the numbers of attendants in one, or both, of the rallies implied in White House press secretary Sean Spicer’s comparison, but uncertain numbers are not facts. As facts describe the materialist, reductionist, objective, scientific view on the universe, they have to be – and they are – discrete and accurate. Alternate facts don’t exist, period.
Alternate truths do, though. Facts are one aspect or layer of reality alongside others. When we include emotions, feelings, morality, intuition, belief, creativity, spirit, soul, body awareness, or other means of perception and ways of knowing, we can begin to make qualitative rather than quantitative statements about reality. Truth in the realm of phenomena and appearances is inescapably subjective in nature. So when you hear me uttering criticism in relation to science, its focus is usually on

  1. the claim that you can keep the observer completely separate from the observed, meaning to say that the scientist can perform a research without having an impact on the result;
  2. the claim that only scientific research results can describe reality accurately and that there can be no truth beside the things science can describe, meaning to say that science has a monopoly on reality, and that facts equal reality;
  3. the notion that we may trust scientific research results and simply believe them because, in principle, we could check their validity, even if we can’t.

I can call myself lucky if anybody read all this without condemning me as someone wearing a tin foil hat, but that would be a waste of hate. I am not rejecting science and its results as a whole. I question the quasi-religious way – scientism – in which its premises, methods, and knowledge are taken at face value. I have not measured the Earth’s circumference and I don’t know anybody who has; when I use 40,000km as a number for modeling an image of the world I live in, I am well aware that there have been – and there still are – other worldviews, and that it’s just a model. The number as such is absolutely meaningless without a framework of references in my individual subjective life. Still, many take facts as a device for establishing universal truths which helps them in their effort to dominate and control nature, the wild, the enemy, the unknown, or by whichever name the other goes.

Professor emeritus of African Studies at the University of New York, anthropologist Marimba Ani, in her seminal work “Yurugu: An Afrikan-centered Critique of European Cultural Thought and Behavior” (1994) identifies the claim for objectivity and universality as vehicles by which slavery, colonialism, cultural imperialism and globalization have been justified as rational, necessary behaviour. In other words, scientism’s claim to objectivity and universality of scientific knowledge is an expression of the West’s urge for domination.

The rejection of scientism therefore poses a threat to the Eurocentric world view. It thus undermines Western dominance. We find a similar notion in the work of professor emeritus of pedagogy at FH Wiesbaden, Marianne Gronemeyer who writes in, “Die Macht der Bedürfnisse” (approx., The power of needs, 1988), that trusting unknowingness more than knowing-it-all constitutes a threat to the premises of science.

Not committing oneself to the monopoly of science has yet another dimension: science, by its core principles, cannot allow the undiscovered, unexplored, and uncharted to exist. They pose a threat which is inherent to anything that has not been fathomed by “reason”: otherness, eeriness – a nuisance that is overgrowing everything. The exorbitant and insatiable obsession with safety, security, and certainty results from the attempt at limiting life to its purely positive aseptic aspects. It drives us to shine a light upon the very last corner of the world in order to turn it into means for satisfying the desire for safety and comprehension. This is how the not-yet-known which rises to awareness inevitably becomes a problem that cries for a solution.”

Albrecht Dürer, 1491/92

It seems, though, as if scientism is beginning to lose its power over people’s minds. Gronemeyer quotes Peter Sloterdijk (“Critique of Cynical Reason”, 1983), saying,

“Nobody believes anymore that today’s learning will prevent tomorrow’s problems. It’s almost certain that it causes them,”

and that

“You can’t be friends with knowledge any longer. Knowing what we know today we don’t consider embracing knowledge; instead, we ask ourselves how to face it without being petrified.”

Gronemeyer continues,

“Not-knowingness (in the sense of Non-scientism) opposes – or rather, evades – the compulsion to penetrate and enlighten,”

a) either by willfully ignoring the unknown, and remaining indifferent to it,
b) or by facing the unknown with awe and respect for its nature,
c) or by exploring the nature of one’s unknowingness, thus increasingly becoming skeptic of the things one takes for granted.

One of those things being the urge to collect endless amounts of factoids in the hope that those might deliver the foundation for protective measures against a future which scares us.

“Having to take a decision that is not based on certain knowledge is bad enough; taking decisions under the illusion of certainty, though, is a catastrophe.” –Amory B. Lovins (Soft Energy Paths”, 1977)

This has implications for the way we may deal with the converging existential threats humanity is facing today. Gronemeyer concludes:

Not-knowingness (i.e. Non-scientism) is not about gaining certainty in decision-making, it is relentlessly busying itself with uncovering the illusion of certainty […] Unknowingness is therefore calling for deliberation and cautiousness. Cautiousness, in turn, is much more connected to our ability to forbear than to our ability to effect. The current state of the world does not require our every last effort, it requires us to desist.”

Letting go of control

Kelly Brogan, psychiatrist, on a trip to Rajasthan, India, collected impressions that resonate with my own sense of being (here). A lot of what she describes got already lost for many a native, due to the fast-progressing urbanisation, mechanisation, automisation, utilisation and exploding consumption, but it is still somehow present in rural areas and can be felt, especially when I perform one of those quick leaps back and forth to Germany.
In her article Spirituality and Mental Illness, Kelly writes:

“They showed us the fact that loving creation allows them to love each other, and to love all that comes in their path. When the son asked me about my job, I seized up, certain that the notion of a psychiatrist would make no sense whatsoever to him. The idea that there are professionals trained to manage and alter the human experience through pharmaceutical drugs – to someone who has faith in all that comes, in the many ways that divinity can be expressed, and in the dividends of a commitment to integrity…to this person, Prozac would not compute. 
This is what India showed me.
It showed me what my American soul had forgotten…which is that there is something more beautiful, more sacred, more wondrous available when we live connected to our trust in something larger. Because this something larger lifts us up out of our limitations, our smallness, our distractions, and holds us in a web of the collective so that there is never something random, awful, and unlucky that can simply just happen. So that there is always meaning and ok-ness.”

Regarding psychiatry, she quotes Charles Eisenstein who said, “The reason that conventional psychiatry – whether pharmaceutical or psychoanalytic – is powerless to substantially help the vast majority of patients is that it does not, and cannot, recognize the wrongness of the world we live in,” and I really couldn’t agree more. Though, in some way, there is no wrong or right, there is just existence as such, on a certain level we are beings that need a framework to live within. Some frames work better than others, and some are utterly destructive because they are dysfunctional from the start:

“It has never been more clear to me that the Guild of Psychiatry is one of the greatest threats to a soul’s journey, perhaps simply because there is no acknowledgement of the soul. This is why I believe that avoiding and coming off of psychiatric medications is the greatest form of initiation to self that exists in the West today.”

An article worth reading, an author worth following.

I love my India

Have you seen the “This Happens Only In INDIA” album?
Damn, this not only makes me laugh out loud, it makes me emotional with feeling so intensely at home in India. Those photographs are the counterpiece to my returning to Germany and obersving how much people take care to avoid any potentially dangerous or embarrassing situation, how they go to great lenghts explaining to others what the rules are and how things are supposed to be, and how they police others into surrendering e.g. to traffic rules or neighbourly behaviour. What a miserable neighbourhood that is.

In India, so much is being done without using the mind, without referring to regulations, without anxiousness about future reverberations.
Yes, there are rules. Masses and masses of rules, and laws and regulations. But where there is no prosecutor, there is no judge – a saying from a tiny 80-Million-folks country called Germany that is most widely applied in an India of 1.3 billion, and guess what – they still don’t have anarchy there.
And yes, things are breaking down. Falling out of order all the time. Not working out in the first place, thanks to human error. But who cares; for sooner or later it would have happened anyway due to the demanding climate and the countless disintegrating animals the Tamils call ‘poochi’ which show us all too clearly that there is little benefit in looking far ahead. Indians can advise every Western punk what it truly means to live a no-future attitude.

When I see all those efforts made regarding standardization of tools, improving food hygiene, or forcing people into wearing helmets on their motorbikes, it really makes me sad how energy is wasted on creating a false safety that has no basis in this clime and culture. But I guess it only follows that first step of India having swallowed the consumerist lure.
Please, please, India. Get tired of it faster than me.

What a life! What a chance!

“If that happened to me, man, I’d just go… WILD!”
Have you ever heard someone say something like that? Me, I heard it all too often, and I felt like that myself all too often. Someone got murdered. Someone got raped. Someone got tortured. Someone got fired, or judged, or debased under the most unjust circumstances. Rage and anger or a feeling of unsettlement, powerlessness, or depression are the most natural reactions to have unto hearing or even suffering yourself such violation of human dignity. It drives us crazy, cries for revenge. No wonder we find those who commit such violations themselves been treated this way. Their suffering is the key to your suffering, so understanding your own grief in turn can be the key to your understanding their motives; they are taking revenge for their needs not being met; they are acting out the lessons they have learned.

Our first reaction to hearing about victims who were forgiving the perpetrators often is incredulity. “How can they? I don’t believe this.” Like Marshall Rosenberg speaking of the Rwandan woman who lost her whole family in the genocide, but shows no hate, no rejection, no call for revenge. She is not in denial. She is not suppressing the grief. On the contrary, her acceptance of grief, her commitment to vulnerability, her insight into the inevitability of physical suffering, is the one thing that healed her psychological wounds and drove her to work in a positive direction, for peace; to break the chain of unmet needs.
Rosenberg might have got her wrong, or he is exaggerating in order to promote his best-selling Non-violent communication books. But I don’t think so.

Having overcome huge amounts of life-long grudge and hatred myself within a few months, I found clear evidence to his accuracy of observation. The film Scared Sacred shows several more of them. Survivors of Bhopal, Hiroshima, 9/11, Intifada, the Khmer Rouge tyranny, the Jewish holocaust, and the wars in Bosnia and Afghanistan opened their hearts to film director Velcrow Ripper and showed how they developed their capacity to transcend hate, stopped thinking of themselves as victims, and turned the lessons learned from grief into positive actions.

From Rumi to Rosenberg, from Buddha to Eisenstein, from Jesus to Krishnamurti, from Ruppert to Adyashanti, from Native Americans to Indian fakirs, from the Shamans of South America to Kübler-Ross, people have shown that, while physical suffering may not be avoided, psychological suffering can be ended. It is merely stories we tell about the world and ourselves. While some say it takes courage to choose a bold one, I believe this is just another story about reasons for not moving on.

Suffering is learning, like making mistakes is learning. If we allow ourselves to examine the grief a certain behaviour brings, or the problems a certain technique creates, we find out about what doesn’t work, so we can turn to something that actually does. The trick is to let go of ideas that feel comfortable, yet don’t work. You don’t stick with a bridge-building technique that ended in a crash, do you? So you may not want to stick with hateful feelings forever, as well. And, as a society, we better not stick with the everyone-for-themselves paradigm, as it has proven to create tremendous amounts of suffering due to its intrinsic inability for meeting needs, both on individual and collective level.

So you see, all that philosophical stuff I am talking about all the time is deeply rooted in everyday life. It is connected to our individual experiences. I am far from preaching morals or virtues; all this is about discovering correlations, connections, ties, between our sense of being and the world at large. By using words, I am limited to offering concepts: the concept of interdependency; the concept of oneness. Don’t just accept them; try to find truth in yourself. If you feel like your psychological suffering means eternal disablement – go ahead; examine that to its farthest reach. Yet, apart from such concepts, there is an age-old insight, shared by all humanity, into a reality beyond suffering. If you can feel it, too, learn about people who touched it. They can help you to proceed.