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.
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]
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.