“Medical Nemisis: The Expropriation of Health” by Ivan Illich

The so-called health professionals have an even deeper, culturally health-defying effect insofar as they destroy the potential of people to deal with their human weakness, vulnerability, and uniqueness in a personal and autonomous way.

Social iatrogenesis is at work when health care is turned into a standardized item, a staple; when all suffering is hospitalized and homes become inhospitable to birth, sickness, and death; when the language in which people could experience their bodies is turned into bureaucratic gobbledegook; or when suffering, mourning, and healing outside the patient role are labeled a form of deviance.

A radical monopoly feeds on itself. Iatrogenic medicine reinforces a morbid society in which social control of the population by the medical system turns into a principal economic activity.

The remaining 39% were subjected to examination by a group of physicians, who selected 45% of these for tonsillectomy and rejected the rest. The rejected children were re-examined by another group of physicians, who recommended tonsillectomy for the 46% of those remaining after the first exam. When the rejected children were examined a third time, a similar percentage was selected for tonsillectomy so that after three exams only 65 of the initial 1000 had not been recommended for tonsillectomy. This test was conducted at a free clinic, where financial consideration could not explain the bias.

Like any other growth industry, the health system directs its products where demand seems unlimited: into defense against death.

These heroic performances serve as a rain-dance for millions, a liturgy in which realistic hopes for autonomous life are transmuted into the delusion that doctors will deliver health from outer space.

The result is a morbid society that demands universal medicalization and a medical establishment that certifies universal morbidity.

In a morbid society, the belief prevails that defined and diagnosed ill-health is infinitely preferable to any other form of negative label or to no label at all. It is better than criminal or political deviance, better than laziness, better than self-chosen absence from work. More and more people subconsciously know that they are sick and tired of their jobs and their leisure passivities, but they want to hear the lie that physical illness relieves them of social and political responsibilities. They want their doctor to act as lawyer and priest. As a lawyer, the doctor exempts the patient from his normal duties and enables him to cash in on the insurance fund he was forced to build. As a priest, he becomes the patient’s accomplice in creating the myth that he is an innocent victim of biological mechanisms rather than a lazy, greedy, or envious deserter of a social struggle for control over the tools of production. Social life becomes a giving and receiving of therapy: medical, psychiatric, pedagogic, or geriatric. Claiming access to treatment becomes a political duty, and medical certification a powerful device of social control.

People unlearn the acceptance of suffering as an inevitable part of their conscious coping with reality and learn to interpret every ache as an indicator of their need for padding or pampering. Traditional cultures confront pain, impairment, and death by interpreting them as challenges soliciting a response from the individual under stress; medical civilisation turns them into demands made by individuals on the economy, into problems that can be managed orĀ producedĀ out of existence.

Now an increasing portion of all pain is man-made, a side-effect of strategies for industrial expansion. Pain has ceased to be conceived as a “natural” or “metaphysical” evil. It is a social curse, and to stop the “masses” from cursing society when they are pain-stricken, the industrial system delivers them medical pain-killers. Pain thus turns into a demand for more drugs, hospitals, medical services, and other outputs of corporate, impersonal care and into political support for further corporate growth no matter what its human, social, or economic cost. Pain has become a political issue which gives rise to a snowballing demand on the part of anesthesia consumers for artificially induced insensibility, unawareness, and even unconsciousness.

Whereas culture recognizes pain as an intrinsic, intimate, and incommunicable “disvalue,” medical civilization focuses primarily on pain as a systemic reaction that can be verified, measured, and regulated.

In this context, it now seems rational to flee pain rather than face it, even at the cost of giving up intense aliveness. It seems reasonable to eliminate pain, even at the cost of losing independence. It seems enlightened to deny legitimacy to all nontechnical issues that pain raises, even if this means turning patients into pets. With rising levels of induced insensitivity to pain, the capacity to experience the simple joys and pleasures of life has equally declined. Increasingly stronger stimuli are needed to provide people in an anesthetic society with any sense of being alive. Drugs, violence, and horror turn into increasingly powerful stimuli that can still elicit an experience of self. Widespread anesthesia increases the demand for excitation by noise, speed, violence – no matter how destructive.

It is the point at which a consumer, trained at great expense, must finally be written off as a total loss. Dying has become the ultimate form of consumer resistance.

The destructive power of medical overexpansion does not, of course, mean that sanitation, inoculation, and vector control, well-distributed health education, healthy architecture, and safe machinery, general competence in first aid, equally distributed access to dental and primary medical care, as well as judiciously selected complex services, could not all fit into a truly modern culture that fostered self-care and autonomy. As long as an engineered intervention in the relationship between individuals and the environment remains below a certain intensity, relative to the range of the individual’s freedom of action, such intervention could enhance the organism’s competence in coping and creating its own future. But beyond a certain level, the heteronomous management of life will inevitably first restrict, then cripple, and finally paralyze the organism’s nontrivial responses, and what was meant to constitute health care will turn into a specific form of health denial.