Straight to the point

Who the hell is Ivan Illich? A philosopher and medieval scholar born in Vienna in 1926, a Catholic priest whose service started out in New York’s toughest neighbourhoods. An educator and a radical. An extreme polyglot, speaker of Italian, Spanish, French, German, Latin, ancient Greek, Hindi and Portuguese. A self-described “errant pilgrim”, a wandering wise man, a theological rap on the door. Handsome too. Think of McConaughey’s character in Contact, but with a splash of the Unabomber.

A righteous scourge where progress is concerned. He fell foul of feminists in the Eighties on account of a book about gender that championed the old-fashioned way of doing sex. Traditional sex roles as a bulwark against undiluted consumer culture or some such gender complementarian red-herring. He was greeted at the college campus in Marburg where he was teaching at the time by a mob brandishing a giant papier-mâché phallus. His reputation never recovered. Up until then, he’d been something of a fixture in academic circles. A Roman Catholic priest-cum-anarchic theorist. A bit of a celebrity, even. An ascetic who never really called anywhere home. His final years of transitory earthly existence he spent refusing to treat a large, painful growth emanating from his neck. Reputedly self-medicated by puffing on opium instead.

The corruption of the best is the worst, a Latin Maxim he frequently cited. Illich was at war with the systematisation of charity. The systematisation of everything, in fact. His most famous book — Deschooling Society — is a denunciation of compulsory education, of the “specialised torpor” it can’t help but induce. “Giving” in the Christian sense should not always have to be broken down into rules. This was the essential message embedded in the parable of the Good Samaritan. You answered the call of a specific suffering. As in antiquity, you should not be bound by place or people, but free to love at will. With the institutionalisation of the Christian message, with its ascension to power, the inclination to force the hand of kindness took hold. The mystery was sucked right out of it, and with it went so much of the power and the glory. The church became the forerunner of the law-abiding modern state, the modern state whose incessant social engineering Illich heaps scorn upon from behind a wall of medieval scholarship.

However, it is a later Illich book, in which he turned the same line of attack onto modern medicine, that I find most provocatively stimulating in a 21st-century context. Written in the Seventies, Limits to Medicine — Medical Nemesis: The Expropriation of Health (catchy title) constitutes one of several blistering critiques of modernity and post-industrial alienation Illich produced in his heyday. The gist of it is that the more we lather ourselves in technology, the more of our autonomy we inevitably sacrifice, and the more technology we need just to get by in turn. Instead of enhancing nature, we attempt to step beyond it. A self-replenishing negative feedback loop ensues. The result: Nemesis, the envy of the gods. “Unbounded material progress has become everyman’s goal. Industrial hubris has destroyed the mythical framework of limits to irrational fantasies, has made technical answers to mad dreams seem rational…” I wonder what he might have made of Dignitas?

For Illich, anguish is a part of health, and the inner resources we acquire putting up with it are more precious than decent blood pressure, than the odd bit of surgery. They are fundamental to the building of community. What he calls the “art of suffering” is paramount. In all pain there is a question mark, he claims. To smother it out entirely is to prioritise one aspect of healing — treatment — at the cost of atrophying all of our cultural and spiritual strengths when dealing with agony. Pain-killing gone too far renders us little more than spectators of our own decay. If we don’t bother trying to turn suffering into meaning, we are left ever more dependent on “the machine”.

The book is broken up into three sections. Beginning with clinical iatrogenesis, when pain and death are a direct result of medical procedure — most obviously, when myopic surgeons do things like amputate the wrong limb, and more obliquely through drug side-effects or antibiotic resistance. Here you’ll lumber into a swamp of footnotes, and far too many Seventies-born statistics, some of which have aged badly. For a start, treatment for cardiovascular disease has come a long way in the last 50 years. You can argue that medical practice sponsors a morbid society by inculcating slovenly lifestyles, but credit where it’s due, I’d far rather suffer this illness today than in 1973.

The sections covering social and cultural iatrogenesis in turn tackle what becomes of society when health policies reinforce an industrial organisation that encourages ill-health. He’s not wrong when he declares that the more energy invested in medicine as a commodity, the greater the delusion that society has a supply of health locked away somewhere. I’ve lived my entire life under this delusion, and will no doubt continue to do so. In fact I’m a prime candidate for an Illichian makeover. I’m depressive, over-ambitious, obsessive-compulsive, an addict and a complete neurotic. I’ve leapt under the knife at every available opportunity. Five times in all. As an adult I’ve had the tonsils out, despite being told it was non-essential. I’ve had two painless, totally benign lumps removed from my neck. Most recently I had a node sliced off of my right vocal cord. I’m the kind of person that starts hammering Solpadine Max the moment I get a sniffle. I expect industrial medicine to sort it, whatever it is, and in no time at all. No self-healing capacity whatsoever.

Illich claims that the negative function of money is the devaluation of that which cannot be bought and sold. The more we dismantle any natural ability to cope, the more we shroud ourselves in pseudo-divine scientist mystification. Obvious enough statements. What’s more interesting is Illich’s attempts to reach behind this dilemma. In his opinion, blaming Big Pharma for the abuse of proscribed chemicals is tantamount to blaming the mafia for the abuse of street drugs. Short-sighted and pointless. When the market for consumer goods reaches a critical level, civilisation convinces itself that the human condition can be remodelled without limit: this is his real gripe, what he considers the root of the problem. When we hit a brick wall, the same thing that birthed the problem is reached for. This cycle of over-consumption he sums up as a kind of compulsive nostalgia, a desperate hankering for yesterday’s progress. In a world unfit for human habitation, Illich’s notion of the “patient” becomes an accomplice to the lie that his failings are biological, as opposed to systemic.

The lofty Catholic material really starts to sing once you get into old age and death in part three: cultural iatrogenesis. “From Stockholm to Wichita the towers of the medical centre impress upon the landscape the promise of a conspicuous final embrace…” Illich is very much in favour of old people being given a corner to die in at the family gaff as opposed to subjecting them to invasive and repeated medical procedures, and instead of outsourcing terminal decline to the old folks’ homes and the hospice. A cruel inversion here he points out: to die at home now is the preserve of the rich. Yet, the more wealth the country from which you hail globally has, the more likely the man in the street is to wind up surrounded by strangers in the closing chapter of his life.

From what I’ve seen, death in the mountains of Kabyle, where half of my family live, looks like more fun than death in working-class England. The intergenerational support network provided by the more “primitive” society is something most of us no doubt miss, subconsciously but bitterly. Have we shunned death? Illich certainly believes so. For us, death is crisis, instead of something to which we relate every step of the way, instead of that which informs and enriches our ability to fully live. Keep it out of sight. It spoils the utopian fantasy that everything is manageable, if we just hurl enough cold rationality at it. Shrouding it in an air of “crisis” justifies near limitless ineffectiveness where science is concerned, our replacement for religion. An excess of futile treatments in the dying embers being symbolic of this. As far as Illich is concerned, at the moment of demise, the insured are paying for participation in their own funeral rites and little more: “in an insidious way the doctor provides each citizen at the last hour with an encounter with society’s deadening dream of infinite power”.

In his antipathy for the industrial world, a lot of the time he goes way too far. He appears drunk on his own ideological fervour. On a botched suicide he writes: “I know of a woman who tried, unsuccessfully, to kill herself. She was brought to the hospital in a coma, with a bullet lodged in her spine. Using heroic measures the surgeon kept her alive, and he considers her case a success; he no longer has to worry about her ever attempting suicide again.” I like a bit of hardcore cynicism, it’s refreshing in a world which seems sworn to naïveté, but isn’t this beyond harsh where the medical practice in question is concerned? He’s not into birth control — I don’t agree but I can look past that, he’s a man of the cloth after all, it’s kind of to be expected — but what good does this statement do anybody? At one point he even appears to call for the scapegoating of doctors as a plausible solution to the overextension of medicine into human civilisation. That to me just sounds like sour grapes.

You’ll often run into this problem reading Illich. Any remedy shy of some kind of Marxism-tinged, back-to-basics, Catholic revolution-cum-devolution is only furthering the grief, only enabling the torment of the species further. He attacks welfare as only deepening the problem, for instance. Unless people are downing tools entirely, they’re not doing enough. They’re complicit in their own damnation. I like the fiery tone, the austere biblical voice, but come on, let’s be pragmatic about this. At the end of the day, who’s going to remove your appendix, your uncle Abdul? Your gran?

That being said, prescribed medication is still the third highest cause of death globally. Some of this stuff has aged badly, but aspects of the underlying philosophical argument he hammers home are perhaps even more valuable today than at the time of writing. Overly radical yes, but Illich is also something of a seer. He’s maybe not your man for a solution, but through the prism of his very specific and expansive learning we can look at the mess of our current state of affairs with fresh clarity.

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