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Ivan Illich, 1926-2002
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Ivan Illich, the polyglot Austro-Croatian-Sephardic-Mexican-American philosopher and social theorist, died at the beginning of December last in Bremen, Germany. He had his hour of fame in the first half of the 1970s, when he appeared to be the most radical radical on the market, but afterwards went out of fashion and soon faded both from view and from the bookshops. Among the documents I found during a recent internet search was a plaintive request from an aging devotee for information about Illich’s current whereabouts and activities. The person asking for this information sounded distraught, like a blind man who had lost his guide dog.
Illich was valued during his comparatively short period of fame for the destructive possibilities of his criticisms of almost all the institutions of industrial society, capitalist or communist, in books such as Deschooling Society (1971) and Medical Nemesis (1975). Since there was not the slightest likelihood of anyone in the Soviet Union giving him a platform or taking him seriously, his criticisms appeared de facto to be of the left: but, on reading him, one is never quite sure whether he was a follower of Trotsky or Joseph de Maistre. His training as a Catholic priest—he later broke from the Church, having applied to it the very same criticisms he applied to all other institutions—was evident in all his work.
Illich delighted the political activists of his day with statements such as “For most men the right to learn is curtailed by the obligation to attend school,” and “The medical establishment has become a major threat to health.” Could any sentiments be more revolutionary than those? Henceforth you could cheek a teacher, or challenge a doctor’s diagnosis, secure in the knowledge that you were helping to bring about the deschooling or demedicalization that Illich advocated. He appeared to be against all forms of authority, even—or especially—those hitherto thought of as benign. For it was precisely in the seeming benignity of teachers and doctors that their danger lay.
And yet Illich was deeply conservative, or at least he would have been had he been born in the Middle Ages. The word reactionary fitted him quite well, insofar as he regarded pre-modern forms of existence as being in may ways superior to our own. He was an anti-Enlightenment figure: while he believed in the value of rational argument and of empirical evidence, and used them himself (as indeed did de Maistre), he certainly did not believe in a heaven on earth brought about by rational action on the part of benevolent governments and bureaucracies. He was completely unimpressed by supposed evidence of progress such as declining infant mortality rates, rising life expectancies, or increased levels of consumption. Indeed, he thought modern man was living in a hell of his own creation: the revolution of rising expectations was really the institutionalization of permanent disappointment and therefore of existential bitterness.
My attitude to Illich was composed half of admiration, half of irritation. He had a distinctly prophetic quality, but he could also be very silly, and some of the things he said were destructive of civilization itself. In Deschooling Society, for example, he stated that “The emerging counter-culture reaffirms the values of semantic content above the efficiency of increased and more rigid syntax.” This endorsement of poor grammar is a little rich coming from a man who studied at the Gregorian University, had a doctorate in history from the University of Salzburg, and was completely fluent in at least five languages, all of which he spoke grammatically as well as idiomatically. No doctrine, indeed, could have been better fitted in practice to enclose forever the poor of western nations in the restricted world in which they found themselves, and exclude them permanently from the worlds of culture, science, and philosophy, while at the same time persuading the self-indulgent scions of privilege that the merest of their spontaneous vaporings was of imperishable value.
And yet in the same book Illich was undoubtedly prescient about the effects of the relentless hypertrophy of formal education and its attendant bureaucracy: how such hypertrophy would inexorably widen the gap between formal schooling and real education. And I think he was one of the few men who would genuinely have understood why, after several years of residence in Africa, I came to the conclusion that mass formal education in the western style was catastrophic in its effects on the continent. Such education is, indeed, the fifth horseman of the African apocalypse.
Medical Nemesis was Illich’s book that most affected me. It was published just after I qualified as a doctor, and I was not entirely pleased to discover that in his opinion the whole medical enterprise was harmful to humanity: I was on duty every second night, and one of the very slight compensations for this unhappy state of affairs was the illusion I might be doing some good to that tiny part of humanity that came within my purview. Soon I was to go to Africa, where I encountered many people who walked fifty or one hundred miles, despite being very ill, to the hospital in which I worked. Either they mistook their own interests, or Illich was wrong.
Still, Illich’s arguments were not so easily disposed of. He argued first that the health of a population had very little to do with its access to doctors and to medical care, and that the tangible benefits that doctors conferred were more than outweighed by the tangible harm that they did. He argued second (and more importantly) that the medical enterprise gave rise to unrealistic expectations in the population it served, disguising from it the fact that suffering was an inevitable part of human life and thus deforming its entire personality. Furthermore, medicine as a profession had inbuilt imperialist pretensions: more and more of ordinary human life came under its jurisdiction.
In many respects, Illich was both right and prescient. It is undoubtedly true that the health of a nation (within quite wide limits) is not proportional either to the number of doctors, to the amount spent per capita on health care. The principal effect of many screening procedures, practiced upon millions of people, is uselessly to raise their anxieties (they are generally entirely ignorant of the statistical reasoning upon which screening tests are performed). It is a moot point whether a technical triumph such as in vitro fertilization has increased the sum of human happiness by granting the dearest wish of a few, or decreased it by dashing the hopes of three times as many. Indeed, by raising the hopes in the first place, it has probably made the condition of childlessness, which might otherwise have been accepted with fortitude, worse than it was before. This was the kind of argument much favored by Illich, and it is far from completely irrational.
Moreover, the Diagnostic and Statistical Manual of the American Psychiatric Association renders so much of human behavior an illness that a satirical paper was once published in the Lancet suggesting that happiness, being outside the statistical norm, was a disease. This diagnostic expansionism would not have surprised Illich: on the contrary, he foresaw it and thought it was inevitable, once medicine was turned into a self-appointing profession with official powers. Nor would it have surprised him that the widespread prescription of allegedly powerful antidepressants has not lessened either human misery or dissatisfaction.
Illich was a modern opponent of the Promethean bargain, whose benefits the political right and left alike usually take for granted. According to Illich, modern man’s fundamental error is to believe in the possibility of progress through advancing knowledge and technique, administered by others. This has led not only to a complete and alienating dependence on experts, but to a crudely materialist outlook, in which personal well-being is measured by physical possessions. I confess that whenever I see a crowd of shoppers, I think (as did Illich) of Sisyphus. Do the crowds really believe that the purchase of yet another unnecessary pair of jeans or piece of gadgetry, for the price of which they have labored, will afford them lasting satisfaction? Will they not be out shopping for even more equally unsatisfying items by the end of the week, because the former purchases disappointed, just as they always did in the past? And will they never learn from their own experience? Can novelty ever confer happiness upon them? Or are they on a treadmill, unable to get off for fear of understanding its futility?
In like manner, Illich saw pain as more than a mere technical problem to be solved by drugs and surgery. The medical profession, he said, holds out the false hope that pain (and other forms of suffering) can be eliminated by its ministrations. In the past, however, before the medical profession achieved its current importance and simulacrum of efficacy, pain and suffering were understood to be an intrinsic and unavoidable part of human life, that had inevitably to be faced and given meaning. In practice, it was religion that gave cosmic meaning not only to pain and suffering, but to the rest of life. Not to accept pain and suffering, when in fact they are as ineluctable as ever, whatever the medical profession might claim or encourage its clientele to hope, is paradoxically to increase their dominion: for without meaning, they are either arbitrary and meaningless, or unjust. To fight against suffering is therefore to increase suffering.
This is not only a point of view that the medical profession generally rejects, but is an answer to a question that it refuses to ask. At the same time, Illich was also guilty of some serious evasion: he did not provide us with a guide as to how to distinguish avoidable from unavoidable pain and suffering. In the context of an entire life, pain and suffering may be inevitable, but surely not that consequent upon the inadequate treatment of a broken leg. To distinguish between the two types calls for judgment: precisely the quality that a good doctor should have.
It would be easy to condemn Illich as a hypocrite. He believed in bicycles and speed limits of fifteen miles an hour, yet jetted around the world, crossing the Atlantic innumerable times, and never by ecologically-friendly row-boat. He condemned formal education, yet spent much of his career teaching in universities. But the obituary in Le Monde mentioned that for the last twelve years of his life, from the ages of sixty-four to seventy-six, he suffered from a disfiguring tumor for which he refused to seek medical treatment. No doubt his desire to prove a point lent meaning to his suffering. For myself, I find something moving in his stubbornness.
He was a flawed figure as a man and as a thinker: but so, no doubt, are we all. And unlike the other radicals of the era such as Herbert Marcuse, he still repays reading. Being not easily pigeon-holed, he forces us to think.
This article originally appeared in The New Criterion, Volume 21 January 2003, on page 78
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