What Does It Mean To Be “Healthy”? | Ivan Illich On Health & The Medical Industrial Complex
While the work of Ivan Illich offers remarkable and counterintuitive insights into a variety of aspects of the modern world, he is best known as a critic of both the modern educational system and the modern health system. In one of his most influential works, Limits to Medicine: Medical Nemesis, The Expropriation of Health, he takes a serious look at the modern medical establishment and offers robust critiques of both its existential legitimacy as well as its practical results. Today’s quote provides a good place to consider his critique:
“A world of optimal and widespread health is obviously a world of minimal and only occasional medical intervention. Healthy people are those who live in healthy homes on a healthy diet in an environment equally fit for birth, growth, work, healing, and dying; they are sustained by a culture that enhances the conscious acceptance of limits to population, of aging, of incomplete recovery and ever- imminent death. Healthy people need minimal bureaucratic interference to mate, give birth, share the human condition, and die.
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.”
– Ivan Illich, Limits to Medicine: Medical Nemesis, The Expropriation of Health
Perhaps I have bitten off more than I can chew with this quote(!) There are so many things in this quote that we could consider, that’s it’s difficult to know where to begin. I’d like to focus on this part: “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.”
Central to Illich’s argument is that in order for humans to lead healthy and happy lives, we must be empowered to deal with the reality of our human frailty and mortality on our own, without the intervention of outside institutions. When we outsource these things, we give up our autonomy and control. In so doing, we find ourselves unable to properly address the most serious existential reality of our physical lives: that we are not invincible, and that we will eventually die.
The modern medical industrial complex destroys the communities of health that used to be baked into our social structures, it relieves us of individual responsibility for our own health, and does everything it can to address each person’s inevitable decline. Illich argues that in order for a person to be truly healthy, they must be empowered to accept the reality of their mortality, rather than ignoring it. The reality, of course, is that regardless of the progress science and medicine have made, human mortality is a fact of life, and because our culture doesn’t know how to process and live with this fact, we are stressed and deeply troubled by the reality that we’re trying to avoid.
Our culture’s avoidance of death is perhaps most visible in the way in which we deal with the elderly, the dying, and the dead. Traditional healthy cultures care for and honor the elderly, offering them a loving and dignified end to their life. In stark contrast to this, the modern world tries to hide the elderly out of its sight. We hire caregivers to care for them, and morticians to deal with their bodies (by “beautifying” them) after they die. It is no wonder that our culture experiences a deep unease when it comes to the topic of death and dying.
OK…that’s it for today! I hope you enjoyed this latest look at the work of Ivan Illich…as always, stay tuned for more by subscribing and downloading The How Did We Get Here? Reading List…and I will see you soon!