I'm now reading Ivan Illich's Medical Nemesis: The Expropriation of Health. It's not the first book I've read by Illich, but it holds a special place, I think, in terms of his coming into his own as a writer and thinker. In a number of places you could even call it prophetic. A passage:
Diagnosis always intensifies stress, defines incapacity, imposes inactivity, and focuses apprehension on non-recovery, on uncertainty, and on one's dependence on future medical findings, all of which amounts to a loss of autonomy for self-definition. It also isolates a person in a special role, separates him from the normal and healthy, and requires submission to the authority of specialized personnel. Once a society organizes for a preventive disease hunt, it gives epidemic proportions to diagnosis. This ultimate triumph of therapeutic culture turns the independence of the average healthy person into an intolerable form of deviance.
In the long run the main activity of such an inner-directed systems society leads to the phantom production of life expectancy as a commodity. 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, and the right of the patient to withhold consent to his own treatment vanishes as the doctor argues that he must submit to diagnosis, since society cannot afford the burden of curative procedures that would be even more expensive.
In these two paragraphs you can see the root of some things that would grow to immense proportions. The ability of a single disease to dominate the entire public agenda as long as government favored scientists choose to make it the top priority, perhaps for more than two years. Countries with legalized euthanasia getting trigger happy with it. The driver of much of this is the increased power of the pharmaceutical industry, which in many cases becomes untouchable. This is a danger Illich saw coming as well.
2 comments:
It looks as if Ivan Ilich had an amazingly good understanding of modern medicine a long time ago, certainly long before I'd begun to think of such things. The portion you've quoted describes very well that we live in an overly dependent society where the doctor's diagnosis and treatment have become the mainstay of our existence.
If it isn't new forms of medical technology looking to fill the hospitals (ie, the machine that goes 'ping!'), it's the pharmaceutical companies pushing their prescriptions or the medical insurers overcharging us or the doctors actually misdiagnosing patients. The end result of this massive societal intrusion of medical care is a system that is counter-productive, crisis driven, bureaucratically motivated, and downright dangerous to personal health.
We hadn't been aware of Canada's 'maid service' until very recently and I can't help but wonder if most Canadians have little or no knowledge about it. There are some very shocking stories about how the country is euthanising the poor..
He was way ahead of the curve, it's true. There are definitely people writing good stuff on iatrogenesis and the medical industry now. Mary Harrington at Unherd is always worth reading. But I give Illich credit for seeing a lot of things early on, when HMOs, for one, were just getting started.
The general state of things at one time was that you were sick if you felt sick or complained about something. Otherwise health was assumed to be the default. And of course it was understood that some people were hypochondriacs. Now the medical establishment is seen as the source of health, and everyone is a patient whether they want to be or not. Hypochondria sometimes seems to be encouraged. Oh, and that scene from Meaning of Life was pretty prescient as well.
The idea of euthanizing the poor is quite shocking if that's what's going on. I mean, the precedents aren't good. Many Western countries have shown insufficient resistance to bad ideas of late.
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