• Ivan Illich

Scott-Samuel offers a clear and cogent memoir of Illich’s contributions to our perspective on medicine in society.¹ The brevity of his memoir should not, and does not, suggest that Illich dealt merely a glancing blow to the negatives in medicine’s dominance in matters of health. His thinking pried open the historically impenetrable vault of true belief that medicine is above critique, particularly by those who are not “qualified.” Illich clearly stunned the establishment with his powerful and often epigrammatic volleys at medicine’s hegemony regarding all-things-health, its often arrogant protectionism, and its failure to deal forthrightly with its shortcomings.

Scott-Samuel’s memoir helps us see Illich’s themes change to be sure, but they seem to be less evolutionary (re fundamental values, etc) than expansive—that is, more inclusive of medicine’s capacity to incorporate changes in society’s interests (and concerns) about health. Illich sensed, for example, the emergence of a powerful new “market” for achieving health and wellbeing and medicine’s quick response to incorporating these profitable dimensions into medical practice. More recently, Illich seemed to be warning that medicine was pathologising health in order to establish itself as the essential resource for promoting health. Scott-Samuel rightly emphasised Illich’s concern about the obsessive pursuit of a healthy body. Do we know anything at all about Illich’s reaction to the emerging thesis that health is largely determined by social and economic factors and forces well beyond medicine’s domain of influence? This, one might guess, could render his early concerns about the medical nemesis less ominous.

I would like to add to Scott-Samuel’s memoir a comment regarding Ivan Illich as a person, a personality framed by his diverse cultural experiences, education as a priest, and his working style (and work with associates like John McKnight). He was such an extraordinarily complex, multi-levelled, entertaining, provocative and occasionally irascible character! For me, it is impossible to separate Illich the scholar from Ivan the social person. One informed the other. He truly lived his own testimony!

I knew and admired his special qualities of mind and spirit and also glimpses, just glimpses, of his private side when we were together briefly in Copenhagen and New Haven (where he stayed at my home). Also, there were several times when we shared a speaking platform. These constitute a rather narrow pedestal upon which to make any insightful observations of Ivan beyond noting that he had a remarkable talent for seeing beyond the limits of our ordinary, predictable analyses of social issues. He would turn things upside down and shake well, letting new perspectives fall out, sometimes in an orderly way and sometimes in a jumble. No doubt about his shock appeal. He knew how to get your attention and to force debate, which, in turn, begat more debate. And so the intelligence began to churn, leaving some perplexed and others never to be the same again. I was in the second group.

Much has been said about Ivan’s intellectual contributions, so I can add little. We agreed more often than not, especially about what we now acknowledge as the important role of social capital.

I think it is necessary, while we stand in awe of his many gifts, that we remember that Ivan had his human side, sharing many traits common to us all. He knew how to enjoy every day and to help those around him not to doze off in the face of the joy of living. As far as I know, Ivan never wore a watch, which he called a “gauge,” and believed needlessly forced an artificial structure on our lives. But he would ask those “gauge bearers” around him many time related questions, for example, when a plane is to depart, how much time before a lecture, when is he expected to be at a meeting, how long is it to the train, etc. Ivan was full of seeming contradictions, but they were really set up to turn our minds around. He despised linear thinking, and worked to rid us of it whenever and however he could.

By all reports, and certainly by the public image Illich projected, his lifestyle was simple, almost spartan. But he had his moments that revealed his pleasure in some of life’s more plebian joys. One such moment took place in a Copenhagen supermarket where Illich joined me in shopping for dinner to be prepared for him after a talk. He insisted initially that “a simple potato” would suffice, but when encouraged to add a few other items, he did so with gusto and with a penchant for choice foods and wines! He revealed to me then and on several other homey occasions that when the spotlight was not on him as a scholar-performer, he thoroughly enjoyed his role as a “family member.”