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Less medicine, more health: a memoir of Ivan Illich
  1. Alex Scott-Samuel
  1. Liverpool Public Health Observatory, Department of Public Health, University of Liverpool, Liverpool L69 3GB, UK;

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    Contemporary medicine is not comfortable with polymaths: it cannot easily handle visions that transcend its narrowly defined specialist boundaries. This is paradoxical given medicine’s cultural imperialism—the ways in which it constantly crosses social boundaries and in which (as Marxists have it) it continually reproduces itself as it gobbles up more areas of our social lives (a current example being the invention of “female sexual dysfunction”1).

    Ivan Illich was well ahead of his time2 in identifying and classifying the health hazards of the “medicalisation of society”. In the mid-1970s he used medicine as an example of his general thesis that industrialisation and bureaucracy were appropriating areas of life previously regarded as personal. In particular, he identified how drugs and other medical technologies remove personal responsibility for suffering and create dependence on health care, which itself has a wide range of hazardous slide effects.3

    Perhaps it is clearer today that medicine’s cultural imperialism is not itself a cultural product but is primarily a result of the profit motive. None the less, it is paradoxical that Illich’s critique was at the time so unwelcome to the “health left”. Navarro found it “unhistorical and unempirical”,4 while for Berliner, Illich gave “additional ammunition to those who seek monopoly capital control of health providers and the health system”.5 Notable among wide ranging characterisations of Illich’s thesis were romantic idealism6 and “vulgar Marxism”.7

    Illich’s dramatic and powerful language enhanced both his positive and negative impacts: “The medical establishment has become a major threat to health”3; “…it now seems rational to flee pain rather than to face it”2; “…irreparable damage accompanies industrial expansion in all sectors”.2

    His perspective was by no means a static one: 10 years after Medical Nemesis, Illich felt that “Today’s major pathogen is, I suspect, the pursuit of a healthy body”.8 And 20 years on, he saw society as viewing life in systems terms, and asked despairingly “…is there still an autonomous self capable of the act of dying?”9 Now holding a gentler view of medicine, he could “see no compelling reason why one who practises medicine could not also be a friend…”9

    I met Illich briefly in 1978 when he visited Manchester and we corresponded for two years. In retrospect, his thesis of the disabling of society through the direct dominance of professionalism and industrialisation seems over-simplistic. Clearly it lacked a critique of capitalism—which is surely the driving force behind professional hegemony. It also gave insufficient credit to the achievements of medicine—as a diabetic with retinopathy, I’d certainly be dead or blind without insulin or the laser. But as a preacher of revolution in the politics of health, Illich had few equals.

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