Ivan Illich, born in Vienna in 1926, was an Austrian philosopher and Roman Catholic priest best recognised for his works claiming that the benefits of the majority of modern technology and society are simply an illusion (Cooley, 2015). He argued that these were a way to undermine a human’s ability to care for themselves, along with their power and dignity (Cooley, 2015). Illich placed much of his focus on the education and modern medical systems, accusing them both of privatising and manipulating life (Cooley, 2015). His major works included the likes of ‘Medical Nemesis: The Expropriation of Health’ (1976), from which his theories gained him much notability. One such theory included ‘medical imperialism’, explaining his belief that the medical system was gaining too much power over society. This is an extension of medicalisation, moving from simply controlling its own growth to expanding and trying to control society, defining what is a ‘normal’ body and what is ‘deviant’/against ‘normal’ standards (Illich, 1976).
In his 1975 work, Illich argued that despite claims that medicine and increased intervention of the health system in the life of humans was improving their quality of life, it was in fact doing the opposite. He viewed the system as a “major threat to health” and that diagnoses’ such as depression, disability and infection were becoming bigger killers than any accidents at work or on the roads (Illich, 2003). Illich does recognise that these institutions may have been created initially to protect the common person against nature caused illnesses (such as due to weather) and against injustices of the ruling class (Illich, 2003). He believed that the common ailments and feelings of helplessness are simply side effects of these attempts (Illich, 2003). He stated, “Progress has come with a vengeance which cannot be called a price” (Illich, 2003, 919), meaning that all the progress that is supposedly being made by the medical institution is coming at an unfair price that we should not have to pay.
In Illich’s opinion, things such as pain and sickness are a reality of humanity, and the ability to cope with these ourselves is what makes us ‘healthy’, it is the ‘normality’ of human’s bodies (Illich, 1976). Modern medicine has become too arrogant with the taking on of its mission to eradicate these realities and is therefore removing an aspect which makes us human (Illich, 1976). The medical system has begun to view itself as ‘godlike’ in its attempt to eradicate these natural realities of life and is attempting to strengthen the position of itself as the only body able to deal with illness (Illich, 1976). In simple terms, the medical profession is attempting to convince the population that they cannot survive without their help, that they have valuable knowledge and the general population therefore does not have a good enough ability to look after matters of health on their own. He sees this as a ‘medical imperialism’, with the medical system trying to take control in all matters of life by increasing the public’s reliance.
Illich pointed out the fact that there has been no evidence given of any relationship between the “mutation of sickness and the so-called progress of medicine” (Illich, 1976, 5). Most people will believe that someone in their lives is still with them as a result of the intervention of the medical system in their lives (Illich, 1976). He believed that the changes in the health status on the nation exist as a result of technological advancements and not down to the activities carried out by these so-called medical professionals with their costly equipment (Illich, 1976). Throughout history, disease epidemics have come and gone time and time again, and the impact that a doctor has had on a given epidemic in the last century has been no more significant than the impact of priests in the past (Illich, 1976).
Illich discusses in much depth the idea of ’iatrogenesis’, meaning harm that is done by doctors (O’Mahony, 2016). He recognises three different types of iatrogenesis: clinical, social and cultural (Illich, 1976). Clinical iatrogenesis refers to “undesirable side-effects” of a doctor’s direct actions towards a patient through mistakes in treatment or attempts to avoid prosecution and blame for their actions (Illich, 1976, 10). It is the direct harm done by the medical body in its treatment of a patient. Illich himself pointed out that 7% of patients suffer further injuries once they have been hospitalised (Smith, 2003). Social iatrogenesis is related to the medicalisation of our everyday lives, which Illich refers to as “social overmedicalization” (Illich, 1976, 11). It is carried out through the action of the medical system in sponsoring various sicknesses and promoting the symptoms, encouraging people to seek medical assistance and to become a consumer of medicine (Illich, 1976). By doing this, the medical institution is able to create a relationship of reliance between the medical bodies and the general public who come to crave treatment. From this idea of social iatrogenesis, Illich coined the term of ‘Sisyphus syndrome’, which means that the higher the amount of healthcare given to the population, the higher the demand for and the reliance on care will be (O’Mahony, 2016). Finally, cultural iatrogenesis refers to the removal of “healthy responses to suffering, impairment and death” (Illich, 1976, 11). In other words, it is the attempt of the medical institution to remove any potential for individuals to deal with their own illnesses and to remove the traditional methods that people may have for coping with a sickness (Illich, 1976). Iatrogenesis has therefore became a common, built in feature of this medical mission. Together they work to change the perceptions of the general public, to psychologically and socially change the beliefs of everyone to create this reliance on the medical institutions (Illich, 1976).
As a result, Illich appears to believe that everyday humans are the best people suited for dealing with illnesses, and that phenomenon such as death are things that must occur to keep us human. Illich stated that the medicines for the more widespread diseases, when not monopolised by the big pharmaceutical companies, are relatively cheap to produce and do not require much interference from the so-called medical professionals (Illich, 1976). He believed that today, money is being poured into treatments and diagnosis’ which have a highly questionable effectiveness but are more worried about by higher numbers of the public (Illich, 1976). “Health, or the autonomous power to cope, has been expropriated down to the last breath” meaning that today people are unable to even choose when to die (Illich, 1976, 77). Though morbid sounding, it simply refers to the lack of choice people now have. A person suffering in critical condition is now attempted to be kept alive until it is decided by a so-called medical professional that enough is enough in order to maintain the authority of the system (Illich, 1976). As a result, “mechanical death has conquered and destroyed all other deaths” and natural death is a much less common occurrence (Illich, 1976, 77). Death now must be socially approved and is allowed when a person is viewed as a total loss, unable to be a producer for and a consumer of the capitalist market anymore, therefore “death has become the ultimate form of consumer resistance” in Illich’s view (1976, 77). This is all what he meant by ‘medical imperialism’, it is creating a medical empire.
The extent to which this theory is accurate today can be argued strongly. In many ways, Illich’s theory of medicine gradually taking control over many aspects of society is coming true. Looking at the US, healthcare spending has gone up from 8% of the GDP to 18% (O’Mahony, 2016). As Illich predicted, “health care has become a monolithic world religion” (Illich, 1976, 776) and the health system has become a commercialised, monopolised part of society. Medicalisation has been able to continue with very little intervention, able to often do whatever it wishes. Today many new diseases have been invented by the medical system such as male pattern alopecia (baldness) and testosterone-deficiency (aging), all in attempts to continue and increase the levels of dependency of the population on the medical system (O’Mahony, 2016). It has also been argued that medicine is a “culture of excess” with over-diagnosis and treatment now becoming a major issue (O’Mahony, 2016, 138). Illness is becoming more of a worry, with people seeking medical assistance for the smallest of issues due to an inability to now be able to deal with illness on their own and self-diagnosing themselves online. However, it has been pointed out by Leibovici and Lièvre that certain “aspects of medicalisation make doctors miserable” and often they are the ones blamed for the bad aspects such as death, pain and handicap by society (2002, 866). Medicalisation is however not always viewed as a bad thing. For example, Parsons (1975) pointed out that this creation of a ‘sick role’ is necessary in order to teach people what it means to be ‘normal’ and conform to those behaviours, and therefore the medical system is needed (Parsons, 1975).
This blog will now continue to look at Illich’s theory of ‘medical imperialism’ within various case studies including HIV/AIDS, men’s bodies and deviant bodies.
Written by Lauren Lisle
References:
Cooley, A. (2015). Ivan Illich Austrian Philosopher and Priest. Available at: https://www.britannica.com/biography/Ivan-Illich (Accessed: 13th May 2019).
Illich, I. (1976). Medical Nemesis. New York: Pantheon Books. Available at: https://archive.org/details/MedicalNemesis/page/n1 (Accessed: 13th May 2019).
Illich, I. (2003). Medical Nemesis, ‘Journal of Epidemiology and Community Health’, 57, pp. 919-922. Reprint.
Leibovici, L, Lièvre, M. (2002). Medicalisation: peering from inside medicine, British Medical Association, 324, pp. 866.
O’Mahony, S. (2016). Medical Nemesis 40 years on: the enduring legacy of Ivan Illich. JR Coll Physicians Edinb, 46, pp. 134-139.
Parsons, T. (1975). The Sick Role and the Role of the Physician Reconsidered, The Milbank Memorial Fund Quarterly Health and Society, 53(3), pp. 257-278.
Smith, R. (2003). Limits to Medicine. Medical Nemesis: the expropriation of health, Journal of Epidemiology and Community Health, 57, pp. 928.
Medicalisation, Normality and the Body. 