Born in Vienna in , Ivan Illich grew up in Europe. He studied theology, philosophy, history, and natural science. During the s he founded centers for cross-cultural communication, first in Puerto Rico and then in Cuernavaca, Mexico. Since the late s, he has divided his time among Mexico, the United States, and Germany.
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Illich was a visionary in a proper sense, a man who dared to question some of our deepest-held beliefs, and to imagine a radically different way of living. When I signed up to do medicine at University, being a doctor seemed an entirely progressive and benevolent enterprise. What could anyone object to about making sick people better? I wanted to go abroad and spread the wonders of western medicine to the underdeveloped world.
But I soon started to hear concerns about the direction of medicine. Wendy Savage came to speak about the over-medicalisation of childbirth. An older student suggested that western doctors working in Africa and Asia could undermine local health systems.
Some people objected to the free alcohol and other perks that the pharmaceutical companies lavished on medical students from the moment they arrived. There was also something disconcerting for me about the relentless study of the facts of the human body. In dissection classes we traced the anatomy of the arm, leg and torso in minute detail, and in other lectures we acquired a meticulous understanding of the cellular structure, physiology and biochemistry of the body.
The whole biology of the human being was laid before us, including the cadaver of some poor soul who had donated their body to medical science. Limits to Medicine put my unease into words. We have come to believe that technology can eradicate all human suffering and provide unblemished and everlasting happiness. We have paid for this irrational expectation with our autonomy, our dignity and our ability to endure.
Difficult as this is to write as a doctor, there is something inherently degrading about medicine. After all, it involves allowing someone else to interfere with your body, your own personal, physical self.
When it was just the local doctor backed up with a few basic medicines, it was a relatively private and contained degradation, but now there is a whole system geared up to examining, testing and adjusting different parts of you. Submitting yourself to medicine now requires the wholesale signing away of your bodily integrity. Illich recognised that modern medicine has developed some incredibly effective interventions. Many of the most useful, such as vaccination, are relatively simple and can be administered without too much interference.
Others, the treatment of heart attacks or cancer for example, require a great deal of bodily intrusion, including surgery to remove diseased parts, insertion of devices, and the ingestion of powerful and debilitating drugs like chemotherapy. There is no doubt that these interventions can give people more years of good or reasonable quality life.
There is a trade-off, however, which is rarely acknowledged since medicine has become such an apparently indispensable part of our lives. Medical miracles come at a cost- and that cost is dignity.
Medicine is no longer confined to the alleviation of suffering, but now involves a life-time of scrutiny, with checks and screening from cradle to grave. Then, when you really get sick, it unleashes relentless efforts to identify, remove or neutralise that part of your body that is malfunctioning.
The problem with medicine is not just its relation with the individual body, however. It is also the premise that we can, and should, do all we can to fight and delay death. Medicine has created a myth that we can heal everything, given enough time and money. Consequently many people have come to believe that medicine has effectively conquered disease; that there is a treatment for every symptom or that the cure is just around the corner. But we are mortal, and death will come sooner or later.
The diseases of aging like most cancers and dementia will most likely never be cured. In any case, there will always be illnesses we cannot treat, that cause early death, pain, suffering and grief.
The wishful thinking that medicine has come to embody obscures the limitations of the human condition, leaving people less aware of their own nature. This denial of our frailty and mortality reduces our ability to withstand the inevitable tragedy of life.
Despite its impassioned arguments, Limits to Medicine is an incredibly scholarly book, drawing extensively on anthropology and cross-cultural literature, as well as scholarship on the epistemology of sickness and the linguistics of suffering among many other areas.
Illich was a remarkable man, an academic and onetime priest, who lived according to his principles, and refused treatment for the cancer that eventually killed him. It would be organised around the needs of people to live meaningful lives, and not around production and consumption for its own sake. It would foster the autonomy of individuals and communities and their ability for self-reliance, but also recognise the necessity of inter-dependence and mutual support.
It would integrate the most useful aspects of modern technology, including medical interventions, but submit these to democratic scrutiny. The idea that our discontents are a manifestation of faulty brains that can be abolished with sophisticated medical treatment is just the sort of illusion that Illich is responding to.
His message was the answers to human suffering lie in social connection and cultural meanings, but this is often a message that people do not want to hear. Thank-you, Joanna. As usual, your writing is excellent.
Garth Daniels, in Australia. Medical hubris and arrogance has led to deliberate torture being considered "good medical practice". And Weds. I'm so busy fighting back and defending in the Psych Wars, that I didn't notice…..
Keep up the good work, Joanna. You are equally as guilty of clear bias in not accepting medical models for mental illness and twisting research to meet your views. If there are illnesses with biological causes for the rest of the body why would there not be for the brain? I am sure that many psychiatric illnesses have a stronger psychological basis and may not require psychiatric medication but equally many of them do. It is very condescending to assume that the majority of psychiatrists are unaware of the long term effects of antipsychotics and do not discuss this with patients, they are!
Whilst you appear to be very anti-medication you seem not to have a lot of advice on how to manage these over medicalised normal mental states, how for instance do my family manage my 4 week periods of sleeping 2 hrs per night, relentless decorating and rearranging the house, constant talking, overspending and climbing the banisters over a large drop to paint the ceiling as it never occurs to me that I would injure myself.
Should I not be allowed to make that choice? What do you think it does to the self esteem and dignity of people like me to have you suggesting that these are merely normal mental states and that we should stop medicalising ourselves and get on with it?
Dear Fiona, Thank you for your comments. I fully recognise that there are situations in which drug treatment is helpful, and in which people can make informed and rational decisions about the risks and benefits.
I think antipsychotics and other sedative drugs can be helpful in reducing the symptoms of mania and acute psychosis. The main point of my work on psychiatric drugs is that we misunderstand how they work and that we do not have evidence that they work by targeting an underlying disease or abnormality as is usually suggested or implied.
I am also concerned that we do not have a good evidence base for the risks and benefits of long-term antipsychotic treatment or other long-term drug treatment. That is why I am doing the Radar study, to try and produce evidence on this. To say that psychiatric drugs do not work by targeting an underlying brain abnormality is not to say that there is no such abnormality present in mental disorders. However, I do not think we currently have evidence of any specific abnormalities in most mental disorders.
Suggesting that mental health problems are not best viewed as a disease is not to say that they are not sometimes deeply problematic- for those who suffer them and for others. I believe drugs can be helpful in some situations, but not in others. I do not think it is useful to encourage the view that drugs are more helpful than the evidence suggests they are.
I am glad you think that psychiatrists are fully aware of the risks and benefits of antipsychotics, and discuss these with their patients.
Historically, the profession has often been reluctant to admit the harms associated with its treatments, however. Hopefully, as you suggest, that is changing with the new climate of greater openness and the emphasis on mutual decision making.
Best wishes, Joanna. So I looked at the molecular biology that magnesium is involved in. The psychiatric drugs will make you worse without exception and should only be used in the short term. The only way to deal with these problems is by working with the requirements of the body and they do not include ANY psychiatric drugs, especially in the long term.
I found that I have to attenuate my life…no strong inputs.. These companies will fail because of pharmacogentics and in particular the emerging Cytochrome P test. Those against psychiatry needs to focus on this financial area if they are to be really effective. You are commenting using your WordPress. You are commenting using your Google account.
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Limits to Medicine: Medical Nemesis: The Expropriation of Health
Let me be very clear at the outset: I am not against health care - the same way as I am not against smart phones! I do not disagree with the positive impact medicine, and more precisely, healthcare as a whole, has had on humanity so far. The services of vast majority doctors and other healthcare professionals are highly commendable; there is no doubt. These are valuable activities which most of the time will not and cannot be undertaken for money, but it can be devalued if too much money is around. These countries will at some point be spending the OECD average2 9.
Limits of Medicine
Illich was a visionary in a proper sense, a man who dared to question some of our deepest-held beliefs, and to imagine a radically different way of living. When I signed up to do medicine at University, being a doctor seemed an entirely progressive and benevolent enterprise. What could anyone object to about making sick people better? I wanted to go abroad and spread the wonders of western medicine to the underdeveloped world. But I soon started to hear concerns about the direction of medicine. Wendy Savage came to speak about the over-medicalisation of childbirth.
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