Reflections on the man and his Medical Nemesis: the Expropriation of Health
|New York City, ca. 1955|
“Cuernavaca was the right place for Illich. It had been a field of Catholic experimentation before Vatican II, under the leadership of Bishop Mendez Arceo. . . . It was a special place in which the local Church as an institution had attempted to engage with the spirit of the times and with the people themselves, even before Vatican II.” 
|Cuernavaca, ca. 1960|
|Robert-Fleury, Galileo before the Holy Office, ca. 1847|
Medical Nemesis was a work of deep scholarship, fluid erudition, and fearless rhetoric. It unapologetically laid bare the excesses and the deficiencies of a profession that had over the previous century claimed immense cultural authority for itself. Illich's earlier published books were largely collections of essays. Medical Nemesis however, was a tightly integrated, wide-ranging review of the expropriation of individual and cultural autonomy by the profession of medicine.
Illich clearly understood the magnitude of what he was taking on. Unlike his earlier works, Medical Nemesis was extensively footnoted with sources ranging from The Lancet to The New England Journal of Medicine to the works of Montesquieu and Wittgenstein. By the end of the second chapter of this eight-chapter book, Illich had already referred to the writings of such medical commentators as Rene Dubos, Thomas Szasz, Michael Balint and Maurice Pappworth, sociologists including Eliot Friedson and Howard Becker, and philosophers and cultural historians including Simone de Bouvoir, Michel Foucault, Eric Voegelin and Lewis Mumford.
“The physician, himself a member of the dominating class, judges that the individual does not fit into an environment that has been engineered and is administered by other professionals, instead of accusing his colleagues of creating environments into which the human organism cannot fit.” (p. 169)
“For rich and poor, life is turned into a pilgrimage through check-ups and clinics back to the ward where it started. Life is thus reduced to a “span,” to a statistical phenomenon which, for better or for worse, must be institutionally planned and shaped. This life-span is brought into existence with the pre-natal check-up, when the doctor decides if and how the foetus shall be born, and will end with a mark on a chart ordering resuscitation suspended.” (p. 79)
“So medicalisation alters our phenomenology of lived experience. . . . We don’t see that we are being led to see/feel ourselves in different ways, we just believe naively that this is experience itself; we imagine that people have always imagined themselves this way. And we are baffled by accounts of earlier ages.” 
“It’s the ultimate book reviewer’s cliché to say that every doctor and medical student should read this book, but those who haven’t have missed something really important. When sick I want to be cared for by doctors who every day doubt the value and wisdom of what they do – and this book will help make such doctors.” 
A PDF copy of the above essay, together with a collation of selected excerpts from his Limits to Medicine. Medical Nemesis: The Expropriation of Health can be downloaded from:
Babette Babich on Ivan Illich:
Life is a Test: Ivan Illich's Medical Nemesis and the "Age of the Show"
A fascinating perspective on the ideas presented by Illich in his Medical Nemesis is offered in the video clip below by Babette Babich, professor of philosophy at Fordham University. This presentation is adapted from a lecture she gave to the International Philosophy of Nursing Society in Quebec, Canada in August 2016.
Forty years after the publication of Medical Nemesis, Babette Babich wryly reflects on the present state of medicine and its contemporary "cutting edge" aspects.
1. E.F. Schumacher. A Voice for Wisdom in an Age of Folly
The economist E.F. Schumacher has served as a source of inspiration for many over the past half-century. His essential message is carried in two books published in the five years before he died, Small is Beautiful. A Study of Economics as if People Mattered (1973) and A Guide for the Perplexed (1977).
This post offers both an audio presentation drawn from two lectures given by Schumacher in the 1970s and a review of some of his ideas as presented in Small is Beautiful.
2. Leopold Kohr. Gentle Messenger of Community, Fellowship and Celebration
Leopold Kohr was professor of economics and public administration at a number of universities in North America, Puerto Rico, and the United Kingdom from the early 1940s to the 1970s. As a younger man, he spent time in Spain as a journalist, sharing an office with Ernest Hemingway, and a friendship and many conversations with Eric Blair, who was later to publish his own writings under the pen name of George Orwell.
The wisdom of Leopold Kohr is the wisdom of one who has realised the essential perplexity of many aspects of human reality and of one who has sought to communicate his insights and offer an alternative, albeit unrealisable vision.