Medical Nemesis: The Expropriation of Health (hardcover) and $4.00 (paper))
by Ivan Illich
Calder & Boyars (London), 184 pp., £1.25 (copies will be available in US bookstores at about $9.00
Ivan Illich’s attack on what he calls excessive “medicalization” is the latest of his critical studies of the basic institutions of modern industrial society. In earlier works he has criticized the modern systems of schooling, transport, and industrial growth itself. Excellent for its purpose of provocative propaganda, this new book creates enough doubts, objections, and disappointments to serve admirably in its publishers’ series “Ideas in Progress.” It is explicitly a first draft, inviting critical comment which Illich will take into account in a fuller version for later publication in the US, and he asks for comments to be sent to him at his research center in Mexico.
The book has already raised much controversy in the press and in medical papers in France and England. It is an effective polemical expression of the diffuse dissatisfaction with medicine which has been gathering force for the last decade or so. Illich marshals, in formidable array, the facts and reasoned arguments that are generally missing from conventional grumbles about the medical profession. At the same time he sets the problem in a social perspective, in order to show how much we ourselves—as individuals and in our institutions—are answerable for the situation.
But Illich directs his attack mainly to the medical profession itself, and it is as fierce as a strongly emotional publicist can make it. After prefatory thanks to a colleague for having “refined my judgment and sobered my expression” he opens with the assertion, “The medical establishment has become a major threat to health.” To validate the charge he turns first to his easiest target, iatrogenic illness, illness actually caused by the physician, including of course the side effects and long-term effects of medication. This is a familiar matter of concern to doctors themselves, and Illich notes that in the standard Index Medicus over a thousand items are listed each year under the heading of iatrogenic diseases. The statistics he gives are not very full, but the rhetoric is vivid:
Total suffering increases with more therapy…. More and more patients are told by their doctors that they have been damaged by previous medication and that the treatment now being given is conditioned by the consequences of their previous treatment, which sometimes had been given in a life-saving endeavour, and much more often for weight control, hypertension, flu or mosquito bite.
However, this is only his starting point. He goes on to extend the limited notion of clinical iatrogenesis to the much broader ones of “social” and “structural” iatrogenesis: those policies and practices that encourage people to accept sickness rather than rebel against the conditions of their lives, and those that undermine our trust in ourselves as largely self-healing organisms with enough resilience and adaptability to meet most of the challenges that the successive stages of life must bring.
In his belief that medicine is a flourishing part, and a prop, of an industrial society which must be drastically changed Illich might seem to be echoing such run-of-the-mill socialist …