In his work of medical nonfiction, Medical Nemesis: The Expropriation of Health
is (1975), Ivan Illich explores the shortcomings of 1970s healthcare in industrialized societies, and how this healthcare is damaging society and our resilience to illness. Still relevant for readers looking to learn more about the evolution of healthcare, the book received a generally positive reception upon publication. Illich was a rebellious Roman Catholic priest best known for his criticism of Western culture and for disrupting long-held ways of thinking; many historians think of him as an anarchist.
Illich’s central premise is that the medical establishment singlehandedly ruined healthcare by focusing on the wrong problem. He claims that modern medicine aims to remove sickness, pain, and suffering from our lives. According to Illich, it is natural for humans to suffer. Suffering is what strengthens us. In other words, it is healthy to get sick sometimes to feel pain. Without this suffering, we miss the human experience, and we don’t learn how to deal with life’s challenges. Healthcare makes us weaker because it doesn’t teach us how to face suffering.
Illich explores the harm done by doctors and how doctors contribute to this society of sickness and fear, in some detail. He uses the word “Iatrogenesis” to describe the harm committed by doctors to their patients and society. Illich claims there are three types of iatrogenesis – clinical, social, and cultural. As a result, Illich divided Medical Nemesis
into four parts: “Clinical Iatrogenesis,” “Social Iatrogenesis,” “Cultural Iatrogenesis,” and a conclusion, “The Politics of Health.”
In “Clinical Iatrogenesis,” Illich examines what he calls the “epidemics” of medicine, claiming there is no proof that modern medicine is responsible for our survival. He argues that doctors and the wider healthcare system trick us into believing that they are essential. The reality is that sanitation, housing, and nutrition are more important to our survival than modern healthcare and antibiotics.
Illich concedes that, while modern medicine isn’t perfect, it is responsible for eradicating or controlling diseases such as polio and measles. However, sometimes it causes needless worrying and side effects. For example, only a few people really need high blood pressure medication, whatever their doctors claim. The other patients are exposing themselves to needless side effects. Illich goes so far as to claim that, in some circumstances, such as medical negligence, doctors do far more harm than good.
In “Social Iatrogenesis,” Illich covers the unforeseen side effects of medical intervention on our society. In this section, he argues that our society depends on the healthcare industry. We are convinced that, if there is no healthcare, we will all die. This dependence eliminates our need to take responsibility for our own health.
Furthermore, illness is often overtreated and exaggerated. Too many people, Illich claims, end up in the hospital for relatively minor illnesses. When we get sick, we expect doctors to treat us, and we always assume the worst. We have lost the art of self-care, not knowing how to separate life-threatening illnesses from mild infections and injuries. That the healthcare industry has such as a monopoly over our society should worry everyone, Illich claims.
“Cultural Iatrogenesis” takes this idea even further. Illich believes we are no longer capable of facing the reality of our life. We don’t know how to suffer, and we’re incapable of accepting death. We assume that every disease must have a cure, when the reality is that we will all die eventually. We are now at a point where we don’t even feel pain during medical procedures. There is no such thing as acceptable suffering or pain tolerance.
Healthcare cons us into believing we are immortal. Illich notes that, before healthcare, everyone prepared for death. In some cultures, they even celebrated it. Now, we are all terrified of our own mortality, and we assume that suffering is beneath us. We avoid terminally sick people because they remind us that doctors cannot cure everything.
In the final section, “The Politics of Health,” Illich considers how the politics around healthcare have evolved over the centuries. What we see in every century is that healthcare is not concerned about sick people—it is all about propaganda, securing public favor, and promoting whatever version of society is popular at the time. Healthcare is politicized as much as any other facet of society. Until we reform how we look at healthcare, it will continue to control us and influence our attitudes towards our own welfare.
Illich uses various countries as examples. He talks about France during the late 18th century and how the government wanted everyone to be healthy to save money. It encouraged self-care and healthy living. Elsewhere in Europe, healthcare became all about paperwork and administrative management. This administrative focus created a new distance between doctors and patients. Illich finds that, ultimately, this commercialized, impersonal healthcare with no tolerance for pain or suffering makes us sicker than ever before.