Ivan Illich (1926–2002)

“Beyond a certain level of ideological aporia, Janus must set in, because argument, like the ouroboros, is gorged upon itself.” – J. Olipo

"Healthy people are those who live in healthy homes on a healthy diet in an environment equally fit for birth, growth, work, healing, and dying; they are sustained by a culture that enhances the conscious acceptance of limits to population, of aging, of incomplete recovery and ever-imminent death. Healthy people need minimal bureaucratic interference to mate, give birth, share the human condition, and die."

On the Old: “A new myth about the social value of the old was developed. Primitive hunters, gatherers, and nomads had usually killed them, and peasants had put them into the back room, but now the patriarch appeared as a literary ideal. Wisdom was attributed to him just because of his age. It first became tolerable and then appropriate that the elderly should attend with solicitude to the rituals deemed necessary to keep up their tottering bodies.”

On the Young: “The engineering approach to the making of economically productive adults has made death in childhood a scandal, impairment through early disease a public embarrassment, unrepaired congenital malformation an intolerable sight, and the possibility of eugenic birth control a preferred theme for international congresses in the seventies.”"

On the Suicidal: “I know of a woman who tried, unsuccessfully, to kill herself. She was brought to the hospital in a coma, with a bullet lodged in her spine. Using heroic measures the surgeon kept her alive, and he considers her case a success: she lives, but she is totally paralyzed; he no longer has to worry about her ever attempting suicide again."

On the Dialysis-Dependent: "The modern fear of unhygienic death makes life appear like a race towards a terminal scramble and has broken personal self-confidence in a unique way. It has fostered the belief that man today has lost the autonomy to recognize when his time has come and to take his death into his own hands."[…] "Complex bureaucracies sanctimoniously select for dialysis maintenance one in six or one in three of those Americans who are threatened by kidney failure. The patient-elect is conditioned to desire the scarce privilege of dying in exquisite torture."

"Although physicians did pioneer antisepsis, immunization, and dietary supplements, they were also involved in the switch to the bottle that transformed the traditional suckling into a modern baby and provided industry with working mothers who are clients for a factory-made formula."

"While in gross infant mortality the United States ranks seventeenth among nations, infant mortality among the poor is much higher than among higher-income groups. In New York City, infant mortality among the black population is more than twice as high as for the population in general, and probably higher than in many underdeveloped areas such as Thailand and Jamaica."

“For the sick,” Hippocrates said, “the least is best.”

"Duty, love, fascination, routines, prayer, and compassion were some of the means that enabled pain to be borne with dignity. Traditional cultures made everyone responsible for his own performance under the impact of bodily harm or grief. "People knew that they had to heal on their own, to deal on their own with their migraine, their lameness, or their grief."

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"Traditional cultures and technological civilization start from opposite assumptions. In every traditional culture the psychotherapy, belief systems, and drugs needed to withstand most pain are built into everyday behavior and reflect the conviction that reality is harsh and death inevitable." […] "The sufferings for which traditional cultures have evolved endurance sometimes generated unbearable anguish, tortured imprecations, and maddening blasphemies; they were also self-limiting."

"Powerful medical drugs easily destroy the historically rooted pattern that fits each culture to its poisons; they usually cause more damage than profit to health, and ultimately establish a new attitude in which the body is perceived as a machine run by mechanical and manipulating switches."

"Oral contraceptives, for instance, are prescribed “to prevent a normal occurrence in healthy persons."

"In many a village in Mexico I have seen what happens when social security arrives. For a generation people continue in their traditional beliefs; they know how to deal with death, dying, and grief. The new nurse and the doctor, thinking they know better, teach them about an evil pantheon of clinical deaths, each one of which can be banned, at a price. […] By their ministration they urge the peasants to an unending search for the good death of international description, a search that will keep them consumers forever."

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"However, delivery of effective basic health services for the entire population is cheap enough to be bought for everyone, provided no one could get more, regardless of the social, economic, medical, or personal reasons advanced for special treatment. If priority were given to equity in poor countries and service limited to the basics of effective medicine, entire populations would be encouraged to share in the demedicalization of modern health care.”

"But the fundamental reason why these costly bureaucracies [socialized medicine] are health-denying lies not in their instrumental but in their symbolic function: they all stress delivery of repair and maintenance services for the human component of the megamachine, and criticism that proposes better and more equitable delivery only reinforces the social commitment to keep people at work in sickening jobs. "

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"As a lawyer, the doctor exempts the patient from his normal duties and enables him to cash in on the insurance fund he was forced to build. As a priest, he becomes the patient’s accomplice in creating the myth that he is an innocent victim of biological mechanisms rather than a lazy, greedy, or envious deserter of a social struggle for control over the tools of production."

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"In every society the classification of disease—the nosology—mirrors social organization. The sickness that society produces is baptized by the doctor with names that bureaucrats cherish. […] The more convincing the diagnosis, the more valuable the therapy appears to be, the easier it is to convince people that they need both, and the less likely they are to rebel against industrial growth.”

"Medicine just cannot do much for the illness associated with aging, and even less about the process and experience of aging itself. It cannot cure cardiovascular disease, most cancers, arthritis, advanced cirrhosis, not even the common cold."

"With rising levels of induced insensitivity to pain, the capacity to experience the simple joys and pleasures of life has equally declined. Increasingly stronger stimuli are needed to provide people in an anesthetic society with any sense of being alive. Drugs, violence, and horror turn into increasingly powerful stimuli that can still elicit an experience of self. Widespread anesthesia increases the demand for excitation by noise, speed, violence—no matter how destructive."

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"Now an increasing portion of all pain is man-made, a side-effect of strategies for industrial expansion. Pain has ceased to be conceived as a “natural” or “metaphysical” evil. It is a social curse, and to stop the “masses” from cursing society when they are pain-stricken, the industrial system delivers them medical pain-killers. Pain thus turns into a demand for more drugs, hospitals, medical services, and other outputs of corporate, impersonal care and into political support for further corporate growth no matter what its human, social, or economic cost. Pain has become a political issue which gives rise to a snowballing demand on the part of anesthesia consumers for artificially induced insensibility, unawareness, and even unconsciousness."

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"Famine will increase until the trend towards capital-intensive food production by the poor for the rich has been replaced by a new kind of labor-intensive, regional, rural autonomy."