I’m wrapping up a multi-part look at ‘To Hell with Good Intentions’ with a short entry about the author of the piece, Ivan Illich. THWGI was originally a 1968 speech addressed to CIASP, a college summer-break volunteer group in the 1960s. The speech has lived on until the present as a piece that challenges the intentions of the international aid movement, and by extension, global health. Illich’s original transcript is here for reference; first post here; second post (and most in-depth discussion overall) is here.
This will wind up being a shorter installment than the last by virtue of the fact while CIASP was representative of a trend that merited some further historical context, Ivan Illich, as it turns out, was fairly singular.
In brief, Illich was a contrarian of pretty extravagant proportions. Various sources that you might encounter will describe him as an intellectual, a polymath, or a philosopher, none of which is inaccurate, and none of which really captures the fact he just disagreed with the prevailing train of thought on everything he came across. Glancing quickly at his bibliography, there is nothing to define his life’s work in terms of a subject matter. He has books on education (Deschooling Society, his most famous work), labor (The Right to Useful Unemployment), technology (Tools for Conviviality), mass transportation (Energy and Equity), and gender (Gender), among others6. Along the way he managed to pack in several other interesting life details that seem – like everything else – to be tossed in just because you probably weren’t expecting it. Illich’s most advanced formal education was seminary – he was an ordained Roman Catholic priest – but that was not before he studied histology and crystallography (huh?) at the University of Florence, theology and philosophy in Rome, and medieval history in Salzburg4. He spent parts of his life all over: childhood in Vienna (he also had Jewish heritage and escaped to Italy in the early 1940s), periods in New York and Mexico (where he encountered CIASP in the 1960s), the last years of life in Bremen, Germany.
I wondered in my last post whether Illich might have approved to some degree of our current state of global health, with its more refined approach today compared to the naiveté of the 1960s movement he criticized in THWGI. Probably not, as it turns out. Though we’ve encountered him in our curriculum as a skeptic of international development projects, it has been lost over the past couple of decades that Illich also gained some notoriety in the 1970s as a skeptic of modern medicine. His philosophy was laid out in Medical Nemesis in 1975 (later re-released in a new edition as the less dramatically-titled Limits of Medicine). Philosophically, he argued that the medicalization of health distracted people from a spiritual need to experience the discomfort of physical infirmity and confront their frailty4,5. In much less abstract terms, his writings also directed attention to a problem largely ignored in that era – of iatrogenic illness and injury2,4. It’s hard to gain a great sense of just how widely these criticisms circulated, but Medical Nemesis was reviewed in the BMJ at the time of its publication4. It would return to print twice, in 1990 and 19951, so it had some staying power. Illich backed up his skepticism of medicine pretty emphatically by refusing to let doctors treat the cancer that eventually took his life in 2002 at the age of 76. He lived for much of the last decade of his life with a tumor growing very visibly from his right cheek1. By the end of his life he was barely able to eat and in constant pain, suffering from seizures, but adherent to the end to the principles he put forth in his thesis.
At any rate, that’s Ivan Illich – an interesting, forgotten character. I recommend that if you’ve read this far, you take a moment to watch him move and talk here; for me it was an endearing experience after having formed an image of a green, unibrowed muppet in a trashcan. For all the cynicism, Illich is remembered almost categorically as a decent, charming, and inviting man3,5,6. I must admit that I listened to the above clip for a few minutes and heard a couple of ideas from 1974 regarding the trajectory of modern medicine that feel uncomfortably prescient 43 years later.
As an appropriate coda, it’s interesting to know that Illich appears to have had at least one outspoken admirer in the medical community, despite Illich’s longstanding critiques of it. Richard Smith, a British doctor and former longtime editor of the BMJ, has written several glowing retrospectives on Illich’s takes on modern medicine1,5. He has called his first time seeing Illich speak “the closest thing I ever came to a religious experience”. I felt it was a fitting irony to find this among the other items on Dr. Smith’s resume: something called the the Ovations initiative, a 2007 global health fund started to fight noncommunicable disease in eight countries. It seems only natural that such a prolific contrarian as Ivan Illich would manage somehow to have admirers who both incorporated him and contradicted him.
- Bunker JP. “Ivan Illich and Medical Nemesis: the appropriation of health”. Journal of Epidemiology and Community Health. 2003; 57:927. http://jech.bmj.com/content/jech/57/12/928.full.pdf
- Edward RHT. “Nemesis, Sisyphus, and a contribution from the medical humanities to health research: Nemesis or Sisyphus?”. Journal of Epidemiology and Community Health. 2003; 57:926-7. http://jech.bmj.com/content/jech/57/12/928.full.pdf
- Levin L. “Ivan Illich: he lived his own testimony”. Journal of Epidemiology and Community Health. 2003; 57:925. http://jech.bmj.com/content/jech/57/12/928.full.pdf
- O’Mahony S. “Medical Nemesis 40 years on: the enduring legacy of Ivan Illich”. Journal of the Royal College of Physicians. 2016, 46: 134-9. https://www.rcpe.ac.uk/sites/default/files/jrcpe_46_2_omahony_0.pdf
- Smith R. “Limits to Medicine. Medical nemesis: the expropriation of health”. Journal of Epidemiology and Community Health. 2003; 57:928. http://jech.bmj.com/content/jech/57/12/928.full.pdf
- Todd, Andrew and Franco La Cecla. “Ivan Illich”. The Guardian. Published 9 December 2002. Accessed 31 July 2017. https://www.theguardian.com/news/2002/dec/09/guardianobituaries.highereducation