This thread started as a conjunctural world system analysis by Kolko, but morphed (my bad) into a debate/discussion of the history and role of the notion of Objectivity… and hence to the question of epistemology, and from there to Illich’s treatise on medicine as out modern Nemisis. Click here to go back to the original comments, but post new comments on this page.
Here is James M with the last comment:
I vote for “Medical Nemesis” getting its own thread. Feel free to bump me or whatever; I just have to ramble a bit on this.
Like most of us here, I have observed at a closer, more personal level of magnification that which Illich critiques: My grandmother (RIP) wasting away in a nursing home, zombie-like, barely moving even to lift a finger, hardly uttering a word and unresponsive to all our attempts at rousing her spirits; she went in for circulatory abnormalities, physically less-than-optimal but never one to sink into apathy or despair … and within a week or so, her condition was that of near-catatonia and an expressed readiness to drift off into the dark night. My sister the PhD in Pharmacology thankfully intervened, only to discover (surprise) this nightmare was of the iatrogenically-induced variety; they’d put her on a list of pills so long and so full of interactions and contraindications as to defy belief. The cure? Taking her off of the previous “cures.” She came back to life and lived about a year longer, with all of us having gotten another lesson in the so-called benefits of institutionalized medicine – a patient reduced to a revenue-stream, with no continuity of care, and no accountability for her condition.
(It’s funny, I think this term “continuity of care” must only have been invented by the medical establishment for the purposes of defining a thing whose lack is so widespread.)
Illich’s argument for the deprofessionalization of medicine has resonance with a recent episode of the excellent tv series “Mad Men” (which is set in the early 1960’s) – the main character’s family is posed with the choice of putting a parent with dementia in a nursing home, or caring for him at their home (with all its attendant hassles.) It’s telling that the family chooses the latter, and that most people I know who saw the episode (myself included) viewed the decision with surprise. We are not only less rooted in family these days and less willing to be bothered thusly; we are also conditioned to trust in the greater competency of the medical establishment to such a degree that the thought of caring for someone ourselves seems beyond our purview. We have given over our autonomy, and that of others, in the way Ilich describes.
But despite all his talk of our Promethean impudence with regard to “natural human limits,” I doubt Illich is (or is he?) decrying the invention of medicines like Penicillin, which he fails to mention when he de-links life expectancy from professional medicine, which (along with other antibiotics) actually does apparently account for a jump of 8 years in human life span (though of course it’s leading to the emergence of antibiotic-resistant bacteria … hmm. Iatrogenesis again.) It’s unclear to me how he’d feel about the medicine I take daily which has reduced my incidences of asthmatic attack to zero, with no side effects I’m aware of. (I feel pretty damn good about it, for my part.) And stem cell research … well, I think I can picture his take on that, actually, were he alive.
What I’m getting at is, is there perhaps not a distinction to be made between the invention of novel therapies, and the institutions which enforce them on us as a matter of “common sense”? Can we have these medicines developed in pursuit of Promethean ideals, while still retaining the cultural permission for the individual to refuse these as the individual desires? Does, along with their introduction, naturally come the expectation (sometimes even enforced by law) that we will avail ourselves or our dependents of them and thereby opt in to the system?
On a different note, what of my experience of British socialized medicine, which I encountered during an emergency as very kind, helpful, and respectful of my wishes as a patient? Are systems like Britain’s NHS perhaps less deserving of many of Illich’s criticisms? Could the profit motive at the core of our version of institutionalized of medicine be the real problem, and its removal a critical step in reducing the sense of dehumanization and alienation, “anaesthetised and solitary” suffering we reflexively and rightly associate with it?
I know as a white American male, these questions are supposed to be rhetorical and I’m expected to have an opinion and defend it even long past the point of tenability (especially on the internet, or in a town hall,) but I’m actually throwing them out there to see what any of you might think.