Revisiting Illich’s latrogenesis: Meditations on Health as “Lived Freedom”
Michelle Harrington, A.M., Divinity, Ph.D(c) Religious Ethics, University of Chicago
In the 1970s, a Roman Catholic sociologist, Ivan Illich, published Medical Nemesis (variously titled Limits to Medicine) and argued that beyond a certain threshold, demand for medical care itself becomes iatrogenic to the social and cultural milieu. Clinical forms of iatrogenesis constitute an important and recognizable consequence of medical interventions, and Illich includes these in his critique, situating them within the complex nodes of professional allegiances and the public authorities that sustain them. His fundamental concerns, however, are social and cultural iatrogenesis, which he defines, respectively, as “impairments to health…due to those socio-economic transformations which have been made attractive, possible, or necessary by the institutional shape health care has taken,” and, even more provocatively, that which “sets in when the medical enterprise saps the will of people to suffer their reality” (Illich, Limits to Medicine (1976), 40, 127).
Illich’s thesis was quite radical at its publication, but our society is arguably far more medicalized today than it was in the 1970s. According to Illich, demand for medical care becomes iatrogenic to the social milieu when individuals begin to doubt that they are capable of doing for themselves that which was formerly mastered, or at least coped with at home or within their communities. Today, problems such as the use of Emergency Departments for non-emergent conditions speak both to socioeconomic inequalities and lack of access to more appropriate channels of health care but also to crises in perception, judgment, and self-efficacy. Many in our society do not have the personal resources to cope with the common cold or with strains and sprains within their own families and communities. We are now generally unskilled and helpless in the face of suffering and death without the comprehensive ministrations of hospice and palliative care. Healthcare, Illich argued, has degraded our health, “the degree of lived freedom” that individuals exercise, a word used to designate “the intensity with which individuals cope with their internal states and their environmental conditions” (242).
Religious communities have historically been repositories of practical wisdom about health and healing—communities that can sustain shared meanings about the significance of illness and death, institutions capable of mobilizing care for fellow members (and even outsiders) over the long haul. The remarkable rise of the “nones” (the religiously unaffiliated) would seem to bode ill for prospects of countering medical nemesis on any wide scale. This paper will argue for the ongoing relevance of Illich’s thesis, and then turn to engage the work of select Christian theologians, including Don S. Browning and Stanley Hauerwas, to illustrate how contemporary Christian responses to social and cultural iatrogenesis may increase the “lived freedom” of their parishioners. The author hopes to spur a robust conversation about setting limits to medicine and identifying religious resources for catalyzing the capacities of individuals within their religious communities so that they engage health care resources in such a way as to maximize their ability to cope with the human condition and to care for one other.
In the 1970s, a Roman Catholic sociologist, Ivan Illich, published Medical Nemesis (variously titled Limits to Medicine) and argued that beyond a certain threshold, demand for medical care itself becomes iatrogenic to the social and cultural milieu. Clinical forms of iatrogenesis constitute an important and recognizable consequence of medical interventions, and Illich includes these in his critique, situating them within the complex nodes of professional allegiances and the public authorities that sustain them. His fundamental concerns, however, are social and cultural iatrogenesis, which he defines, respectively, as “impairments to health…due to those socio-economic transformations which have been made attractive, possible, or necessary by the institutional shape health care has taken,” and, even more provocatively, that which “sets in when the medical enterprise saps the will of people to suffer their reality” (Illich, Limits to Medicine (1976), 40, 127).
Illich’s thesis was quite radical at its publication, but our society is arguably far more medicalized today than it was in the 1970s. According to Illich, demand for medical care becomes iatrogenic to the social milieu when individuals begin to doubt that they are capable of doing for themselves that which was formerly mastered, or at least coped with at home or within their communities. Today, problems such as the use of Emergency Departments for non-emergent conditions speak both to socioeconomic inequalities and lack of access to more appropriate channels of health care but also to crises in perception, judgment, and self-efficacy. Many in our society do not have the personal resources to cope with the common cold or with strains and sprains within their own families and communities. We are now generally unskilled and helpless in the face of suffering and death without the comprehensive ministrations of hospice and palliative care. Healthcare, Illich argued, has degraded our health, “the degree of lived freedom” that individuals exercise, a word used to designate “the intensity with which individuals cope with their internal states and their environmental conditions” (242).
Religious communities have historically been repositories of practical wisdom about health and healing—communities that can sustain shared meanings about the significance of illness and death, institutions capable of mobilizing care for fellow members (and even outsiders) over the long haul. The remarkable rise of the “nones” (the religiously unaffiliated) would seem to bode ill for prospects of countering medical nemesis on any wide scale. This paper will argue for the ongoing relevance of Illich’s thesis, and then turn to engage the work of select Christian theologians, including Don S. Browning and Stanley Hauerwas, to illustrate how contemporary Christian responses to social and cultural iatrogenesis may increase the “lived freedom” of their parishioners. The author hopes to spur a robust conversation about setting limits to medicine and identifying religious resources for catalyzing the capacities of individuals within their religious communities so that they engage health care resources in such a way as to maximize their ability to cope with the human condition and to care for one other.