Medicalization Still Undermining Health and Vocation: Illich's Medical Nemesis at 50 Years
Farr Curlin, MD, Duke University
“Cultural iatrogenesis … sets in when the medical enterprise saps the will of people to suffer their reality.” Illich, Medical Nemesis, p127
In his seminal 1975 book Medical Nemesis: The Expropriation of Health, Ivan Illich argued that the “medicalization of life” was profoundly iatrogenic. Industrial, technocratic medicine exhibited “specific counterproductivity”: its attempts to improve health often made health worse. This essay revisits Illich’s critique fifty years later.
Clinical, social, and cultural iatrogenesis are even more apparent in 2025. Medicine’s claims to diagnose and treat all manner of human challenges have grown pervasive, and—as Illich predicted—the counterproductivity of medicalization is more obvious and troubling, yet harder to escape. Illich called for a political reckoning. The Make America Healthy Again (MAHA) movement may represent one such reckoning, insofar as it resists medical experts’ authority over daily life. Yet MAHA introduces its own medicalization—of fitness, diet, and vitality—through idiosyncratic health programs.
This essay amends and develops Illich’s argument in three ways:
First, it improves his characterization of health. Illich defined health as “the intensity of autonomous coping ability,” later admitting this was a mistake: “I was unaware that by construing health in this self-referentially cybernetic fashion, I unwittingly prepared the ground for a worldview in which the suffering person would get even further out of touch with the flesh.” By detaching health from the organism’s well-functioning, Illich left his critique vulnerable to experts who medicalize even the challenge of coping with medicalization. To clarify medicine’s role in human flourishing, we must recover health as a norm of the living body—the flesh.
Clarity about health makes Illich’s argument more precise by distinguishing when medicalization is specifically counterproductive to health from when medicalization, even if not counterproductive with respect to health, nevertheless undermines human flourishing. Remedies for both counterproductivities require skepticism toward many claims of medical expertise and selective renunciation of medical diagnoses and interventions. Medicine must relinquish some territory and abandon imperial ambitions. Reform will not come through holistic expansion but through chastening and retreat—a pruning that begins with choices by patients and clinicians.
Second, this essay amends Illich’s argument by proposing vocation as a standard to guide discernment regarding when medicalization is fitting and when it is counterproductive to health or human flourishing. Framing medicine as serving the patient’s vocation—within the physician’s vocational commitment to bodily health—resists medicine’s tendency to intrude upon the communities, commitments, and patterns of life that constitute any flourishing human’s life. The question becomes not how medicine can extend its reach, but how it can get out of the way.
Third, the essay develops Illich’s brief allusion to religion’s role in resisting undue medicalization. Christian tradition teaches us to expect a world disordered in which we find we are ill at ease and suffer trials of many kinds. It offers resources for understanding medicine as gift while rejecting its idolatrous pretensions to comprehensive management of the human condition. Biblical references to physicians and healing, along with patristic reflections on suffering, suggest that “secular medicine” (scientific medicine) was honored but humbled—ordered within the life of the Church and granted limited authority. This posture seems to promote a specific form of the communal solidarity and care that Illich saw as the antidote to technocratic managerialism. Illich also emphasized the importance of individuals recovering their capacity to negotiate life’s trials and challenges, “the will to self care.” In describing the dignity of the human person, Catholic Social Teaching emphasizes that each person, insofar as possible, is to be the agent of his or her own integral development. And Christian patience in suffering contrasts sharply with the reflex to seek medical deliverance from every human limitation.
In his seminal 1975 book Medical Nemesis: The Expropriation of Health, Ivan Illich argued that the “medicalization of life” was profoundly iatrogenic. Industrial, technocratic medicine exhibited “specific counterproductivity”: its attempts to improve health often made health worse. This essay revisits Illich’s critique fifty years later.
Clinical, social, and cultural iatrogenesis are even more apparent in 2025. Medicine’s claims to diagnose and treat all manner of human challenges have grown pervasive, and—as Illich predicted—the counterproductivity of medicalization is more obvious and troubling, yet harder to escape. Illich called for a political reckoning. The Make America Healthy Again (MAHA) movement may represent one such reckoning, insofar as it resists medical experts’ authority over daily life. Yet MAHA introduces its own medicalization—of fitness, diet, and vitality—through idiosyncratic health programs.
This essay amends and develops Illich’s argument in three ways:
First, it improves his characterization of health. Illich defined health as “the intensity of autonomous coping ability,” later admitting this was a mistake: “I was unaware that by construing health in this self-referentially cybernetic fashion, I unwittingly prepared the ground for a worldview in which the suffering person would get even further out of touch with the flesh.” By detaching health from the organism’s well-functioning, Illich left his critique vulnerable to experts who medicalize even the challenge of coping with medicalization. To clarify medicine’s role in human flourishing, we must recover health as a norm of the living body—the flesh.
Clarity about health makes Illich’s argument more precise by distinguishing when medicalization is specifically counterproductive to health from when medicalization, even if not counterproductive with respect to health, nevertheless undermines human flourishing. Remedies for both counterproductivities require skepticism toward many claims of medical expertise and selective renunciation of medical diagnoses and interventions. Medicine must relinquish some territory and abandon imperial ambitions. Reform will not come through holistic expansion but through chastening and retreat—a pruning that begins with choices by patients and clinicians.
Second, this essay amends Illich’s argument by proposing vocation as a standard to guide discernment regarding when medicalization is fitting and when it is counterproductive to health or human flourishing. Framing medicine as serving the patient’s vocation—within the physician’s vocational commitment to bodily health—resists medicine’s tendency to intrude upon the communities, commitments, and patterns of life that constitute any flourishing human’s life. The question becomes not how medicine can extend its reach, but how it can get out of the way.
Third, the essay develops Illich’s brief allusion to religion’s role in resisting undue medicalization. Christian tradition teaches us to expect a world disordered in which we find we are ill at ease and suffer trials of many kinds. It offers resources for understanding medicine as gift while rejecting its idolatrous pretensions to comprehensive management of the human condition. Biblical references to physicians and healing, along with patristic reflections on suffering, suggest that “secular medicine” (scientific medicine) was honored but humbled—ordered within the life of the Church and granted limited authority. This posture seems to promote a specific form of the communal solidarity and care that Illich saw as the antidote to technocratic managerialism. Illich also emphasized the importance of individuals recovering their capacity to negotiate life’s trials and challenges, “the will to self care.” In describing the dignity of the human person, Catholic Social Teaching emphasizes that each person, insofar as possible, is to be the agent of his or her own integral development. And Christian patience in suffering contrasts sharply with the reflex to seek medical deliverance from every human limitation.