Questions About the Current Pandemic From the Point of View of Ivan Illich — davidcayley.com

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Author: David Cayley
Full Title: Questions About the Current Pandemic From the Point of View of Ivan Illich — davidcayley.com
Category: #articles
URL: https://www.davidcayley.com/blog/2020/4/8/questions-about-the-current-pandemic-from-the-point-of-view-of-ivan-illich-1

Highlights

Medicine, he said, had gone through “two watersheds.” The first had been crossed in the early years of the 20th century when medical treatments became demonstrably effective and benefits generally began to exceed harms. For many medical historians this is the only relevant marker – from this point on progress will proceed indefinitely, and, though there may be diminishing returns, there will be no point, in principle, at which progress will stop. This was not the case for Illich. He hypothesized a second watershed, which he thought was already being crossed and even exceeded around the time he was writing. Beyond this second watershed, he supposed, what he called counterproductivity would set in – medical intervention would begin to defeat its own objects, generating more harm than good. This, he argued, was characteristic of any institution, good or service – a point could be identified at which there was enough of it and, after which, there would be too much. Tools for Conviviality, was an attempt to identify these “natural scales” – the only such general and programmatic search for a philosophy of technology that Illich undertook.
What really concerned him was the way in which excessive medical treatment weakens basic social and cultural aptitudes. An instance of what he called social iatrogenesis is the way in which the art of medicine, in which the physician acts as healer, witness, and counsellor, tends to give way to the science of medicine, in which the doctor, as a scientist, must, by definition, treat his or her patient as an experimental subject and not as a unique case.
And, finally, there was the ultimate injury that medicine inflicts: cultural iatrogenesis. This occurs, Illich said, when cultural abilities, built up and passed on over many generations, are first undermined and then, gradually, replaced altogether. These abilities include, above all, the willingness to suffer and bear one’s own reality, and the capacity to die one’s own death. The art of suffering was being overshadowed, he argued, by the expectation that all suffering can and should be immediately relieved – an attitude which doesn’t, in fact, end suffering but rather renders it meaningless, making it merely an anomaly or technical miscarriage.
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Behind Illich’s arguments lay a traditional Christian attitude. He affirmed that suffering and death are inherent in the human condition – they are part of what defines this condition. And he argued that the loss of this condition would involve a catastrophic rupture both with our past and with our own creatureliness. To mitigate and ameliorate the human condition was good, he said. To lose it altogether was a catastrophe because we can only know God as creatures – i.e. created or given beings – not as gods who have taken charge of our own destiny.
This recognition was just the beginning of a new stance on Illich’s part. Medical Nemesis had addressed a citizenry that was imagined as capable of acting to limit the scope of medical intervention. Now he spoke of people whose very self-image was being generated by bio-medicine. Medical Nemesis had claimed, in its opening sentence, that “the medical establishment has become a major threat to health.” Now he judged that that the major threat to health was the pursuit of health itself.
“I believe,” he told me in 1988, “that…there [has been] a change in the mental space in which many people live. Some kind of a catastrophic breakdown of one way of seeing things has led to the emergence of a different way of seeing things. The subject of my writing has been the perception of sense in the way we live; and, in this respect, we are, in my opinion, at this moment, passing over a watershed. I had not expected in my lifetime to observe this passage.”
Illich characterized “the new way of seeing things” as the advent of what he called “the age of systems” or “an ontology of systems.” The age that he saw as ending had been dominated by the idea of instrumentality – of using instrumental means, like medicine, to achieve some end or good, like health. Characteristic of this age was a clear distinction between subjects and objects, means and ends, tools and their users etc. In the age of systems, he said, these distinctions have collapsed. A system, conceived cybernetically, is all encompassing – it has no outside. The user of a tool takes up the tool to accomplish some end. Users of systems are inside the system, constantly adjusting their state to the system, as the system adjusts its state to them. A bounded individual pursuing personal well-being gives way to an immune system which constantly recalibrates its porous boundary with the surrounding system.
what Illich called “the pathogenic pursuit of health” may involve an intense, unremitting and virtually narcissistic preoccupation with one’s bodily state. Why Illich conceived it as disembodying can best be understood by the example of “risk awareness” which he called “the most important religiously celebrated ideology today.” Risk was disembodying, he said, because “it is a strictly mathematical concept.” It does not pertain to persons but to populations – no one knows what will happen to this or that person, but what will happen to the aggregate of such persons can be expressed as a probability. To identify oneself with this statistical figment is to engage, Illich said, in “intensive self-algorithmization.”
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The choice is existential; the information on which it is based is the probability curve on which the chooser has been inscribed. Illich found this to be a perfect horror. It was not that he could not recognize that all human action is a shot in the dark – a prudential calculation in the face of the unknown. His horror was at seeing people reconceive themselves in the image of a statistical construct. For him, this was an eclipse of persons by populations; an effort to prevent the future from disclosing anything unforeseen; and a substitution of scientific models for sensed experience.
Increasingly people were acting prospectively, probabilistically, according to their risk. They were becoming, as Canadian health researcher Allan Cassels once joked, “pre-diseased” – vigilant and active against illnesses that someone like them might get. Individual cases were increasingly managed as general cases, as instances of a category or class, rather than as unique predicaments, and doctors were increasingly the servo-mechanisms of this cloud of probabilities rather than intimate advisors alert to specific differences and personal meanings. This was what Illich meant by “self-algorithmization” or disembodiment.
Religiosity is the ground on which we stand, our feeling about how and why things are as they are, the very horizon within which meaning takes shape. For Illich, the createdness, or given-ness of the world was the foundation of his entire sensibility. What he saw coming was a religiosity of total immanence in which the world is its own cause and there is no source of meaning or order outside of it – “a cosmos,” as he said, “in the hands of man.” The highest good in such a world is life, and the primary duty of people is to conserve and foster life. But this is not the life which is spoken of in the Bible – the life which comes from God – it is a rather a resource which people possess and ought to manage responsibly. Its peculiar property is to be at the same time an object of reverence and of manipulation. This naturalized life, divorced from its source, is the new god. Health and safety are its adjutants. Its enemy is death. Death still imposes a final defeat but has no other personal meaning. There is no proper time to die – death ensues when treatment fails or is terminated.
Illich, in his later years, concluded that humanity, at least in his vicinity, had taken leave of its senses and moved lock, stock and barrel into a system construct lacking any ground whatsoever for ethical decision. The bodies in which people lived and walked around had become synthetic constructs woven out of CAT-scans and risk curves. Life had become a quasi-religious idol, presiding over an “ontology of systems.” Death had become a meaningless obscenity rather than an intelligible companion.
He believed that medicine had so far exceeded the threshold at which it might have eased and complemented the human condition that it was now threatening to abolish this condition altogether. And he had concluded that much of humanity is no longer willing to “bear…[its] rebellious, torn and disoriented flesh” and has instead traded its art of suffering and its art of dying for a few years of life expectancy and the comforts of life in an “artificial creation.”
At the heart of the coronavirus response has been the claim that we must act prospectively to prevent what has not yet occurred: an exponential growth in infections, an overwhelming of the resources of the medical system, which will put medical personnel in the invidious position of performing triage, etc. Otherwise, it is said, by the time we find out what we’re dealing with, it will be too late.
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- Note: Living in a future which may never come, which we have only scattered and contradictory and badly understood evidence regarding whether it will become reality
An expression like “flattening the curve” can become overnight common sense only in a society practiced in “staying ahead of the curve” and in thinking in terms of population dynamics rather than actual cases.
Beck portrayed late modernity as an uncontrolled science experiment. By uncontrolled he meant that we have no spare planet on which we can conduct a nuclear war to see how it goes, no second atmosphere which we can heat and observe the results. This means that techno-scientific society is, on the one hand, hyper-scientific and, on the other, radically unscientific insofar as it has no standard against which it can measure or assess what it has done.
All these, insofar as they have unforeseeable and unpredictable consequences, already constitute a kind of living in the future.
In his late writings Illich introduced, but never really developed, a concept that he called “epistemic sentimentality” – not a catchy phrase, admittedly, but one that I think sheds on light on what is currently going on. His argument, in brief, was that we live in a world of “fictitious substances” and “management-bred phantoms” – any number of nebulous goods from institutionally-defined education to the “pathogenic pursuit of health” could serve as examples – and that in this “semantic desert full of muddled echoes” we need “some prestigious fetish” to serve as a “Linus blanket.” In the essay I’ve been quoting “Life” is his primary example. “Epistemic sentimentality” attaches itself to Life, and Life becomes the banner under which projects of social control and technological overreach acquire warmth and lustre. Illich calls this epistemic sentimentality because it involves constructed objects of knowledge that are then naturalized under the kindly aegis of the “prestigious fetish.”