Social Analysis
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Illich suggests that the pursuit of health mat itself be a sickining disorder. He punctures the myth of health care. It is not a commodity that can be "delivered". Care is not something that can come out of a system. As always, Illich calls us back from the mesmerising draw of technological progress and the power exercised over us by self-certified professionals. His emphasis is on trusting our own personal experience, exercising our freedom of choice and finding hospitality and care among friends and community.
By Ivan Illich  
  Many persons are confused today about something called "health". Experts prate knowingly about "health care systems". Some persons believe that without access to sophisticated and expensive treatments, people will be sick. Everyone worries about increasing costs. One even hears talk of a "health care crisis". I would like to say something about these matters.

First, I believe it necessary to assert the truth of the human condition: I suffer pain; I am afflicted with certain impairments; I will certainly die. Some undergo greater pain, some more debilitating disorders, but we all equally face death.

Looking around me, I see that we as people in other times and places have great capacity to care for one another, especially in the moments of birthing, accident and dying. Unless unbalanced by historical novelties, our households, in close cooperation with their surrounding communities, have been wonderfully hospitable, that is, generally adequate to care for the real needs of living, celebrating and dying.

In opposition to this experience, some of us today have come to believe that we desperately need packages, commodities, all under the label of "health", all designed and delivered by a system of professionalised services. Some try to convince us that an infant is born, not only helpless needing the loving care of a household, but also sick requiring specialised treatment by self-certified experts. Others believe that adults routinely require various drugs and interventions in order to become old, while the dying need medical treatment.

Many have forgotten or are no longer able to enjoy those commonsense ways of living that contribute to one's well-being and ability to recover from illness. Many have allowed themselves to become dependent on a self-aggrandising technological myth, against which they nevertheless complain, because of the impersonal ways in which it impoverishes many while enriching a few.

Sadly, I recognise that many of us are infected with a strange illusion: a person has a "right" to something called health care. Thus, one states a claim to receive tha latest assortment of technological therapies, based on some professional's diagnosis, to enable one to survive longer in a situation which is often ugly, injurious, depressing or just boring.

I believe it is time to state clearly that specific situations and circumstances are sickening, rather than that people are sick. The symptoms which modern medicine attempts to treat often have little to do with the condition of our bodies; they are, rather, signals pointing to the disorders and presumptions of modern ways of working, playing and living.

Nevertheless, many of us are mesmerised by the glitter of high-tech "solutions", we pathetically believe in "fix-it" drugs, we mistakenly think all pain is an evil to be suppressed, we seek to postpone death at almost any cost.

I appeal to the actual experience of people, to the sensibleness of the ordinary person, in direct opposition to professional diagnosis and judgment. I appeal to peoples' memories, in opposition to the illusions of progress. Let us look at the conditions of our households and communities, not at the quality of "health care" delivery; health is not a deliverable commodity and care does not come out of a system.

I demand certain liberties for those who would celebrate living rather than preserve "life":

the liberty to declare myself sick;
the liberty to refuse any and all medical treatment at any time;
the liberty to take any drug or treatment of my own choosing; the
liberty to be treated by the person of my choice, that is, by
anyone in the community who feels called to the practice of
healing,whether that person be an acupuncturist, a homeopathic
physician, a neurosurgeon, an astrologer, a witch doctor, or
someone else;
the liberty to die without diagnosis.

I do not believe that countries need a national "health" policy, something given to their citizens. Rather, the latter need the courageous virtue to face certain truths:

we will never eliminate pain;
we will not cure all disorders;
we will certainly die.

Therefore, as sensible creatures, we must face the fact that the pursuit of health may be a sickening disorder. There are no scientific, technological solutions. There is the daily task of accepting the fragility and contingency of the human situation. There are reasonable limits which must be placed on conventional "health" care. We urgently need to define anew what duties belong to us as persons, what pertains to our communities, what we relinquish to the state.

Yes, we suffer pain, we become ill, we die. But we also hope, laugh, celebrate; we know the joy of caring for one another; often we are healed and we recover by many means. We do not have to pursue the flattening out of human experience.

I invite all to shift their gaze, their thoughts, from worrying about health care to cultivating the art of living. And, today, with equal importance, to the art of suffering, the art of dying.
Ivan Illich is an ex-professional itinerant teacher and philosopher. He is author of Limits to Medicine: Medical Nemesis - The Expropriation of Health (Penguin 1976).
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