On the black sacrificial lamb
Medicine means “doom”. "Medical Nemesis", a report. Thus, the author close to the action, committed. On whose pay – unknown. His message, however – how contradiction-free betraying! – neutral, scientific, honest. Modest in his demands and means ("refraining from hubris").
He may be assumed to be aware of the inadequacy of the diagnosis and the prognosis – which is, of course, infauste, hopeless – on the one hand, and his therapeutic proposals, of which he at least gives vague indications, on the other.
Indeed, the scope and depth of the task could well be adequately outlined with the help of a judgement by W. REICH (1948), since – if one has read ILLICH – there is no reason to assume that the problem could have lost its urgency if one waits much longer.
"I venture to say that no revolution and certainly not the overcoming of the plague of the Middle Ages can compete with this task in terms of scope, depth and dangers. The solution to this task will in all probability require the greatest revolution in thought and action that mankind has ever had to accomplish. It will not be an achievement of single persons, but an achievement of society "(WILHELM REICH,"The Biopathology of Cancer").
Compared to that, ILLICH appears quite resigned. People should be satisfied with rediscovering the art of mutual self-treatment, in terms of content: rediscover the medicine of the poor. They should learn again to deal with death, pain and frailty. Above all, they should once again include dying at the right time into their life program.
Terrible conditions, in which even quietist appeals of this kind are not devoid of, if not a revolutionary, then at least a progressive valence.
That this is the case does not require a long search for reasons in ILLICH. One rather has to look for the principle [Grundsatz]. But most of all for the opposition [Gegensatz]. Part of the principle – and we have known this for a long time – is that death, pain and frailty are taken away from their bearers, are expropriated (ILLICH).
That therefore the many illnesses, accordingly invented, handled and replaced by doctors in the form of a monstrous labeling swindle, are exchanged as commodities for medicines, insurance and other medical commodities "of equal value", so that what stands for their "cure" penetrates as illness out of the techniques of their "overcoming" into the producer-consumer of illness "from the outside", depending thus, as a result of the "overmedicalization", on nothing but the commodity doctor, now only existing as this commodity.
Their reclamation and affirmation through the refusal of therapy, for example, historically an atavism, can thus – if we interpret ILLICH correctly – in single cases [Einzelfall] (not to say in the cell of solitary confinement) [Einzelzelle, Einzelhaft] become a necessary transition stage in the struggle for life autonomy and emotionality, thus bringing revolutionary things to light ((Ur-Teilsgegensatz – primordial division and opposition of judgement)).
General blunting and apathy, addiction to consumption and indifference at the pole of society as a whole, taken as a patient [Gesamtpatient Gesellschaft], increasing differentiation and the perfecting of illness as a growth-intensive apparatus, infection and contagion, poisoning and mutilation of the many as "side effects" of medicynical care (clinical iatrogenesis), killing of the revolt that is inherent in illness through a health policy in self-inflicted complicity with industrial organizations that makes people sick (social iatrogenesis), restriction of vital autonomy in the single person through medically promoted behaviors that sprout like cancer in delusions of a better life (structural iatrogenesis) on the one hand, unlimited increase in power of the medical profession (mafia , ILLICH), culminating in the totalitarianism of an unprecedented and absolutely unsurpassable expansion of social control right into all the innards on the other side.
It is about the agony of everybody in its lifelong, thousandfold variations. But please always according to the rules of the medical system ((Iatrocracy, brain imperialism)): "Death no longer occurs, except as a self-fulfilling prophecy of the medicine man" (p. 148*).
* All quotations in this translation refer to the English edition: IVAN ILLICH, Medical Nemesis, The Expropriation of Health, published by Calder Boyars, London, 1976. (Note from the translator)
Incidentally, this also applies within the medical profession: in Chile, for example, five politically disliked doctors around Allende were killed within a week due to denunciations by medical associations who kept black lists.
"Indeed, people would even rebel against it, unless doctors provided them with a diagnosis which explains their inability to cope with the situation as a health defect." (p. 118)
Given this situation, it might come as a slight surprise that ILLICH, despite all the reasons for resignation, is still optimistic enough to encourage patients – and after him (we have already said it) somehow all are patients – to self-treatment. It is precisely people from the profession [Leute vom Fach] who deny them even the ability to organize themselves (as only recently again senior physician DÖRNER in his last Suhrkamp pocketbook).
For more than half a decade, patient organizations have been the privileged fair game of medically triggered persecution by mobile murder squads protecting the state (see DAVID COOPER "The Grammar of Living" for the accumulation of analogous incidents in the Third World, no different from Europe). And last but not least, ILLICH sees how, in revolutionary China, medical care by learning laypeople (barefoot doctors) is once again increasingly ceded in the responsibility of academic experts.
But that's not all: "No matter how thoroughly the medical-industrial complex is controlled or even curtailed ... this limitation would only transfer the social control now performed by medicine to another hegemony" (p. 160).
In other words: not even the CLUB OF ROME – just assuming it really wanted and had the power to drastically curtail the "growth rate", let alone introduce socialism – would have the slightest chance to avert that “doom” that is programmed in and as medicine, that is the prospective total annihilation of the human life apparatus, or better said: BIOPATHY (W. REICH).
On the contrary: the extension of the medical control to the "well-being of healthy people" (up to 35% of the net income is social security contributions) results to them becoming patients anyway, "without being sick" (p. 25), breeding an exponentially growing demand for the patient role, so that "medically certified symptoms exempt people from destructive wage labor and give them leave from fighting for the society they live in" (p. 26).
If ILLICH nevertheless places his hope of averting the "nemesis", which as a modern one, in contrast to the Greek-classical, is collaboration with the rulers, on the "disempowerment of the medical guild" and on the otherwise unspecified "mutual self-treatment of patients”, he does that for several reasons, of which he deals with one, let's say strategic, another, which one could call existential, and one theoretical.
The main reason, the uncompromising practice of resistance and attack against the identity of illness and capitalism, against the transformation of the masses into the sick labor-force-commodity, [Verwandlung der Massen in die kranke Ware Arbeitskraft], against this differential euthanasia, for the elimination of iatrocracy without replacement and more, this effective OPPOSITION [GEGENSATZ] to the sediment [Bodensatz] of the base and the superstructure [Bodensatz von Basis und Ueberbau], even ILLICH has not yet been able to integrate into his reports.
Regarding the strategic reason: "Therefore it is no less important to choose the medical guild as a target for radical disempowerment ... and since medicine is a sacred cow, its slaughter would have an ‘echo effect’" ((to slaughter also the rest)).
Regarding the existential reason: "Only people who can face suffering and death without need for magicians and mystagogues are free to rebel against other forms of expropriation ..." (p. 161).
(Incidentally, it should be noted that the author never calls the capitalist class, capitalism in whatever form, profit maximization etc. by its name, that he prefers paraphrased expressions such as industrial society, growth and the like with exclusivity; that he juggles with the methods of Marxist analysis as diligently as superficially, and that on top of that he also throws planned economy into one pot, regardless of whether it concerns "Wall Street" or "the party").
The political consequence of all this, if ILLICH had drawn this conclusion, would be the conception of a RETURN to a society free of domination in the sense of a naive anarchism. But how could he then still seek refuge in government regulations, laws, ordinances, etc., something that is repeatedly alluded to in detail?
This is only possible without contradiction, in so far as he admits that such afflictions are the reflex of his stillborn quietist positionality from the spirit of the determined negation, which in any case is still closer to the doctor-free theocracy than to the concrete utopia of spiritualized nature as the home of naturalized man.
Regarding the theoretical reason: the commonality [Gemeinsamkeit] that is brought about by experiencing pain, forms the germ of a future social synthesis that is more fundamental than anything that the money-mediated form of value can falsely reflect in terms of maddening and displacing [verrueckenden] categories and relationships (see p. 93 et seq).
Pain, this extreme of singularizing loneliness [Extrem der Vereinzelung], the UN-VALUE (ILLICH) par excellence, withstands so little in itself, but on the other hand is in principle so little interchangeable that it would evade the increasingly intensified mechanisms of alienation to which its genesis has entirely passed over.
It would seem, however, that the author places not a small part of his optimism on the repression of "terror and violence" through the experience of "physical pain" as an indispensable component of life's autonomy. Culturally patched up, medically anesthetized, drowned in drugs and alcohol, kept in dependency of most modern resuscitation devices in political torture ((and through "traceless" extermination torture in solitary cells)), today, the pain no longer marks the social barrier (!) of the transformation of man from a middle [Mitte] into a means [Mittel] of killing pain, because this means would consume violence, terror and drugs as "the only stimuli that can still mediate [vermitteln] an experience of self-awareness" (p. 106).
What remains would display itself as a senseless, unquestionable remnant of horror (Hiroshima). Of course, there could be no question of a communitizing function [vergemeinschaftende Funktion] of this kind of pain. In any case, it has long since lost its significance – if we want to believe ILLICH that it ever had such – of even setting an insurmountable barrier to the abuse of man by man.
But especially in view of the observations of a FRANTZ FANON ("The Wretched of the Earth") on the collective-forming function of terror and violence, in view of the laws worked out by COOPER in SARTRE (“Reason and Violence") as they are constituting the dialectics of series and group, where the violence of common freedom (including the freedom to die) are the decisive catalysts of the synthesis, in view of all this it remains unclear, especially in the interest of "mutual self-treatment", what kind of mediation the being against one another of value and pain actually should carry.
ILLICH simply lacks the practice that could have taught him that out of pain, despair, death threats and frailty, in short: out of everything that essentially remains of illness (its substance) when in mutual self-control it is referred back to the capitalist social system, from which it originates, arises with the compelling necessity of a law of nature precisely that terror which is the product of the freedom of all, which extends to the truly infinite because it breaks down the barriers of alienation in the innards and in those of the group – and turns illness into a weapon.
From: SPK-Documentation Part 3, 1st edition 1977
Patients’ Front / Socialist Patients’ Collective, PF/SPK(H), 15.07.2021