'To hell with good intentions'

This post by Tim Worstall on 'iatrogenic-deaths' prompted my memory of the great Ivan Illich who popularised the term 'iatrogenic' (meaning roughly, doctor-induced harm) in his seminal 1975 work 'Medical Nemesis: The Appropriation of Health'.

From his Guardian obituary in 2002:

He worked in 10 languages; he was a jet-age ascetic with few possessions; he explored Asia and South America on foot; and his obligations to his many collaborators led to a constant criss-crossing of the globe in the last two decades.

Best known for his polemical writings against western institutions from the 1970s, which were easily caricatured by the right and were, equally, disdained by the left for their attacks on the welfare state, in the last 20 years of his life he became an officially forgotten, troublesome figure (like Noam Chomsky today in mainstream America). This position obscures the true importance of his contribution. His critique of modernity was founded on a deep understanding of the birth of institutions in the 13th century, a critical period in church history which enlightened all of his work, whether about gender, reading or materiality. He was far more significant as an archaeologist of ideas, someone who helped us to see the present in a truer and richer perspective, than as an ideologue.

This is what he had to say on the American desire to 'do good' in the world:

"The compulsion to do good is an innate American trait. Only North Americans seem to believe that they always should, may, and actually can choose somebody with whom to share their 'blessings'. Ultimately, this attitude leads to bombing people into the acceptance of 'gifts'..."

And here's Anthony Daniels (aka Theodore Dalrymple) who admired Illich and was irritated by him in equal measure:

He argued first that the health of a population had very little to do with its access to doctors and to medical care, and that the tangible benefits that doctors conferred were more than outweighed by the tangible harm that they did. He argued second (and more importantly) that the medical enterprise gave rise to unrealistic expectations in the population it served, disguising from it the fact that suffering was an inevitable part of human life and thus deforming its entire personality. Furthermore, medicine as a profession had inbuilt imperialist pretensions: more and more of ordinary human life came under its jurisdiction.

He wasn't an easy read. An extremely complex character and something of a paradox himself he nevertheless produced works which forced his readers toTHINK and, in many cases, fundamentally changed the way they thought about subjects such as health, education, work and institutions:

His fundamental argument, widely admired in some quarters and ridiculed and caricatured in others, was that once our institutions developed beyond a certain scale, they became perverse, counterproductive to the beneficial ends for which they were originally conceived. The end result of this paradoxical counter-productivity was schools which make people dumb, complacent and unquestioning; hospitals which produce disease; prisons which make people violent; travel at high speed which creates traffic jams; and ‘aid and development’ agencies which create more and more ‘needy’ and ‘underconsuming’ people.

Part of the problem is that Illich’s work does not come easily. His erudition and the fiery complexity of his style and thought make it difficult to unravel the many threads in his polemics. The other part of the problem is that undermining long-inculcated certainties in people’s lives tends to create anxiety in them, especially when the critique of those certainties rings true, but they do not know what to do about it. Too often the response is simple denial.

If you've never come across Illich and you've got a spare hour or so do yourself a favour. Forget those tedious blog posts analyzing the scandal of Labour party funding or what Nadine Dorries had for breakfast and get your teeth into some real intellectual meat:

Ivan Illich 1926 - 2002.