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Medical Iconoclast Attacks the 'Holistic' Path

April 15, 1986|ALLAN PARACHINI | Times Staff Writer

It was 10 years ago that philosopher-social scientist-historian Ivan Illich trained his sights on medicine in a book called "Medical Nemesis."

A decade later, Illich has returned to the subject, convinced that, in some ways, the cure for what ailed medicine has turned out to be worse than the disease. This time, he is pursuing the new American obsession with health , a development he says is worse than "national hypochondria."

Central to the problem he identified in 1976, contended Illich--borrowing a Greek-origin term from the medical lexicon and then radicalizing it--had become a phenomenon called iatrogenesis , or the problem of illness and injury caused by doctors, not cured by them.

Doctors and the technological system of hospitals and science they had created, Illich charged a decade ago, were running amok--perhaps bearing responsibility for as much suffering and disease as they cured.

A Radical Idea in the Mid '70s

Radical though it was in its time, it was an allegation that grew to attain great currency in an era only beginning to question the role of medicine in society and conclude that physicians were something less than god-like. And in the decade since "Medical Nemesis" was first published in its American form (an earlier version appeared in England in 1974), Illich's philosophy became perhaps the seminal work in the movement challenging both medicine and doctors.

Now, Illich has returned to the scene, leveling new charges not against medicine, but against the American system of "health" consciousness that has sprung up at the behest of a wide variety of professionals and paraprofessionals. One of the ironies is that many of these new players, knowingly or unknowingly, base their claims to legitimacy on the questions Illich himself first raised.

This new enterprise at large has often been called the holistic health movement, a term that was coined as a means of describing care intended to oversee the whole range of health challenges but which has, in Illich's view, turned too frequently into nothing more than a marketing ploy.

In the new perception of health, it is fashionable for the consumer to refer to "my body" as if it is a device like a car or a microwave oven that exists somehow apart from the intelligence of the individual, Illich contends. As simply another of life's hard goods, then, it can be repaired, modified and subjected to all manner of performance enhancement techniques, with the degree to which health is achieved becoming a measure of one's success as a human.

The spectacle of daily pilgrimages to aerobics classes and Nautilus fitness centers is a part of this, to be sure, Illich argues. But what is happening also includes stress-relief clinics, nutrition-advice centers, consumer-health publications and medical services advertised as somehow capable of engendering "health"--as opposed to merely the absence of disease--in a body not currently blessed with it.

One of the problems, argues Illich, is that such aggressive promotion of the concept of health implies that whatever health is can be achieved by anyone if he or she will only go to the trouble of pursuing it. This sense of health leaves no room for unattractive bodies that are not capable of lifting enough, running or swimming fast enough or otherwise excelling. Nor does it permit behavior that does not conform to an acceptable form of health consciousness.

Massive Overresponse Seen

So great is the magnitude of what Illich thinks is this now massive overresponse to the questions he and others have raised about traditional medicine, that he now believes--based on a collaboration with a German feminist historian--that the American health craze has so distorted reality that it has established itself as "the major pathogen" (organism that can cause disease) in society today.

Not only is this preoccupation a societal pathogen, they argue, but it is also unprecedented in Western history. In fact, say Illich and historian Barbara Duden, currently on leave from the Technical University of Berlin to teach this year at Pitzer College in Claremont, both the establishment of medicine as a strictly technical endeavor and its successor--the headlong pursuit of health --are concepts that existed nowhere prior to the last 30 years.

There is not yet a book in this from Illich and there may never be. He is concerned about the difficulties posed by reducing such a historical-philosophical complex into consumer form. "While 'Medical Nemesis' could be written as a popular rabble rouser," Illich said in his pronounced Austrian accent, "this is very delicate, not (necessarily) for mass consumption." (Illich also wrote "Deschooling Society," a broadside against the American educational system in the 1960s.)

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