Medical Nemesis

by Ivan Illich
Pantheon, $8.95
Medical Nemesis is a relentless argument that modern medicine—far from improving our general well-being—has solved few of its major research problems and has become, paradoxically, “a major threat to health.”
This is an alarming diagnosis, and meant to be so. But Illich does not mean to suggest that doctors are useless. He does believe that over the past century or so medicine has shrouded itself in professionalism and mystery. Patients have come to believe more and more in the limitless capacity of medicine to expel disease, eliminate pain, and forestall death. And doctors have not resisted the satisfactions of that enshrinement. The result is an emotional climate in which the responsibility for health has been transferred from the patient (where, says Illich, it belongs) to the doctor. “Healthy people,” says Illich, “are those who live in healthy homes on a healthy diet in an environment equally fit for birth, growth, work, healing, and dying: they are sustained by a culture that enhances the conscious acceptance of limits to population, of aging, or incomplete recovery and ever-imminent death.”
As in his other books, Illich’s principal target is materialist society and its encouragement of “efficient” bureaucratic processes that chip away at intellectual and spiritual autonomy, that place more and more responsibility for our educational, economic, and medical well-being in the hands of managers or other professionals. Critics of the Illich perspective object to his presumption of class warfare, his “tunnel vision.” and to the utter impracticability of the alternatives to modernity that his books appear to recommend. Many doctors will add that the Illich criticisms are widely acknowledged among thoughtful members of the profession, and ask what the fuss is all about. Even so, few writers have examined the workings of modern medical practice with such riveting clarity or in such awesome detail. Anyone seriously interested in the state of modern medicine, or the tensions of modern life, will want to read this remarkable book.
C. Michael Curtis