By Jean-Pierre Dupuy
(*)The original french article “Le veritable heritage d’Ivan Illich — sur une pretendue ‘sacralisation de la vie” was published in the journal AOC on January 21, 2021.
Among the critics of the health policy carried out against the Covid-19 crisis, some more or less explicitly claim the thought of Ivan Illich, denouncing the “idolatry of life” to the point of succumbing to the fashion of covidoscepticism. However, what the philosopher criticized was not the sacralization of life, but its degradation. Should it not therefore be protected when it is in danger? Jean-Pierre Dupuy discusses here what is most painful for him: the legacy of Ivan Illich. Second part of a series of two articles.
The first time I saw Ivan Illich was on a TV screen. He was interviewed by the director of Esprit magazine Jean-Marie Domenach in the courtyard of a mansion on Rue de l'Université in Paris. It was 1971 or 1972. What struck Illich from the outset was his profile as a bird of prey and his voice that was both smooth and sharp, with the aristocratic accent of Central Europe marrying with an almost brutal way of accentuating the last syllable of words.
The conversation had lasted more than an hour when Domenach asked the question that had remained in the background throughout the interview: “And the Church, Ivan, the Church, in all this? The question was all the more relevant to those who knew the basic elements of the biography of this fascinating man, born in Vienna in 1926, who had been a priest and even Monsignor in the hierarchy of the Catholic Church before being subjected to an inquisitorial trial in Rome.
As he usually did, Illich meditated for a moment before pronouncing: “The Church is a whore, but she is also my mother.”
Like many viewers no doubt, I was stunned. Domenach was a friend and I knew from him that Illich, author of two books that had already created a lot of controversy, Liberating the Future and A Society Without School, had started a program of research, meetings, and discussions on medical institutions in Cuernavaca, some 60 kilometers south of Mexico city, where he had settled. Domenach, who knew that I was working on the subject myself, introduced us to each other and this was the beginning of a friendship that was not to end until Illich's death in December 2002.1)
I passed several stays in Cuernavaca, working in particular on the booklet Energy and Equity (Seuil, 1973), a criticism of the transportation system and a demystification more relevant than ever on the idea that we would have an ever-increasing need for energy. It was during the winter of 1975 that I wrote in close complicity with Illich what would become the French version of his great book on medicine, under the title Némésis médicale (Seuil, 1975).
I mention these circumstances because they plunge me back into an era and place so far from ours that I sometimes wonder if they ever existed. Every winter, very mild and sunny in this region of Mexico, the whole world ran to Cuernavaca in order to sketch the paths of metamorphosis. All languages were spoken there, and of course Spanish. Illich’s Spanish was very good and allowed him to play on the double meaning of the word “salud”: health and salvation. He could therefore state that just as the Church had acquired a “radical monopoly” on the production of salvation, medicine has done the same with regard to the production of health. In either case, the result is that the more the institution grows, the more it becomes an obstacle to the very end it was supposed to serve. This is the origin of the concept of counterproductivity.
If I contributed anything to our discussions in the winter of 1975, it was to have insisted on the distinction between two forms of counterproductivity, one social, the other structural. As they pull in two opposite directions, it was inevitable that they would blur the message. According to the first, Illich presents himself as a progressive activist; according to the second, as a thinker who is now thought to be reactionary. However, there is only one Illich.
At the time, my friend the sociologist Serge Karsenty, who passed too early, and I published a book that had achieved some scandalous success, The Pharmaceutical Invasion (Seuil, 1974), in which we introduced a notion that flourished, the “medicalization of life”, and a formula “medicine has become the alibi of a pathogenic society.” By this we meant that many evils of modern society, such as the excessiveness of production units, the density of urban spaces, the fragmentation of living spaces, the acceleration of transportation, the disintegration of families, the anxiety that results from unbridled competition between individuals and so on, are treated as pathologies that can be presented to the medical profession and receive therapy.
These issues, which fall within the political sphere, are thus naturalized. Medicine, consciously or unconsciously, is complicit in the status quo. This is its social counterproductivity. Illich took up this analysis.
He must have regretted it some fifteen years later. His technique for convincing was to shock. The paradox was his favorite weapon. When his ideas entered the common consciousness, especially when they were taken up by the very professionals who were the target of his criticism, they lost all usefulness in his eyes. This is what happened over the years with some of the doctors, who clearly saw that what they were increasingly asked to accomplish was not what they had been taught on the benches the faculty. Following Illich's lesson as they understood it, it now seemed urgent to them to “de-medicalize” society and “return power to patients”, encouraging their autonomy and promoting their personal care.
Illich replied in a paper he delivered on September 14, 1990, in Hanover, Germany, under the significant and cyrano-esque title: “Would health be my personal responsibility? No, thank you! I quote here the magnificent conclusion of this paper.2) It illustrates the core of what I have called the structural counterproductivity of medicine above:
"It does not seem to me that it is necessary for States to have a national policy of "health", something they grant to their citizens. What they need is the courageous ability to face certain truths:
—we will never eliminate pain;
—we will never cure all afflictions;
—We will certainly die.
That is why, as thinking creatures, we must understand that the quest for health can become unhealthy. There are no scientific or technical solutions. There is the daily obligation to accept the contingency and fragility of the human condition. Reasoned limits should be set for conventional health care. The urgency must be to define the duties incumbent on us as individuals, those that we return to our community, and those we leave to the State.
Yes, we hurt, we get sick, we die, but it is no less true that we hope, laugh, celebrate; we know the joys that strive to take care of each other. The means are diverse that often allow us to recover and heal. Our sensitivity does not have to follow a uniform and trivialized path.
I invite everyone to turn their eyes and thoughts away from the pursuit of health, and to cultivate the art of living. And, just as important today, the art of suffering and the art of dying."
I understand that those who think that we have exaggerated the current pandemic can find comfort in these words. That would be a mistake. It is always uncomfortable to make the dead speak, but I imagine Illich reacting to the current situation. The huge difference that would separate him from the doxa of intellectuals is that he would have no need to belittle life to criticize the supposed control of the state and the medical profession over the course of the epidemic.
He saw life as an art, made up of daily duties and obligations, but also of joys and friendships. He would have burst into gales of laughter —he could be cruel, but cruelty directed only against stupidity —on hearing the slices into which these logic chopping intellectuals had carved life by distinguishing between social life, economic life, and naked, raw life, “biological life.” That baroque expression would have turned his laughter to anger. He would have asked sociologists if they studied “sociological society” and anthropologists if they looked at the fate of someone called “anthropological man.”
Illich's critique is not against the idolatry of human life placed on a pedestal in the hierarchy of “values” (a word he abhorred) by the state allied with the medical profession, but, on the contrary, about its debasement. In what is probably his best book, although posthumous and which is in fact an interview with Canadian journalist David Cayley,3) Illich discloses all the horror he feels having to confront representation of the human body that makes it an assembly of parts forming a system, each of which can be replaced, for a fee, by another taken from a dead person. What would he say today about the biotechnologies that are called “advanced” and which aim, some to “edit” the human genome, and others to fabricate life from non-life?
If we mean by “biological life” the conception of life that is derived from biology, then the observation is very brutal. François Jacob could write in 1970: “Life is no longer questioned today in laboratories. […] Biology is interested in the algorithms of the living world today.”4) To the question asked in 1943 by the physicist Erwin Schrödinger, “What is Life,” a question that was to lead to the discovery of DNA as a molecule of heredity and to the invention, via cybernetics, of molecular biology, the journal Nature answers today: “A silly question!”5) Our intellectuals strive in vain to denounce the sacralization of life. Biology has gone farther than they will ever dare to go by reducing it to nothing.
Illich has often been compared to Michel Foucault by making the first a kind of disciple of the second, having borrowed his concept of biopower from him. It's a misinterpretation. At the time of the release of François Jacob's book, the author of Words and Things did not hide his enthusiasm: “A lifeless biology? […] We must no longer think of life as the great continuous and attentive creation of individuals; we must think of the living as the calculable game of chance and reproduction.6) We can't be further from Illich's thought. Foucault would probably be one of the flag bearers of this sinister fashion that denigrates life today.
It was in the book of interviews he had with David Cayley that Illich, for the first time, spoke about how he would like to die. It tells the last day of the Dominican brother Girolamo Savonarola, who was executed for heresy in Florence on May 23, 1498. With two other brothers who had publicly supported him, he had to be hanged before being burned, a sign of the advanced civilization of the Tuscan capital, notes Illich ironically. Savonarola turns to one of his companions and said to him: ‘it was revealed to me last night that when you are taken to the gallows you must say, “no, don’t hang me, burn me alive.” We are not masters of our death. Let us be happy if we can die the death that God assigns to us.’
If we limit ourselves to saying that Illich preaches the reconquest of autonomy in the face of the grip of medicine, we do not understand that he was able to oppose what many today consider “ethical” progress, the free decision about the time of his death. Life, a pure gift every day miraculously renewed, is stronger than death. She knows better than we when it will be time.
Alas, a thousand times alas, David Cayley who knew how to get Illich to confess to things he had never said before, especially about how his faith informed his thought, has succumbed to the spirit of the times. In an April 2020 article entitled ‘Questions asked of the current pandemic from Ivan Illich's point of view,’7) he multiplies clichés and expresses his ignorance. This of course begins with the classic minimization of the severity of the pandemic. “Can we really say that an influenza epidemic (sic!)8) which seems to kill the old people above all (re-sic!) and vulnerable people are comparable [to diseases] that ravage entire populations?”
As for the feeling of crisis and panic that has seized the entire planet, it is much more the result of the measures taken to contain the epidemic than of the epidemic itself. The mere fact of naming the circulation of the virus a “pandemic” has contributed to the “social construction” of the event as a global disaster. As for these measures, their main purpose was to protect the health system much more than the patients. They could have done very well by taking care of each other “at home” (re-re-sic!).
I am almost ashamed to report these stupidities, but there is a more serious matter than that. David Cayley says, like Illich, that the life that must be preserved is a statistical life, which can be added up to others like anchovies in an anchovy box, to produce huge figures that break new records every day, and not the life lived — felt authentic life. At the end of April, New York State alone had 1,000 deaths per day, at a rate of 30,000 deaths per month, and almost 400,000 deaths per year. What lived experience can these numbers relate to? This does not prevent him from speaking, with Oliver Rey and others, about the idolatry of naked life and the divinization of health.
The case is interesting, because it is Illich's disciples who succumb to the fashion of covidoscepticism. On the one hand, they faithfully take up his ideas. Thus Olivier Rey: ‘In the past, death was the necessary termination of earthly life, which medicine could in some cases delay. 9) Today, death is a failure of the health system. This echoes one of Illich’s famous formulas, which he repeated many times: ‘Do not let us succumb to the diagnosis, but deliver us from health ailments.’10) On the other hand, these same intellectuals separate from him on a crucial point, which touches on the alleged sacralization of life.
In the light of the Illichian critique, something seems paradoxical in the covidosceptical criticism of biopower. The latter would sacrifice everything —freedoms, the economy and even the leisure we have to think of something other than this damn pandemic11)— to save as many lives as possible. But this goal implies that the lives we save en masse are of the species of “biological life”, the one we share with all living beings, therefore the least specifically human. Thus, sacrificing everything to an idol, life, would make it insignificant. It should be admitted that biopower would not see the inconsistency in placing above all a value, life, which would lose all value because of the priority it is given. There are few deities who vanish when they are offered sacrifices.
But is it true that counting the dead en masse, a practice that did not always exist and probably dates from the French Revolution, necessarily leads to the degradation of life? It is useful to know that the First World War killed 10 million people, and the second, 60 million. It is essential to think about the fact that America, in 1961, was planning a global nuclear war that would have caused a billion deaths, or a third of the world's population at the time.12) We cannot imagine what these figures mean, which are pure abstraction. As benchmarks, however, they are essential. It is not statistics that make all corpses interchangeable. It's war, or the epidemic.
The protagonist of Albert Camus' Plague, Dr. Rieux, is accused by a journalist, who is a little too sentimental, of ‘living in abstraction.’ The narrator, who is none other than Rieux, notes: ‘Was it really an abstraction that these days spent in his hospital where the plague worked hard, bringing the average number of victims per week to five hundred? Yes, there was some abstraction and unreality in misfortune. But when abstraction begins to kill you, you must worry about abstraction.’13)
Even assuming that biopower has the destructive effect on life and health that the critics assume, it does not follow that life does not deserve to be protected if it is attacked. This proposal would be obvious if criticism had not muddied the waters, as we have just seen, by confusing sacralization and degradation. But protecting life is exactly what Illich does by treating it as pure data and denouncing the biopower that reduces it to a material that men shape at will to satisfy their needs. It is life that Illichian criticism defends without ‘idolizing it.’