Modern medicine is a negation of health. It isn’t organized to serve human health, but only itself, as an institution. It makes more people sick than it heals.
Modern medicine is a negation of health. It isn’t organized to serve human health, but only itself, as an institution. It makes more people sick than it heals.
Ivan Illich
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by Ivan Illich
I. Clinical Iatrogenesis
The Epidemics of Modern Medicine
During the past three generations, the diseases affecting western societies have undergone dramatic changes. Polio, diphtheria, tuberculosis, commonly known as TB, are vanishing; one injection of an antibiotic often cures deadly diseases such as pneumonia or syphilis, and so many mass killers have come under control that two-thirds of all death is now associated with the diseases of old age. Those who die young are more often than not victims of accidents, violence, or suicide.
These changes in health status are generally equated with the decrease in suffering and attributed to more or better medical care. Almost everyone believes that at least one of his friends would not be alive and well except for the skill of a doctor. But there is, in fact, no evidence of any direct relationship between this change in the pattern or nature of sickness on the one hand and the so-called progress of medicine on the other hand. These changes are the results of political technological changes. They are not related to the activities that require the preparation and status of doctors or the costly equipment in which doctors take pride. In addition, an increase in the number of new diseases in the last fifteen years are themselves the result of medical intervention. They are doctor-made or iatrogenic?
After a century of pursuit of medical Utopia, and contrary to current conventional wisdom, medical services have not been important in producing the changes in life expectancy that have occurred. A vast amount of contemporary clinical care is incidental to the curing of disease, but the damage done by medicine to the health of individuals and populations is very significant. These facts are obvious, well documented, and well repressed.
Doctors’ Effectiveness – An Illusion
The study of the evolution of disease patterns provides evidence that during the last century doctors have effected such patterns no more profoundly than did priests during earlier times. Epidemics came and went, imprecated by both and untouched by either. They are not modified any more decisively by rituals performed in medical clinics than by exorcisms custormary at religious shrines. Discussions of the future of health care might usefully begin with the recognition of this fact.
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Useless Medical Treatment
Awe-inspiring medical technology has combined with egalitarian rhetoric to create the impression that contemporary medicine is highly effective. Undoubtedly, during the last generation, a limited number of specific procedures have become extremely useful. But where they are not monopolized by professionals as tools of their trade, those which are applicable to widespread diseases are usually very inexpensive and require a minimum of personal skills, materials, and custodial services from hospitals. In contrast, most of today’s skyrocketing medical expenditures are destined for the kind of diagnosis and treatment whose effectiveness at best is doubtful.32 To make this point I will distinguish between infectious and noninfectious diseases.
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by Ivan Illich
Introduction
The medical establishment has become a major threat to health. The disabling impact of professional control over medicine has reached the proportions of an epidemic. Iatrogenesis, the name for this new epidemic, comes from iatros, the Greek word for “physician”, and genesis, meaning “origin”. Discussion of the disease of medical progress has moved up on the agendas of medical conferences, researchers concentrate on the sick-making powers of diagnosis and therapy, and reports on paradoxical damage caused by cures for sickness take up increasing space in medical dope-sheets. The health professions are on the brink of an unprecedented housecleaning campaign. “Clubs of Cos,” named after the Greek Island of Doctors, have sprung up here and there, gathering physicians, glorified druggists, and their industrial sponsors as the Club of Rome has gathered “analysts” under the aegis of Ford, Fiat, and Volkswagen. Purveyors of medical services follow the example of their colleagues in other fields in adding the stick of ” limits to growth ” to the carrot of ever more desirable vehicles and therapies. Limits to professional health care are a rapidly growing political issue. In whose interest these limits will work will depend to a large extent on who takes the initiative in formulating the need for them: people organized for political action that challenges status-quo professional power, or the health professions intent on expanding their monopoly even further.
The public has been alerted to the perplexity and uncertainty of the best among its hygienic caretakers. The newspapers are full of reports on volte-face manipulations of medical leaders: the pioneers of yesterday’s so-called breakthroughs warn their patients against the dangers of the miracle cures they have only just invented. Politicians who have proposed the emulation of the Russian, Swedish, or English models of socialized medicine are embarrassed that recent events show their pet systems to be highly efficient in producing the same pathogenic—that is, sickening—cures and care that capitalist medicine, albeit with less equal access, produces. A crisis of confidence in modern medicine is upon us. Merely to insist on it would be to contribute further to a self-fulfilling prophecy, and to possible panic.
This book argues that panic is out of place. Thoughtful public discussion of the iatrogenic pandemic, beginning with an insistence upon demystification of all medical matters, will not be dangerous to the commonweal. Indeed, what is dangerous is a passive public that has come to rely on superficial medical housecleanings. The crisis in medicine could allow the layman effectively to reclaim his own control over medical perception, classification, and decision-making. The laicization of the Aesculapian temple could lead to a delegitimizing of the basic religious tenets of modern medicine to which industrial societies, from the left to the right, now subscribe.
My argument is that the layman and not the physician has the potential perspective and effective power to stop the current iatrogenic epidemic. This book offers the lay reader a conceptual framework within which to assess the seamy side of progress against its more publicized benefits. It uses a model of social assessment of technological progress that I have spelled out elsewhere¹ and applied previously to education² and transportation,³ and that I now apply to the criticism of the professional monopoly and of the scientism in health care that prevail in all nations that have organized for high levels of industrialization. In my opinion, the sanitation of medicine is part and parcel of the socio-economic inversion with which Part IV of this book deals.
The footnotes reflect the nature of this text. I assert the right to break the monopoly that academia has exercised over all small print at the bottom of the page. Some footnotes document the information I have used to elaborate and to verify my own preconceived paradigm for optimally limited health care, a perspective that did not necessarily have any place within the mind of the person who collected the corresponding data. Occasionally, I quote my source only as an eyewitness account that is incidentally offered by the expert author, while refusing to accept what he says as expert testimony on the grounds that it is hearsay and therefore ought not to influence the relevant public decisions.
Many more footnotes provide the reader with the kind of bibliographical guidance that I would have appreciated when I first began, as an outsider, to delve into the subject of health care and tried to acquire competence in the political evaluation of medicine’s effectiveness. These notes refer to library tools and reference works that I have learned to appreciate in years of single-handed exploration. They also list readings, from technical monographs to novels, that have been of use to me.
Finally, I have used the footnotes to deal with my own parenthetical, supplementary, and tangential suggestions and questions, which would have distracted the reader if kept in the main text. The layman in medicine, for whom this book is written, will himself have to acquire the competence to evaluate the impact of medicine on health care. Among all our contemporary experts, physicians are those trained to the highest level of specialized incompetence for this urgently needed pursuit.
The recovery from society-wide iatrogenic disease is a political task, not a professional one. It must be based on a grassroots consensus about the balance between the civil liberty to heal and the civil right to equitable health care. During the last generations the medical monopoly over health care has expanded without checks and has encroached on our liberty with regard to our own bodies. Society has transferred to physicians the exclusive right to determine what constitutes sickness, who is or might become sick, and what shall be done to such people. Deviance is now legitimate only when it merits and ultimately justifies medical interpretation and intervention. The social commitment to provide all citizens with almost unlimited outputs from the medical system threatens to destroy the environmental and cultural conditions needed by people to live a life of constant autonomous healing. This trend must be recognized and eventually be reversed.
Limits to medicine must be something other than professional self-limitation. I will demonstrate that the insistence of the medical guild on its unique qualifications to cure medicine itself is based on an illusion. Professional power is the result of a political delegation of autonomous authority to the health occupations which was enacted during our century by other sectors of the university-trained bourgeoisie: it cannot now be revoked by those who conceded it; it can only be delegitimized by popular agreement about the malignancy of this power. The self-medication of the medical system cannot but fail. If a public, panicked by gory revelations, were browbeaten into further support for more expert control over experts in health-care production, this would only intensify sickening care. It must now be understood that what has turned health care into a sick-making enterprise is the very intensity of an engineering endeavor that has translated human survival from the performance of organisms into the result of technical manipulation.
Health, after all, is simply an everyday word that is used to designate the intensity with which individuals cope with their internal states and their environmental conditions. In Homo sapiens, healthy is an adjective that qualifies ethical and political actions. In part at least, the health of a population depends on the way in which political actions condition the milieu and create those circumstances that favor self-reliance, autonomy, and dignity for all, particularly the weaker. In consequence, health levels will be at their optimum when the environment brings out autonomous personal, responsible coping ability. Health levels can only decline when survival comes to depend beyond a certain point on the heteronomous (other-directed) regulation of the organism’s homeostasis. Beyond a critical level of intensity, institutional health care—no matter if it takes the form of cure, prevention, or environmental engineering—is equivalent to systematic health denial.
The threat which current medicine represents to the health of populations is analogous to the threat which the volume and intensity of traffic represent to mobility, the threat which education and the media represent to learning, and the threat which urbanization represents to competence in homemaking. In each case a major institutional endeavor has turned counterproductive. Time-consuming acceleration in traffic, noisy and confusing communications, education that trains ever more people for ever higher levels of technical competence and specialized forms of generalized incompetence: these are all phenomena parallel to the production by medicine of iatrogenic disease. In each case a major institutional sector has removed society from the specific purpose for which that sector was created and technically instrumented.
by Ivan Illich
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Introduction
I owe my interest in public education to Everett Reimer. Until we first met in Puerto Rico in 1958, I had never questioned the value of extending obligatory schooling to all people. Together we have come to realize that for most men the right to learn is curtailed by the obligation to attend school. The essays given at CIDOC and gathered in this book grew out of memoranda which I submitted to him, and which we discussed during 1970, the thirteenth year of our dialogue. The last chapter contains my afterthoughts on a conversation with Erich Fromm on Bachofen’s Mutterrecht.
Since 1967 Reimer and I have met regularly at the Center for Intercultural Documentation (CIDOC) in Cuernavaca, Mexico. Valentine Borremans, the director of the Center, also joined our dialogue, and constantly urged me to test our thinking against the realities of Latin America and Africa. This book reflects her conviction that the ethos, not just the institutions, of society ought to be “deschooled.”
Universal education through schooling is not feasible. It would be no more feasible if it were attempted by means of alternative institutions built on the style of present schools. Neither new attitudes of teachers toward their pupils nor the proliferation of educational hardware or software (in classroom or bedroom), nor finally the attempt to expand the pedagogue’s responsibility until it engulfs his pupils’ lifetimes will deliver universal education. The current search for new educational funnels must be reversed into the search for their institutional inverse: educational webs which heighten the opportunity for each one to transform each moment of his living into one of learning, sharing, and caring. We hope to contribute concepts needed by those who conduct such counterfoil research on education–and also to those who seek alternatives to other established service industries.
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Why We Must Disestablish School
Many students, especially those who are poor, intuitively know what the schools do for them. They school them to confuse process and substance. Once these become blurred, a new logic is assumed: the more treatment there is, the better are the results; or, escalation leads to success. The pupil is thereby schooled to confuse teaching with learning, grade advancement with education, a diploma with competence, and fluency with the ability to say something new. His imagination is schooled to accept service in place of value. Medical treatment is mistaken for health care, social work for the improvement of community life, police protection for safety, military poise for national security, the rat race for productive work. Health, learning, dignity, independence, and creative endeavor are defined as little more than the performance of the institutions which claim to serve these ends, and their improvement is made to depend on allocating more resources to the management of hospitals, schools, and other agencies in question.
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Learning webs
The operation of a peer-matching network would be simple. The user would identify himself by name and address and describe the activity for which he sought a peer. A computer would send him back the names and addresses of all those who had inserted the same description. It is amazing that such a simple utility has never been used on a broad scale for publicly valued activity.
by Ivan Illich
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4. Convivial Reconstruction
Societies in which most people depend for most of their goods and services on the personal whim, kindness, or skill of another are called underdeveloped, while those in which living has been transformed into a process of ordering from an all-encompassing store catalogue are called advanced.
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5. The Multiple Balance
5.4 Polarization
The present organization of tools impels societies to grow both in population and in levels of affluence. This growth takes place at the opposite ends of the privilege spectrum. The underprivileged grow in number, while the already privileged grow in affluence. The underprivileged thus strengthen their frustrating claims, while the rich defend their presumed rights and needs. Hunger and impotence lead the poor to demand rapid industrialization, and the defense of growing luxuries pushes the rich into more frantic production. Power is polarized, frustration is generalized, and the alternative of greater happiness at lower affluence is pushed into the blind spot of social vision.
This blindness is a result of the broken balance of learning. People who are hooked on teaching are conditioned to be customers for everything else. They see their own personal growth as an accumulation of institutional outputs, and prefer what institutions make over what they themselves can do. They repress the ability to discover reality by their own lights. The skewed balance of learning explains why the radical monopoly of commodities has become imperceptible. It does not explain why people feel impotent to correct those profound disorders which they do perceive.
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5. The Multiple Balance
5.5 Obsolescence
In a society caught up in the race for the better, limits on change are experienced as a threat. The commitment to the better at any cost makes the good impossible at all costs. Failure to renew the bill of goods frustrates the expectation of what is possible, while renewal of the bill of goods intensifies the expectations of unattainable progress. What people have and what they are about to get are equally exasperating to them. Accelerating change has become both addictive and intolerable. At this point the balance among stability, change, and tradition has been upset; society has lost both its roots in shared memories and its bearings for innovation. Judgment on precedents has lost its value.
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5. The Multiple Balance
5.6 Frustration
Counterfoil research is concerned first with an analysis of increasing marginal disutility and the menace of growth. It is then concerned with the discovery of general systems of institutional structure which optimize convivial production. This kind of research meets psychological resistance. Growth has become addictive. Like heroin addiction, the habit distorts basic value judgments. Addicts of any kind are willing to pay increasing amounts for declining satisfactions. They have become tolerant to escalating marginal disutility. They are blind to deeper frustration because they are absorbed in playing for always mounting stakes. Minds accustomed to thinking that transportation ought to provide speedy motion rather than reduction of the time and effort spent moving are boggled by this contrary hypothesis. Man is inherently mobile, and speeds higher than those he can achieve by the use of his limbs must be proven to be of great social value to warrant support by public sacrifice.
To Hell with Good Intentions
by Ivan Illich
IN THE CONVERSATIONS WHICH I HAVE HAD TODAY, I was impressed by two things, and I want to state them before I launch into my prepared talk.
I was impressed by your insight that the motivation of U.S. volunteers overseas springs mostly from very alienated feelings and concepts.
I was equally impressed, by what I interpret as a step forward among would-be volunteers like you: openness to the idea that the only thing you can legitimately volunteer for in Latin America might be voluntary powerlessness, voluntary presence as receivers, as such, as hopefully beloved or adopted ones without any way of returning the gift.
I was equally impressed by the hypocrisy of most of you: by the hypocrisy of the atmosphere prevailing here. I say this as a brother speaking to brothers and sisters. I say it against many resistances within me; but it must be said. Your very insight, your very openness to evaluations of past programs make you hypocrites because you – or at least most of you – have decided to spend this next summer in Mexico, and therefore, you are unwilling to go far enough in your reappraisal of your program. You close your eyes because you want to go ahead and could not do so if you looked at some facts.
It is quite possible that this hypocrisy is unconscious in most of you. Intellectually, you are ready to see that the motivations which could legitimate volunteer action overseas in 1963 cannot be invoked for the same action in 1968. “Mission-vacations” among poor Mexicans were “the thing” to do for well-off U.S. students earlier in this decade: sentimental concern for newly-discovered. poverty south of the border combined with total blindness to much worse poverty at home justified such benevolent excursions. Intellectual insight into the difficulties of fruitful volunteer action had not sobered the spirit of Peace Corps Papal-and-Self-Styled Volunteers.
Today, the existence of organizations like yours is offensive to Mexico. I wanted to make this statement in order to explain why I feel sick about it all and in order to make you aware that good intentions have not much to do with what we are discussing here. To hell with good intentions. This is a theological statement. You will not help anybody by your good intentions. There is an Irish saying that the road to hell is paved with good intentions; this sums up the same theological insight.
The very frustration which participation in CIASP programs might mean for you, could lead you to new awareness: the awareness that even North Americans can receive the gift of hospitality without the slightest ability to pay for it; the awareness that for some gifts one cannot even say “thank you.”
Now to my prepared statement.
Ladies and Gentlemen:
For the past six years I have become known for my increasing opposition to the presence of any and all North American “dogooders” in Latin America. I am sure you know of my present efforts to obtain the voluntary withdrawal of all North American volunteer armies from Latin America – missionaries, Peace Corps members and groups like yours, a “division” organized for the benevolent invasion of Mexico. You were aware of these things when you invited me – of all people – to be the main speaker at your annual convention. This is amazing! I can only conclude that your invitation means one of at least three things: Some among you might have reached the conclusion that CIASP should either dissolve altogether, or take the promotion of voluntary aid to the Mexican poor out of its institutional purpose. Therefore you might have invited me here to help others reach this same decision.
You might also have invited me because you want to learn how to deal with people who think the way I do – how to dispute them successfully. It has now become quite common to invite Black Power spokesmen to address Lions Clubs. A “dove” must always be included in a public dispute organized to increase U.S. belligerence.
And finally, you might have invited me here hoping that you would be able to agree with most of what I say, and then go ahead in good faith and work this summer in Mexican villages. This last possibility is only open to those who do not listen, or who cannot understand me.
I did not come here to argue. I am here to tell you, if possible to convince you, and hopefully, to stop you, from pretentiously imposing yourselves on Mexicans.
I do have deep faith in the enormous good will of the U.S. volunteer. However, his good faith can usually be explained only by an abysmal lack of intuitive delicacy. By definition, you cannot help being ultimately vacationing salesmen for the middle-class “American Way of Life,” since that is really the only life you know. A group like this could not have developed unless a mood in the United States had supported it – the belief that any true American must share God’s blessings with his poorer fellow men. The idea that every American has something to give, and at all times may, can and should give it, explains why it occurred to students that they could help Mexican peasants “develop” by spending a few months in their villages.
Of course, this surprising conviction was supported by members of a missionary order, who would have no reason to exist unless they had the same conviction – except a much stronger one. It is now high time to cure yourselves of this. You, like the values you carry, are the products of an American society of achievers and consumers, with its two-party system, its universal schooling, and its family-car affluence. You are ultimatelyconsciously or unconsciously – “salesmen” for a delusive ballet in the ideas of democracy, equal opportunity and free enterprise among people who haven’t the possibility of profiting from these.
Next to money and guns, the third largest North American export is the U.S. idealist, who turns up in every theater of the world: the teacher, the volunteer, the missionary, the community organizer, the economic developer, and the vacationing do-gooders. Ideally, these people define their role as service. Actually, they frequently wind up alleviating the damage done by money and weapons, or “seducing” the “underdeveloped” to the benefits of the world of affluence and achievement. Perhaps this is the moment to instead bring home to the people of the U.S. the knowledge that the way of life they have chosen simply is not alive enough to be shared.
By now it should be evident to all America that the U.S. is engaged in a tremendous struggle to survive. The U.S. cannot survive if the rest of the world is not convinced that here we have Heaven-on-Earth. The survival of the U.S. depends on the acceptance by all so-called “free” men that the U.S. middle class has “made it.” The U.S. way of life has become a religion which must be accepted by all those who do not want to die by the sword – or napalm. All over the globe the U.S. is fighting to protect and develop at least a minority who consume what the U.S. majority can afford. Such is the purpose of the Alliance for Progress of the middle-classes which the U.S. signed with Latin America some years ago. But increasingly this commercial alliance must be protected by weapons which allow the minority who can “make it” to protect their acquisitions and achievements.
But weapons are not enough to permit minority rule. The marginal masses become rambunctious unless they are given a “Creed,” or belief which explains the status quo. This task is given to the U.S. volunteer – whether he be a member of CLASP or a worker in the so-called “Pacification Programs” in Viet Nam.
The United States is currently engaged in a three-front struggle to affirm its ideals of acquisitive and achievement-oriented “Democracy.” I say “three” fronts, because three great areas of the world are challenging the validity of a political and social system which makes the rich ever richer, and the poor increasingly marginal to that system.
In Asia, the U.S. is threatened by an established power -China. The U.S. opposes China with three weapons: the tiny Asian elites who could not have it any better than in an alliance with the United States; a huge war machine to stop the Chinese from “taking over” as it is usually put in this country, and; forcible re-education of the so-called “Pacified” peoples. All three of these efforts seem to be failing.
In Chicago, poverty funds, the police force and preachers seem to be no more successful in their efforts to check the unwillingness of the black community to wait for graceful integration into the system.
And finally, in Latin America the Alliance for Progress has been quite successful in increasing the number of people who could not be better off – meaning the tiny, middle-class elites – and has created ideal conditions for military dictatorships. The dictators were formerly at the service of the plantation owners, but now they protect the new industrial complexes. And finally, you come to help the underdog accept his destiny within this process!
All you will do in a Mexican village is create disorder. At best, you can try to convince Mexican girls that they should marry a young man who is self-made, rich, a consumer, and as disrespectful of tradition as one of you. At worst, in your “community development” spirit you might create just enough problems to get someone shot after your vacation ends_ and you rush back to your middleclass neighborhoods where your friends make jokes about “spits” and “wetbacks.”
You start on your task without any training. Even the Peace Corps spends around $10,000 on each corps member to help him adapt to his new environment and to guard him against culture shock. How odd that nobody ever thought about spending money to educate poor Mexicans in order to prevent them from the culture shock of meeting you?
In fact, you cannot even meet the majority which you pretend to serve in Latin America – even if you could speak their language, which most of you cannot. You can only dialogue with those like you – Latin American imitations of the North American middle class. There is no way for you to really meet with the underprivileged, since there is no common ground whatsoever for you to meet on.
Let me explain this statement, and also let me explain why most Latin Americans with whom you might be able to communicate would disagree with me.
Suppose you went to a U.S. ghetto this summer and tried to help the poor there “help themselves.” Very soon you would be either spit upon or laughed at. People offended by your pretentiousness would hit or spit. People who understand that your own bad consciences push you to this gesture would laugh condescendingly. Soon you would be made aware of your irrelevance among the poor, of your status as middle-class college students on a summer assignment. You would be roundly rejected, no matter if your skin is white-as most of your faces here are-or brown or black, as a few exceptions who got in here somehow.
Your reports about your work in Mexico, which you so kindly sent me, exude self-complacency. Your reports on past summers prove that you are not even capable of understanding that your dogooding in a Mexican village is even less relevant than it would be in a U.S. ghetto. Not only is there a gulf between what you have and what others have which is much greater than the one existing between you and the poor in your own country, but there is also a gulf between what you feel and what the Mexican people feel that is incomparably greater. This gulf is so great that in a Mexican village you, as White Americans (or cultural white Americans) can imagine yourselves exactly the way a white preacher saw himself when he offered his life preaching to the black slaves on a plantation in Alabama. The fact that you live in huts and eat tortillas for a few weeks renders your well-intentioned group only a bit more picturesque.
The only people with whom you can hope to communicate with are some members of the middle class. And here please remember that I said “some” -by which I mean a tiny elite in Latin America.
You come from a country which industrialized early and which succeeded in incorporating the great majority of its citizens into the middle classes. It is no social distinction in the U.S. to have graduated from the second year of college. Indeed, most Americans now do. Anybody in this country who did not finish high school is considered underprivileged.
In Latin America the situation is quite different: 75% of all people drop out of school before they reach the sixth grade. Thus, people who have finished high school are members of a tiny minority. Then, a minority of that minority goes on for university training. It is only among these people that you will find your educational equals.
At the same time, a middle class in the United States is the majority. In Mexico, it is a tiny elite. Seven years ago your country began and financed a so-called “Alliance for Progress.” This was an “Alliance” for the “Progress” of the middle class elites. Now. it is among the members of this middle class that you will find a few people who are willing to send their time with you_ And they are overwhelmingly those “nice kids” who would also like to soothe their troubled consciences by “doing something nice for the promotion of the poor Indians.” Of course, when you and your middleclass Mexican counterparts meet, you will be told that you are doing something valuable, that you are “sacrificing” to help others. And it will be the foreign priest who will especially confirm your self-image for you. After all, his livelihood and sense of purpose depends on his firm belief in a year-round mission which is of the same type as your summer vacation-mission.
There exists the argument that some returned volunteers have gained insight into the damage they have done to others – and thus become more mature people. Yet it is less frequently stated that most of them are ridiculously proud of their “summer sacrifices.” Perhaps there is also something to the argument that young men should be promiscuous for awhile in order to find out that sexual love is most beautiful in a monogamous relationship. Or that the best way to leave LSD alone is to try it for awhile -or even that the best way of understanding that your help in the ghetto is neither needed nor wanted is to try, and fail. I do not agree with this argument. The damage which volunteers do willy-nilly is too high a price for the belated insight that they shouldn’t have been volunteers in the first place.
If you have any sense of responsibility at all, stay with your riots here at home. Work for the coming elections: You will know what you are doing, why you are doing it, and how to communicate with those to whom you speak. And you will know when you fail. If you insist on working with the poor, if this is your vocation, then at least work among the poor who can tell you to go to hell. It is incredibly unfair for you to impose yourselves on a village where you are so linguistically deaf and dumb that you don’t even understand what you are doing, or what people think of you. And it is profoundly damaging to yourselves when you define something that you want to do as “good,” a “sacrifice” and “help.”
I am here to suggest that you voluntarily renounce exercising the power which being an American gives you. I am here to entreat you to freely, consciously and humbly give up the legal right you have to impose your benevolence on Mexico. I am here to challenge you to recognize your inability, your powerlessness and your incapacity to do the “good” which you intended to do.
I am here to entreat you to use your money, your status and your education to travel in Latin America. Come to look, come to climb our mountains, to enjoy our flowers. Come to study. But do not come to help.
by Ivan Illich
The machine-like behavior of people chained to electronics constitutes a degradation of their well-being and of their dignity which, for most people in the long run, becomes intolerable. Observations of the sickening effect of programmed environments show that people in them become indolent, impotent, narcissistic and apolitical. The political process breaks down because people cease to be able to govern themselves; they demand to be managed.
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Dwelling
To dwell is human. Wild beasts have nests, cattle have stables, carriages fit into sheds, and there are garages for automobiles. Only humans can dwell. To dwell is an art. . . . The human is the only animal who is an artist, and the art of dwelling is part of the art of living. A house is neither nest nor garage. Most languages use living in the sense of dwelling. To put the question, “where do you live?” is to ask for the place where your daily existence gives shape to the world. Just tell me how you dwell and I will tell you who you are. This equation of dwelling and living goes back to times when the world was still habitable and humans were in-habitants. To dwell then meant to inhabit one’s own traces, to let daily life write the webs and knots of one’s biography into the landscape.
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Dwelling
From commons for dwelling the environment has been redefined as a resource for the production of garages for people, commodities and cars. Housing provides cubicles in which residents are housed […] The vernacular space of dwelling is replaced by the homogeneous space of the garage. Settlements look the same from Taiwan to Ohio and from Lima to Peking. Everywhere you find the same garage for the human — shelves to store the work-force overnight, handy for the means of its transportation.
Those who insist now on their liberty to dwell on their own are either very well off or treated as deviants. This is true both for those whom so-called ‘development’ has not yet untaught the desire to dwell, and for the unpluggers who seek new forms of dwelling that would make the industrial landscape habitable — at least in its cracks and weak spots. They will be branded as intruders, illegal occupants, anarchists and nuisances, depending on the circumstance under which they assert their liberty to dwell: as Indians who break in and settle on fallow land in Lima; as favellados in Rio de Janeiro, who return to squat on the hillside from which they have just been driven by the police; as students who dare to convert ruins in Berlin’s Kreuzberg into their dwelling; as Puerto Ricans who force their way back into the walled-up and burnt buildings of the South Bronx. They will all be removed, not so much because of the damage they do to the owner of the site, or because they threaten the health or peace of their neighbors, but because of the challenge to the social axiom that defines a citizen as a unit in need of a standard garage.
‘Build-it-yourself’ is thought of as a mere hobby — or as a consolation for shanty-towns. The return to rural life is dubbed romanticism. Inner-city fishponds and chickencoops are regarded as mere games. Neighborhoods that ‘work’ are flooded by highly-paid sociologists until they fail. House-squatting is regarded as civil disobedience, restorative squatting as an outcry for better and more housing. But in the field of housing, as much as in the fields of education, medicine, transportation or burial, those who unplug themselves are no purists. I know a family that herds a few goats in the Appalachians and in the evening plays with a battery-powered computer. I know an illegal occupant who has broken into a walled-up Harlem tenement and sends his daughters to a private school.
Neither ridicule nor psychiatric diagnosis will make the unpluggers go away.