Medical Nemesis: The Expropriation of Health by Ivan Illich (review)

1913 the heroes were Hermann Hesse, Spengler (European youth), Buddhism, Tagore (love not power—in the contemporary scene it is make love not war), and, of course, Lenin. The New Left is not so new. Apparently, on this score, too, the new humanism is not so new. Hamburgh says that in Germany students threw feces through university windows while in the United States they throw rocks, and "which is better or worse depends on the nature of one's preference." How can he overlook the tremendous disparity of motives and symbols which decides on feces or rocks! It is not a caprice. The utter and almost hopeless fatalism of the former (feces) against the optimism of the latter (rocks) is a tremendous difference. A look at history will give you a view of the results. Indeed, literature can be dangerous to your health! Nonetheless, there are seminal and prophetic books which open up the meaning of events which I would have liked to have seen brought in, to try to understand recent events. One of them is Gustave Le Bon's The Crowd, published in the 1890s. It far surpasses many other studies of power. It can explain such phenomena as rebellion, insurgency, and reform and also enters into the posture of do-your-own-thing—a hallmark of alienation. Another book of the same caliber is Norman Cohen's The Pursuit ofthe Millennium. But Hamburgh has some fine observations. One, for example, is that the Viet Nam war, contrary to other wars, did not produce GI humor or songs. It is because we have lost the ability to laugh at ourselves? I don't know, but it is worthy of contemplation. The author's best chapter is "The Origin of Arousal," where he ties up the historical undercurrents in the attempt to understand contemporary events. His chapter, "Roots of Religion," is a disappointment: after five expository pages it is hardly more than statements from 12 conscientious objectors to their Selective Service Boards as to why they elected their stance. Despite the drawbacks, the author is disarming in his humility. Erwin DiCyan 500 Fifth Avenue New York, New York 10036 Medical Nemesis: The Expropriation ofHealth. By Ivan Illich. New York: Random House, 1976. Pp. 294. $8.95. Literature and philosophy have long been the means through which western man has come to understand what is amiss with the higher enterprises of his kind. Nowadays a few dollars invested in a paperback allows one to experience the delight of Molière's lampoon ofdoctors, the hilariousLe Malade imaginaire, or the pitiless terror of Kafka's vision of man helpless before the law in his masterful though incomplete novel The Trial. And an unstated rule is that no work of philosophy is worth the devoted study necessary to penetrate its argument unless the critique not only serves to inform us of our condition but also prescribes remedial means to our betterment. The first American edition of Ivan Illich's Medical Nemesis is a critique of the medical profession which, one would like to think, will bring to the eyes of doctors what G. W. F. Hegel's The Philosophy ofLaw brought to the legal profession a century and a half ago: a critique which is radical (in that it searches to the Perspectives in Biology and Medicine · Autumn 1976 | 163 roots), stimulating, and prescriptive, by which we might discover exactly what is wrong and what to do about it. We know that there is definitely something wrong; the medical literature is full to the brim with reports on dysfunctional medicine. It is now no longer possible for us to rely on works of metaphor or abstraction for hard words of criticism and advice. With voluminous references to scientific and medical journals, government studies, United Nations agency reports, and statistical summaries, Illich builds a clear and convincing case for the argument that opens his book: "The medical establishment has become a major threat to health." The disease which afflicts society through the practice of medicine is termed "iatrogenesis": this refers to the clinical iatrogenesis which he says results in one out of five patients contracting a doctor-caused illness, as well as to...