COVID-19 is our Medical Nemesis and Ivan Illich saw it coming nearly 50 years ago
excerpt:
"Much suffering has always been man-made: history is the record of enslavement and exploitation. It tells of war, and of the pillage, famine, and pestilence which come in its wake. War between commonwealths and classes has so far been the main planned agency of man-made misery. Thus, man is the only animal whose evolution has been conditioned by adaptation on two fronts. If he did not succumb to the elements, he had to cope with use and abuse by others of his kind. He replaced instincts by character and culture, to be capable of this struggle on two frontiers. A third frontier of possible doom has been recognized since Homer; but common mortals were considered immune to its threat. Nemesis, the Greek name for the awe which loomed from this third direction, was the fate of a few heroes who had fallen prey to the envy of the gods. The common man grew up and perished in a struggle with Nature and neighbor. Only the élite would challenge the thresholds set by Nature for man.
Prometheus was not Everyman, but a deviant. Driven by Pleonexia, or radical greed, he trespassed the boundaries of the human condition. In hubris or measureless presumption, he brought fire from heaven, and thereby brought Nemesis on himself. He was put into irons on a Caucasian rock. A vulture preys at his innards, and heartlessly healing gods keep him alive by regrafting his liver each night. The encounter with Nemesis made the classical hero an immortal reminder of inescapable cosmic retaliation. He becomes a subject for epic tragedy, but certainly not a model for everyday aspiration. Now Nemesis has become endemic; it is the backlash of progress. Paradoxically, it has spread as far and as wide as the franchise, schooling, mechanical acceleration, and medical care. Everyman has fallen prey to the envy of the gods. If the species is to survive it can do so only by learning to cope in this third group.
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Man’s consciously lived fragility, individuality, and relatedness make the experience of pain, of sickness, and of death an integral part of his life. The ability to cope with this trio in autonomy is fundamental to his health. To the degree to which he becomes dependent on the management of his intimacy he renounces his autonomy and his health must decline. The true miracle of modern medicine is diabolical. It consists of making not only individuals but whole populations survive on inhumanly low levels of personal health. That health should decline with increasing health-service delivery is unforeseen only by the health manager, precisely because his strategies are the result of his blindness to the inalienability of health.
The level of public health corresponds to the degree to which the means and responsibility for coping with illness are distributed amongst the total population. This ability to cope can be enhanced but never replaced by medical intervention in the lives of people or the hygienic characteristics of the environment.
That society which can reduce professional intervention to the minimum will provide the best conditions for health. The greater the potential for autonomous adaptation to self and to others and to the environment, the less management of adaptation will be needed or tolerated.
*This article was originally published in the Lancet in 1974 by Ivan Illich based on his prophetic book Medical Nemesis