Hygienic Bureaucracy

ivan-illich

Once a society is so organized that medicine can transform people into patients because they are unborn, newborn, menopausal, or at some other “age of risk,” the population inevitably loses some of its autonomy to its healers. The ritualization of stages in life is nothing new; what is new is their intense medicalization. The sorcerer or medicine man—as opposed to the malevolent witch—dramatized the progress of an Azande tribesman from one stage of his health to the next. The experience may have been painful, but the ritual was short and it served society in highlighting its own regenerative powers. Lifelong medical supervision is something else. It turns life into a series of periods of risk, each calling for tutelage of a special kind. From the crib to the office and from the Club Mediterranée to the terminal ward, each age-cohort is conditioned by a milieu that defines health for those whom it segregates. Hygienic bureaucracy stops the parent in front of the school and the minor in front of the court, and takes the old out of the home. By becoming a specialized place, school, work, or home is made unfit for most people. The hospital, the modern cathedral, lords it over this hieratic environment of health devotees. From Stockholm to Wichita the towers of the medical center impress on the landscape the promise of a conspicuous final embrace. For rich and poor, life is turned into a pilgrimage through check-ups and clinics back to the ward where it started. Life is thus reduced to a “span,” to a statistical phenomenon which, for better or for worse, must be institutionally planned and shaped. This life-span is brought into existence with the prenatal check-up, when the doctor decides if and how the fetus shall be born, and it will end with a mark on a chart ordering resuscitation suspended. Between delivery and termination this bundle of biomedical care fits best into a city that is built like a mechanical womb. At each stage of their lives people are age-specifically disabled. The old are the most obvious example: they are victims of treatments meted out for an incurable condition.

 

– Ivan Ilich

 

 

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