On 7/27/2017 5:40 AM I began drafting this Blog entry to my physician Stephen C MD: Good afternoon Stephen, I enjoy visiting with you and always bring a book to read before you arrive for our appointment and as always we briefly discuss what the book is about. I had Ivan Illich’s book Toward a History of Needs, with me the other day, it has been in my library for decades and I began several times to read it but I guess we were not ready for its message. I am finally getting serious about gathering together my mother’s Silver Dollar AA Newsletter columns for a book and the first column I read, she mentions Abraham Maslow’s Self-Actualization Need, which is central in my essay.
Now, what is this? It is Illich’s book, watching me from my bookcase suggesting it has something to contribute!” After reading a few pages, I realize this work is deep, complex, and very relevant to the need issues we need to address – in particular the need for health – the health care debate now raging, July 4, 2017, when this blog entry began and even more so now, January 1, 2021, as Covid-19 kills 1000 Americans a day. One issue before for us, “Is health care a right or a privilege?” Without ‘health’ there is no ‘self-actualization’ – there is no humanity, there is no civilization!
I cannot fully address the issues now, only suggest, that if we have a Constitutional right to life, liberty, and the pursuit of happiness it has to be a healthy life, health holds the ‘center’ point in Maslow’s theory – unless we are healthy, all of the higher-level needs, love, esteem, and self-actualization, which make up liberty and happiness are inaccessible! We have to be healthy in order to self-actualize – creating liberty and happiness.
So, the issue before us is to examine the processes involved in self-actualization. If the medical profession is not addressing this human need with every patient, it is failing us! Stephen, can you say you are filling this requirement with every patient? Yes, we explore this dimension of life during our meetings, however, this is at my initiative and I suspect you and your colleagues do not go into this with any of your patients! Am I correct? Illich, however, addresses this issue for us and offers a protocol to apply this medical procedure.
As I mentioned, Illich addresses all ‘professions’ but in particular the ‘medical profession’ as the source of our current dysfunctional healthcare culture. Stephen, I listened carefully to your description of the conflict you experienced in working overtime to cover patients and the push-back you received from hospital administrators concerned about the cost of having to staff those additional hours. As you put it, “hospital administers are money motivated, the profit motive controls the health care industry”. Later in the day, after our meeting, I re-opened Illich’s book on a history of needs and re-read the last paragraph I had read, it was in my mind when you were describing your experience, and now as I re-read it I realized it was what you were describing. Illich writes:
“Only during the last 25 years has medicine turned from a liberal into a dominant profession by obtaining the power to indicate what constitutes a healthy need for some people in general. Health specialists as a corporation have acquired the authority to determine what Health Care must be provided to society at large. It is no longer the individual professional who imputes a “need” to the individual client, but a corporate agency that imputes they need two entire classes of people and then claims the mandate to test the complete population in order to identify all who belong to the group of potential patients. And what happens in health care is fairly consistent with what goes on in other domains. New pundits constantly jump on the bandwagon of the therapeutic – care provider: educators, social workers, the military, com planners, judges, policemen, and their ilk have obviously made it. They enjoy wide autonomy in creating the diagnostic tools by which they then catch their clients for treatment. Dozens of other need – creators try: International Bankers “diagnose” the ills of an African country and then induce it to swallow the prescribed treatment, even though the “patient” might die; security specialist evaluate the loyalty risks of a citizen and then extinguished their private sphere; dog catchers sell themselves to the public has pest controllers and claim a monopoly over the lives of stray dogs. The only way to prevent the escalation of needs is a fundamental, political exposure of those illusions that legitimate dominating professions” (Toward a history of needs, p.29).
Ivan Illich gives this lecture on 09.12.1974 to mark the launch of his book Medical Nemesis: The Expropriation of Health in which he continues his critique of the medical profession and the ‘delusions’ of importance that exist in Western culture regarding the medical profession. Illich contrasts personal responsibility with individual impotence and questions the corporate indoctrination that reorganizes society within such excesses of professionalization. Here is Ivan Illich on the Medical Nemesis: The Expropriation of Health.
Life is a Test: Ivan Illich’s Medical Nemesis and the ‘Age of the Show’ is presented by Babette Babich Fordham University. It is a detailed presentation which was published on Nov 22, 2016 at the International Philosophy of Nursing Society; Keynote address 20th Annual Meeting in Quebec City, Quebec. This is Chapter 1, the remaining chapters can be seen following this one.
Stephen, I am not yet at the deepest understanding of “systems” producing the illness of which we suffer, however, it is obvious we suffer more each day. Thank you for watching my health! I expect soon to read your “Prescription for a healthy mind, body, spirit, and civilization”. Sounds like a title? What else you got to do on the lake? sas