Portal de Periódicos da CAPES

Ivan Illich

2003; Elsevier BV; Volume: 361; Issue: 9352 Linguagem: Inglês

10.1016/s0140-6736(03)12233-7

1474-547X

Pearce Wright,

Empathy and Medical Education

Theologian, philosopher, sociologist, historian. His controversial books were widely disseminated in the 1970s, with four particularly famous titles Deschooling Society (1971), Tools for Conviviality (1973), Energy and Equity (1974), and Medical Nemesis (1975). Born on Sept 4, 1926 in Vienna, Austria; died from cancer at home on Dec 2, 2002, aged 76 years in Bremen, Germany Ivan Illich was a radical thinker whose ideas influenced the development in the 1970s of the environmental movement and of alternative and self-help health styles. He railed against modern technology, the education system, and standardised health care. One of his best known works was Medical Nemesis, in which he argued that a major threat to health in the world was modern medicine and said that hospitals in particular caused more sickness than health. He popularised the word iatrogenesis to describe what he saw as a relentless increase in disease induced by doctors. His publications were more polemic than analysis, but the rhetoric was powerful and in the 1970s his views were labelled extreme. Although Illich made little impression on mainstream medicine 27 years ago, many of his attitudes are reflected in changes in health care, such as those that have occurred in doctor-patient relationships. And the latest report from the UK's Public Health Laboratory Service on the rising death rate in hospitals from meticillinresistant Staphylococcus aureus gives Medical Nemesis something of a prophetic quality. Ivan Illich was a Catholic priest before he became a critic of industrial society. Born in Vienna, he was forced to leave school in 1941 by the Nazis because of his mother's Jewish ancestry. The family moved to Italy and he began studies in natural science and art history in Florence University, and in 1943 moved to Rome to study as a priest at Gregorian University. He later obtained a doctorate in history from the University of Salzburg. In 1951 he was sent as a parish priest to a Puerto Rican community in New York, to whom he became dedicated. In 1956 he was appointed vice-rector of the Catholic University of Puerto Rico and in 1959, when he was only 33 years old, he was made a Monsignor. His liberal approach, in which he taught students to question assumptions about western superiority and religious patriarchy, soon embroiled him in ecclesiastical controversy and he was eventually recalled to New York. After a 3000 mile trip on horse and foot across South America in 1961 he founded a centre for cross-cultural studies, in Cuernavaca, Mexico, to prepare missionaries to work in Mexico and Latin America. His radical teachings continued and his view that the Catholic Church should dissolve its bureaucracy scarcely helped his standing with the Vatican. Church funds were withdrawn from his centre. So he severed ties with the Church and resigned the priesthood. But by then he had chosen the social causes for which his centre became an international focus for intellectual debate and a respected think tank, from where Illich produced a steady flow of books and articles preaching counterintuitive sociology. In addition to his disquiet with organised religion, he argued that school made people dumb, and the legal system, rather than providing people with solutions, heightened their frustration. He argued that even science was being strangled by institutionalisation. Illich scythed his way through numerous institutions he believed outmoded. He was a priest who thought there were too many priests, and a teacher of more than 50 years standing who maintained that children learnt best at home or in casual situations rather than through formal education. He also suggested that modern technology was oppressive, claiming, for example, that automobiles enslaved society and bicycles were a faster way to travel. But iatrogenesis was a centrepiece of his ideology, and he defined it at three levels. Clinical iatrogenesis was the injury done to patients by ineffective, toxic, and unsafe treatments that he listed in extensive footnotes. He described the need for evidence-based medicine 20 years before the term was coined. Social iatrogenesis resulted from the medicalisation of life. More and more problems were seen as amenable to medical intervention, with pharmaceutical companies developing expensive treatments for what he described as non-diseases. His most biting words were cultural iatrogenesis, the destruction of traditional ways of dealing with, and making sense of, death, pain, and sickness. He used the medical profes-sion's own statistics to argue that many of the diseases over which doctors claimed victory were on their way out in the natural rhythm of things. Since 1979 he divided his time between writing and teaching in Mexico, the USA, and Germany, and the international lecture circuit. He was a visiting professor of philosophy and of science, technology, and society at Penn State, and taught at the University of Bremen.