IN THE BUBBLE JOHN THACKARA - witz cultural

More and more people are convinced that, if they do not feel right, is it because there
is something disordered inside them, and not because they are manifesting a healthy
refusal to adapt to an environment or life that is difficult and sometimes intolerable.
Adaptation to the misanthropic, genetic, climatic and cultural consequences of
growth is now described as health. As sensible creatures we must face the fact that
the pursuit of health may be a sickening disorder. There are no scientific or technological
solutions to death. There is the daily task of accepting the fragility and contingency
of the human condition. 15
Illich was not antitechnology. He argued that self-care and the use of modern
technology could be mutually supporting. But he warned that technology
push in health may itself be a sickening disorder. ‘‘When people no
longer have the need or desire to resolve their problems within the network
of their own relationships, medicine becomes the alibi of a pathogenic
society.’’ 16 Illich concluded that we have thrust the bad things of life—old
age, death, pain, and handicap—onto doctors so that families and society
will not have to face them.
It took thirty years for Illich’s ideas to gain mainstream acceptance, but
in 2002 the British Medical Journal, a bastion of the medical establishment,
called for a turning back of the ‘‘medicalisation of everyday life.’’ 17 The
journal, citing Illich and the biologist René Dubois as its inspiration, proposed
that we redefine good health as ‘‘the autonomous personal capacity
to master one’s conditions of life, to adapt oneself to accidental modifications
of one’s surroundings, and to refuse if necessary environments that
are not tolerable.’’ 18
Jean-Pierre Dupuy, who has studied the stress and burnout suffered by
the medical profession firsthand, says that when doctors are asked to provide
the impossible to patients, they do not gain power or control—they
suffer: ‘‘The ability to cope with a series of profoundly intimate threats
that all men face and will face—namely pain, disease and death—comes,
in traditional societies, from his culture. The sacred plays a fundamental
role in this. The modern world was born on the ruins of these traditional
symbolic systems.’’ 19
Decentralization
Conviviality 117
Few health care professionals are ready to embrace ideas so radical as those
of Illich, but the many actors in health and care are being urged to work in
less-directed, more decentralized, and therefore less costly, ways. Hospitals