Table of Contents:
Chapter V: The World under Control
The War on Suffering
The war on germs is just one expression of a medical system based on control. Control, in turn, arises from our sense of self, that we are separate beings in an alien and indifferent universe. Not being part of any purpose beyond ourselves, naturally we seek to maximize the security, comfort, pleasure, and other interests of those selves. Technology is one form that ambition takes.
If pain, like the rest of life’s events, has no larger purpose or meaning, then why not avoid it? The logic parallels that regarding colds and flus. If we are discrete and separate beings in a fundamentally competitive world, then any confluence of interests must be accidental, any larger purpose must be our own projection, and our well-being must come from gaining as much control as possible over that at-best indifferent but often hostile universe. Remember the logical conclusion of the Technological Program: the elimination of all suffering. That this is a feasible goal is fundamental to the assumption that the world is in essence controllable, and medicine is a key technology in implementing that control.
Despite its colossal disappointments, the myth of the imminent perfection of modern medicine holds that its technological marvels are on the verge of dramatic new improvements on the human body: gene therapy to reverse aging, nanotechnology to cure cancer. “In such a society,” wrote Ivan Illich, “people come to believe that in health care, as in all other fields of endeavor, technology can be used to change the human condition according to almost any design.” The can-do attitude of the engineer improving on nature motivates such medical fads as the indiscriminate tonsillectomies of the 1930s and 1940s, the routine removal of wisdom teeth in the last two decades, the technological hijacking of the birth process, and, at this writing, pronouncements by certain authorities that at least half the population would benefit from cholesterol-reducing drugs. Just as technology in general says nature could use some improvement, medical technology assumes the same of the human body. Hence we remove organs that we think are unnecessary, most notably the uteruses of post-menopausal women, and alter body chemistry (for the better!) with hormone replacement therapy. And we think that yet better health will come from the refinement of control to the cellular and molecular level, with nanotechnology and genetic engineering.
The dogma of control blinds us to the fact of sustained, generalized decline in health despite, or perhaps because of, these interventions. Few doctors realize that the rate of serious birth complications is far lower in Holland, where home births predominate, than in America’s high-tech obstetrical wards. They similarly cannot see the horrendous side-effects and marginal benefit of cholesterol-lowering statins. The trend of routine medicalization continues headlong: who knows what medicines they’ll be adding to the public water supply (in addition to those already there such as fluoride)?
We can already see the final destination of this trend: the medicalization of all life, the conversion of all people into patients. Writing almost thirty years ago, Illich observed that “in some industrial societies social labeling has been medicalized to the point where all deviance has to have a medical label.” As children we were horrified at the Soviet practice of locking up dissidents in mental hospitals under the assumption that anyone who could object to the socialist utopia must be crazy. Today we are witnessing an analogous phenomenon on a vastly wider scale. The tens of millions of people who find themselves unhappy in our modern technological paradise, this world under control, are diagnosed with some psychiatric disorder and medicated with mind-altering drugs. The same thing happens to children who resist the breaking of their spirits: they are diagnosed with “oppositional defiant disorder” or “attention deficit disorder.” I look upon these “disorders” as signs of health, not illness. A sane, strong-willed child will resist the mindless routines, the busywork, and the hours cooped up inside a classroom; she will steal moments of play at any opportunity. I also think adult depression can be a sign of health. When we have been frightened away from our creative purpose into a life not really worth living, the soul rebels by withdrawing from that life. This is the paralysis of depression. “I would rather not participate in life at all,” says the soul, enforcing its resolve by shutting down the mind, body, and spirit. We no longer feel motivated to live. For a while, sheer willpower and the habit of routine keeps us going, but eventually the soul’s call to withdraw becomes undeniable and we sink into the throes of clinical depression, chronic fatigue syndrome, and the like.
Another pathologized symptom of health is anxiety, the feeling that “something isn’t right around here, and it needs urgent attention.” What is that something? Again, afraid to look in the shadows for the key, we direct it onto trivial fears. However, the underlying emotion is a valid response to the facts of the world. Something, indeed, is terribly wrong around here, and it does need urgent attention. On the physical side, anxiety has a counterpart in newly emergent diseases such as multiple chemical sensitivity and fibromyalgia. (A physical counterpart of ADD is vision problems or dyslexia: you can make me sit at a desk but you can’t make me see straight!)
The medicalization of these psychiatric conditions is predicated on the assumption that life and the world as we know it is just fine. Like the dissidents in socialist utopia, if living this good life renders you depressed, anxious, or unable to concentrate then, well, you’ve got an illness my friend. The problem isn’t the world, and it isn’t the life you have chosen; it is the chemistry of your brain. And that can be adjusted.
One consequence of the killing of pain, whether physical or psychological, is that it makes a painful world more tolerable. “Any society in which the intensity of discomforts and pains inflicted renders them culturally ‘insufferable’ could not but come to an end.” If it were not for these pharmaceutical methods of controlling the psychological pain of living the modern life, society as we know it would quickly crumble. The same holds on the individual level: just as the medication of society allows it to exist at a much higher level of pain than it otherwise could, so does the suppression of symptoms in the individual allow life to go on as normal. People on SSRIs such as Prozac have told me that the medicine enables them to cope with life. And it does. It allows life as usual to proceed.
The reason that conventional psychiatry—whether pharmaceutical or psychoanalytic—is powerless to substantially help the vast majority of patients is that it does not, and cannot, recognize the wrongness of the world we live in. The psychiatrists have bought in along with the rest of us. Psychiatry operates on the assumption that we should be happy with it. The same assumption of the rightness, or at least the unalterability, of the world given to us underlies the quest to “cope with stress.” That life is inherently stressful is not questioned. Psychiatric treatment is infamously impotent to address serious mental conditions because the psychiatrists, as fully enculturated elite members of society, are constitutionally unable to call into question the cultural assumptions in which they are so deeply invested. Their investment blinds them to the underlying rightness and fundamental sanity of a patient’s reaction to a world gone wrong. Conventional treatment (particularly pharmaceutical treatment) actually exacerbates the illness by affirming, “Yes, the life society proffers is fine; the problem is with you.” I have witnessed dramatic healing simply by affirming to someone, “You are right, this isn’t how life is supposed to be”—a realization that empowers change. Not that psychiatry ignores the need for change altogether; it is just usually unable to carry the change deeply enough. In essence, it tells us that we need to adjust to the world and seeks to make us normal again, functioning members of society.
No. We are meant for more. “Everyone can sense the emptiness, the void underneath the forms and structures of modern society.” Any psychiatry that seeks to adjust us to such a society is itself insane.
You would be crazy to busily polish the silverware as your house burned down. Similarly, it is insane to live a normal life in today’s world. Maybe if millions of children were not malnourished, maybe if torture were not commonplace around the globe, maybe if species and entire ecosystems were not dying, maybe if genocide were forever gone, maybe if all the injustices I’ve chronicled in these pages did not exist… maybe then the “normal” life presented us would be sane. Maybe then it would make sense to absorb ourselves in professional sports, soap operas, the stock market, material acquisition, and the lives of celebrities. Given the reality of the world today though, the only life that makes sense to live is an extraordinary life.
The teenagers in their idealism and their defiance, the depressed in their rejection of the lives offered them, the anxiety-ridden in their sense that something is not right… all are quite sane. Any psychiatry that doesn’t recognize this is doomed from the start. It tells us the problem is not the world, it is ourselves. It merely adds to the chorus of voices telling us, “All is well, all is normal—who are you to think any differently?” That’s the same message we get from the media that immerse us, suggesting with their subject matter that we can afford to care about the trivial and the superficial: the sports, celebrities, and so forth. As well, the whole mania for “entertainment” suggests that our world is sound enough that we can afford constant distraction from it. “Things will be fine. Don’t worry.” I imagine myself on board the Titanic. “Hey guys, we’re pretty far north, don’t you think we should slow down? Hey guys, isn’t that an iceberg up ahead?”
“Charles, relax! Have a drink. Come listen to the band. Everything is fine—see, no one else is worried.”
Not only do we live today in a fraudulent, life-denying society into which nobody fits, but the incompatibility of that society with human fulfillment only grows with each passing year. Along with it grows the need for medicating expanding swaths of the population. We have seen this happening with the increasing ubiquity of SSRIs and similar drugs across every age group. The world grows more painful physically as an increasingly toxic environment gives rise to new diseases, as commerce and industry corrupt the food supply, and as the tempo and pressure of life-as-usual quickens. All of these factors accelerate the conversion of citizens into patients.
The medicalization of society contributes to “life under control” in another way by the authority it invests in doctors. A schoolteacher friend of mine told me that school policy only allows his third-graders to visit the bathroom three times each day, the only exception being—you guessed it—children with a note from their doctor. When we give authority to judge of health and illness to a doctor—someone external to the person suffering or not suffering—we are attempting to objectify pain, the primary indicator of health. While explicit attempts to quantify pain have failed, the ostensible objectivity of the doctor’s note (and its current incarnation in the reams of paperwork that our medical system generates) allows human health to be incorporated into the framework of technological society, which must treat it, like anything else, according to the standardized, anonymous, objective methods of industry. That is, it becomes the province of certified specialists. Unfortunately, the objectification of illness and professionalization of medicine have also separated ourselves from our own bodies, rendered us helpless to heal ourselves, and made pain and illness all the more frightening.
The killing of pain is oddly reminiscent of the mentality of agriculture. Just as the farmer pulls out the bad plants (the weeds) to maintain a field of only good plants (crops), so do we discriminate between good and bad feelings. Life under control means eliminating anything that might cause a painful sensation or feeling, an objective tantamount, we think, to eliminating suffering itself.
The confusion between pain and suffering is fundamental. Suffering comes not from pain per se, but from resistance to pain and, more generally, from resistance to life. It is no wonder that technological society, predicated on the elimination of pain and the control of nature, has generated suffering unprecedented on planet earth. Technology, which resists the ordinary processes of nature, is mirrored in our psychology as a resistance to the ordinary processes of life. Our internalized dictator—the voice of culture—judges and filters our every feeling and emotion, clinging to the good and weeding out the bad. Attachment and aversion: precisely what Buddha identified as the origin of suffering. The internalized dictator that seeks to maintain and extend control over our every thought and emotion is nothing less than an Orwellian Big Brother, who is always watching. The Thought Police are always on patrol in this ultimate tyranny of the finite part of ourselves over the infinite.
Illich writes, “[Good health] means to be able to feel alive in pleasure and in pain; it means to cherish but also to risk survival” [emphasis added]. The first step to freedom is simply to allow yourself to fully feel whatever there is to feel. This, and not mind control, is where the true benefit of meditation lies. This is also what is meant by accepting God’s gifts. If God is good, then every moment is by definition a gift, and to deny it is to separate oneself from God—the Jewish and Christian mystics’ explanation of suffering.
The technotopian promise that “the pain can be killed” has led us to believe that pain need not be felt, and this belief generates a resistance to pain that exacerbates the suffering all the more. The promise is a lie, because pain is unavoidable. To be human is to be born into pain. Loved ones pass away. Good things come to an end. Our bodies get old, sick, and injured, and someday we die. Let us not pretend that technology will someday eliminate such occurrences, nor pretend that such occurrences are not painful. Suffering only comes when we do not allow ourselves to feel the pain, when we resist it. That effort is quite logical when we buy in to the big lie of the world under control: that pain need not be felt. When we operate under this delusion, we inevitably become resentful of our pain, and therefore prone to all the abuses of victim mentality and entitlement.
Our deluded conflation of pain and suffering means that the medical program to reduce and eventually eliminate suffering is doomed. What’s more, because suffering comes from resistance to pain and not from pain itself, the focus of medicine should not even be on the elimination of pain—yet this is what reductionistic, symptom-oriented medicine naturally tends toward. While such painkillers as morphine are valuable and have their place in medicine, the role of a true healer is not to make life more tolerable, which is essentially what the suppression of symptoms does. No, the role of the healer is just as Illich implies, to help the patient feel more alive in pleasure and in pain. We go to the doctor because it hurts, and our expectation is that he will give us something to make it stop hurting. That is an error. Pain is our friend, never to be sought out, of course, but neither to be resisted. Let it hurt. When we feel what there is to feel, we cease maintaining separation between ourselves and our sensations and therefore come into greater wholeness, greater health. The full experience of pain opens the door to health: whether we are on the sickbed, or facing the psychological pain of life’s transitions, or the subdued agony of life in a world gone wrong.
When we allow the full experience of pain, the window to health that opens may indeed utilize the skills of a surgeon, homeopath, herbalist, or other healer. I am not enjoining the reader to forgo all medical care! Please. But bodily recovery is not the only benefit, which is fortunate because the result of healing might not always be what we hope for. There can be healing in death as well as in recovery. Another benefit of non-resistance to pain is that it brings an unexpected miracle: the pain doesn’t hurt as much. Even if the pain is still there in all its intensity, we don’t suffer as much from it. In this regard, pain is much like any other object of control. Control generates its own necessity, which intensifies over time at ever-greater cost.
Health means to be alive in pleasure and in pain. I have always thought of this book as a work of healing, and I hope that in reading it you feel more alive. Returning to the depression, anxiety, etc. discussed above, I cannot and will not ameliorate that suffering by assuring you that it’s not so bad, that everything is okay. No, it is every bit as bad as you suspect, and even worse.
When we awaken to the enormity of our crisis and the magnitude of our loss, often the first response is a crushing despair. I have been through that; I know what it is like. Yet on the other side of despair is fullness and an urgency to live life beautifully. We can choose a different world—the “more beautiful world our hearts tell us is possible” and to which I have dedicated this book—but to choose it we must be familiar with what we are choosing. We must be fully cognizant of the world we have chosen up until now. Knowing the pain of the world fills me with energy and confirms the rightness of my life’s direction. Otherwise what would stop me from occupying my hours with the trivial and the vain, staying comfortable for as long as possible until I died? We need not avert our gaze from ugliness and pain in order to live a happy life. Ignorance is not bliss. Quite the contrary: the more we insulate ourselves, the weaker we become, the less able we are to take on reality. The more we numb and defer the pain, the more afraid of it we are, until we willingly submit to confinement in the (temporarily) secure, predictable, controlled semblance of life our society offers.
 Illich, Medical Nemesis, p. 73
 Illich, p. ***
 For a similar analysis of psychiatric disorders like ADD, depression, and so on read Commonsense Rebellion by the renegade psychologist Bruce Shapiro.
 Illich, Medical Nemesis, p. 135
 Illich, p. ***