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Truculent Priest

Seamus O’Mahony

The Prophet of Cuernavaca: Ivan Illich and the Crisis of the West, By Todd Hartch, Oxford University Press, 235 pp, $29.95, ISBN 978-0190204563

In Dostoevsky’s The Brothers Karamazov, Ivan relates to Aloysha a parable called “The Grand Inquisitor”. Set in Seville during the Spanish Inquisition, a prisoner – Christ Himself – is interrogated by a cardinal, the Grand Inquisitor. He had been arrested when recognised by the crowd after performing a series of miracles. The Inquisitor explains to his prisoner why His return would not be in the Church’s interest, and that He should have accepted the three temptations offered by Satan. Mankind, observes the Grand Inquisitor, is not fit for the freedom He had given them. The Church’s secret is that they follow Satan, “the wise spirit, the dread spirit of death and destruction”, not Jesus Christ. The Inquisitor concludes: “Tomorrow, I will burn thee.” Silent throughout this questioning, Christ kisses the Inquisitor on his “bloodless, aged lips”. The cardinal, surprised and caught off-guard by this gesture, releases Him with the famous phrase: “Go, go, and return no more.” On June 17th, 1968, Ivan Illich – priest, social philosopher, historian, theologian – who had been called from Mexico to the Vatican to answer charges of heresy − was dismissed with the same words by Cardinal Franjo Šeper, prefect of the Congregation for the Doctrine of the Faith of the Catholic Church − previously known as the Inquisition.

Rarely has a reputation declined so precipitously as that of Ivan Illich (1926-2002). A superstar public intellectual in the 1970s, admired and quoted by left-leaning academics, environmentalists, home-schoolers and progressive priests, he is now almost forgotten. Todd Hartch, an American historian (and Catholic convert), attempts to correct this neglect with his new book, The Prophet of Cuernavaca: Ivan Illich and the Crisis of the West, which examines the development of Illich’s ideas on institutions during his years (1961-76) in Mexico.

Illich was born in Vienna; his father, Piero, was a Croatian Catholic aristocrat, his mother a German of Sephardi Jewish origin. Illich grew up in a wealthy, cultured home; his parents’ friends included Rainer Maria Rilke, the philosopher Rudolf Steiner and the French theologian Jacques Maritain. After Piero’s death, Ivan was officially reclassified as Jewish and the family fled Vienna for Italy. Illich initially studied histology and crystallography at the University of Florence, mainly to obtain an identity card under a false name. After the war, he returned to Austria and enrolled at the University of Salzburg, where he studied history and eventually obtained a PhD. His dissertation was on the global histories of Arnold Toynbee and the problem of knowledge in history. While working on his doctoral research he returned to Italy, and began his studies for the priesthood at the Gregorian University in Rome. He was deeply influenced by the writings of Thomas Aquinas: his old family frien Jacques Maritain was France’s ambassador to the Vatican during Illich’s years as a seminarian and the eminent theologian ran a seminar on Aquinas, which had a profound effect on Illich: “I discovered Thomism – no, Thomas – as I discovered him through Jacques Maritain, as the architecture which has made me intellectually free to move between Hugh of St. Victor and Kant, between Shutz . . . and Freud, or again into the world of Islam, without getting dispersed.”

Illich’s intellectual gifts were spotted by Giovanni Montini (later Pope Paul VI), who encouraged the young Austrian to enter the Accademia dei Nobili Ecclesiastici, the training college of the Church’s diplomatic service. Illich declined the offer and decided instead on an academic career. In 1951 he moved to the US, with the intention of embarking on postdoctoral studies at Princeton. When he arrived in New York he was struck by the plight of the city’s new Puerto Rican immigrants, and particularly by the failure of the Catholic Church to reach out to this new congregation. With his natural gifts for languages, Illich quickly learned Spanish and was accepted as a curate in a parish with a large Puerto Rican community. He abandoned plans for an academic career and devoted his considerable intellect and energies to ministering to this new flock. He even spent his vacations in Puerto Rico, immersing himself in the culture and travelling to remote parts of the island, where he said Mass and performed baptisms and marriages. Back in New York, he organised an open-air Mass at Fordham University to celebrate the holy day of San Juan, Puerto Rico’s patron saint: thirty-five thousand people attended. Cardinal Francis Spellman, the primate of the archdiocese of New York, was so impressed that he promoted the young Austrian to the title of monsignor: he was then the youngest priest in the US to hold this title. Spellman would be Illich’s protector until his death in 1967.

In 1956, Spellman appointed him to the post of vice-rector of the Catholic University in Ponce, Puerto Rico, and also as founder and leader of the Institute of Intercultural Communication, which trained priests and nuns, teachers, policemen and social workers in the Spanish language and Latin American culture. Illich had very specific views on the training of missionaries: he believed that the process was a spiritual experience – “an intimate mystical imitation of Christ in His Incarnation”, and that learning a language was “one of the few occasions in which an adult can go through a deep experience of poverty, of weakness, and of dependence on the good will of another”. In Ponce, Illich clashed with the local (Irish-American) hierarchy: he called Bishop James McManus “a well-meaning Irish turkey”, and Bishop James Davis “a self-seeking, vain careerist”. He displeased McManus by his support for the liberal governor, Luis Muñoz Marín, and his vocal opposition to the rival Catholic party (supported by the bishops). In 1960, after deliberately disobeying McManus – he attended a dinner given by Muñoz Marín − Illich was ordered to leave his post at the university and recalled to New York.

In the mid-twentieth century, the population of Latin America increased dramatically. The vast majority of the population was nominally Catholic, but priests were few and scattered: many went unbaptised and Catholic religious education was poor. Three successive popes – Pius XII, John XXIII and Paul VI – encouraged the North American church to send missionaries to the sub-continent. Pope John went so far as to suggest that ten per cent of all American priests – a “tithe” – should be sent to South America. Fr John Considine, head of the National Catholic Welfare Conference’s Latin America Bureau (LAB) realised that missionaries would need training if they were to work effectively in Latin America. Following a trip to Ponce, he identified Ivan Illich as the ideal man to head a new centre for the training of would-be missionaries. Considine was warned that Illich could be difficult: Illich’s friend and fellow priest John Fitzpatrick said this in 1969:

He’s an extraordinarily intelligent man. He likes to have intelligent people at his side and he finds it difficult to hide his disdain for what he considers stupidity. He’s a polyglot genius who speaks nine languages almost without an accent and he’s a cosmopolitan who feels at home anywhere in Europe or the Western Hemisphere. He was educated in Rome for a career in the Vatican, so he knows canon law, diplomacy, and church politics perfectly, to the degree that he often makes intelligent clerics feel like children. He devours books and reads more in a night than most people could read in a week. He can be extremely cordial when it’s appropriate, but he can also respond with ridicule, or, even worse, contempt. … He is, and will always be, a sign of contradiction and a focus of controversy.

Paul Tanner, the general secretary of the LAB, had identified Illich as a troublemaker, and vetoed his appointment. Considine and Illich got around this by persuading Fordham University to sponsor the training centre. A premises (an old hotel) in Cuernavaca – near Mexico City – was identified, and the Centre for Intercultural Formation (CIF) was formally established, with the remit of providing intensive courses in the Spanish language as well as classes in Latin American culture and history.

Sometime between his sacking from Ponce and the establishment of CIF in Cuernavaca, Illich began to have major doubts about the missionary enterprise. His experience in Puerto Rico persuaded him that “development” did not bring the benefits it promised, a view re-enforced by a journey he undertook in 1960, when he travelled alone, on horseback, from Santiago in Chile to Caracas in Venezuela. In Colombia, he encountered American priests distributing powdered milk, creating what Illich called “milk Christians”: he concluded that American missionaries were spreading a “delusive belief in the ideals of democracy, equal opportunity and free enterprise”. Illich stopped such food distribution in one area, and was later accused of having caused the deaths of dozens of children. He developed a great respect for existing Catholic practices in Latin America (particularly in Puerto Rico), and concluded that these spiritual traditions were not in need of a Western-imposed “reform”. Illich concluded that the mission was a perversion of Christian charity.

CIF opened for business in June 1961, and almost from the start Illich engaged in a deliberate and secret strategy of sabotage. He persuaded many of these would-be missionaries to go home. Students at CIF were told, among other things, that they were bourgeois thrill-seekers, agents of US cultural imperialism, “a colonial power’s lackey chaplains”, and apostolic tourists. He told them that he had opened the centre to minimise the damage they would do in Latin America. He told a nun: “I hate Yankees.” He compared convents to brothels and nuns to prostitutes, and observed that religious orders were asylums for inadequates who couldn’t survive in the real world. The language classes – five hours a day (three hours in guided drills, one hour in the language lab, one hour in directed conversation) were so demanding and draining that many fell prey to nervous exhaustion. One student said: “It was so intensive that you’d have people almost breaking down. This was Illich’s approach, of course. If you cracked, fine; he’d either build you back up or he’d lose you.” Time magazine reported: “He yells at them and lectures them, plays and prays with them, insults them and drinks with them.” Illich’s assistants included Fr Alejandro del Corro (later chaplain to the Marxist guerrillas in Argentina) and the radical missionary Fr Leo Mahon. Only thirty-two of sixty-two students completed the first course at CIF. Flushed with this success, Illich hosted twenty-three “workshops” for the superiors of the teaching orders, such as the Jesuits, Christian Brothers  and Benedictines. His unstated aim was to dissuade them from setting up schools in the region, and in this he was mainly successful.

Illich flirted with liberation theology. He hosted several meetings of progressives such as Gustavo Gutiérrez (later author of A Theology of Liberation), Segundo Galilea and Juan Luis Segundo. Although Illich facilitated its development, he did not take the theology of liberation very seriously. He dismissed two American priests who had attached themselves to Guatemalan guerrillas as “dilettantes” and “ingénus”. When Daniel Berrigan, the Jesuit priest, poet and anti-Vietnam activist, turned up in Cuernavaca in 1965, Illich remarked: “Berrigan is a nice poet trying to play a parlour game, afraid to live fully.” The FBI astutely concluded that Illich was an “anti-communist with a leftist-reformist attitude”. He was not easily pigeon-holed: he dismissed Castro’s regime as “an odious tyranny”; he upset feminists when he argued that women had been better off in traditional societies in which they devoted themselves to their families; the counter-culturalists who devoured his books discovered that he regarded their enthusiasm for promiscuous sex and drugs as repugnant.

It took that poor booby Fr Considine several years to realise what was going on: Illich had strung him along with a mixture of flattery and deceit. In 1967, he finally admitted what he was up to, when he wrote a polemic called “The Seamy Side of Charity” in which he openly accused missionaries of being nothing more than the vectors of American consumerism: “Foreign aid thus becomes a major factor of alienation by creating a new kind of dependence … alms of this kind foster an ill-disguised attitude of begging in the clergy … the Church is becoming colonial.” He followed this with an equally provocative piece called “The Vanishing Clergyman”, which described the Catholic Church as “the world’s largest non-governmental bureaucracy” and argued for greater involvement of the laity in the sacraments. Illich’s luck finally ran out in December 1967, when Spellman, his powerful protector, died. A chance conversation, while aboard an internal flight in Brazil, with a local bishop called Adalberto Almeida Merino, led to his summons to the Vatican by the Congregation for the Doctrine of the Faith of the Catholic Church (CDF). Illich had boasted to Almeida that, among other things, he had been initiated into a polytheistic Afro-Brazilian religion, that he had close links with many leftist politicians in South America, and that, should he choose to, he could make “millions of pesos” by selling information on Latin America. (The story illustrates the grave dangers of in-flight hospitality.) Although Almeida did not personally dislike Illich he was indiscreet, and soon the apostolic delegate Guido de Mestri got to hear of the conversation and ordered Almeida to supply him with a detailed account.

The Vatican had been watching Illich closely for some years. Early in 1968, Cardinal Franjo Šeper, the prefect of the CDF, wrote to inform him that he was under formal investigation. Illich travelled to Rome in June 1968 for his trial. He was greeted warmly, and somewhat apologetically, by Šeper (a Croat), but the actual interrogation was conducted by Monsignor Giuseppe Casoria:

I am Illich.
I know.
Monsignor, who are you?
Your judge.
I thought I would know your name.
That is unimportant. I am called Casoria.

Illich refused to take an oath of secrecy and demanded that any questions be put in writing. The trial was adjourned and later that day Illich was given a list of eighty-five questions, which included:

How do you respond to those who present you as petulant, adventurous, imprudent, fanatical, and hypnotizing, a rebel to any authority, disposed to accept and recognize only that of the Bishop of Cuernavaca?
What do you think of heaven and hell, and also of limbo?
What did you have to do with kidnapping of the Archbishop of Guatemala?

Illich suspected that many of these questions were based on CIA reports and wrote to Šeper that he would not defend himself and that the Church’s treatment of him was “a distortion of the Gospel”. He delivered the letter himself to Šeper. The two Croats embraced (did Illich kiss his “aged bloodless lips”?), and Šeper dismissed Illich with the words of Dostoevsky’s Grand Inquisitor. Illich – as Šeper knew he would − recognised the literary allusion immediately: was Šeper comparing him to Christ? Did the prefect of the modern Inquisition imply, by using this phrase, that the Church had lost the spirit of Christ? “A most extraordinary thing,” Illich later observed.

On January 14th, 1969, Ivan Illich formally resigned from the “public duties” of the priesthood but for the remainder of his life continued to live as a priest, remaining celibate and reciting the priest’s daily office. He regarded priestly identity as permanent; many years later, Cardinal Josef Ratzinger (later Pope Benedict XVI), Šeper’s successor as director of the CDF, confirmed that Illich remained a priest in good standing. On January 18th, Illich received a letter from the papal delegate to Mexico prohibiting priests and nuns from attending courses at the centre. CIF then became CIDOC (Centro Intercultural de Documentación). Although the centre continued to provide language courses for missionaries, it became a sort of informal university and what Illich called a “thinkery” and “a meeting place for humanists”. There were only three rules, and no curriculum, examinations or degrees. Students were free to attend any lectures or symposiums they chose to, and equally free to leave then at any time if they found them dull.

The centre had a hundred staff and six hundred students. The role of the students was to finance Illich’s intellectual programme: many of them found it boring and frustrating and found the paradox (and hypocrisy) of the CIDOC’s view of itself as a “non-institution”, yet one that was obsessed with bureaucracy, intolerable. In 1972, an attempted rebellion by students fizzled out. Illich told students that “the right to be unjust” was one of CIDOC’s most important values, and that he was “in the business of exploiting Americans”, this being the main function of the language school. The sociologist Peter L Berger later wrote:

CIDOC declined along with Illich’s influence as the cultural climate changed. Opposed to anything that smacked of “schooling”, he made almost no effort to control the program. All sorts of people were allowed to lecture, some of them with quite outlandish ideas. A sort of intellectual Gresham’s Law ensued: the good people increasingly stayed away. When this became evident to Illich, he made what must have been a difficult decision: he shut the place down …

The highlight of every day at CIDOC was the “El Ciclo” lecture, given at 11am by Illich himself. The New Yorker columnist Francine du Plessix Gray visited CIDOC in 1970 and captured something of Illich’s charisma:

Ivan Illich, tall, aquiline, smiling affably, gesticulating with long gangling arms, conversing in five languages at once, walks swiftly through the rooms of CIDOC, an elegant Palladian villa in the flowered hills above Cuernavaca … He smiles and throws back his shock of black hair with a boyish gesture. When smiling, Ivan Illich looks like the young Voltaire: long-faced; beak-nosed; the deep-set brown eyes both gentle and cynical; the mysterious wide mouth curving up in a sarcastic, knowing smile, a little kinder and more ingenuous than Voltaire’s.

Over time, Illich turned these lectures into informal discussions, where he engaged in dialogue with other teachers he respected: “a continuing public conversation with a small group of colleagues”. The students were generally ignored; if they had the temerity to speak up, Illich told them “to sit down and shut up”. Using these sessions to clarify and refine his thoughts, Illich arrived at his central theme, which was that institutionalisation had corrupted Western civilisation. His ideas were heavily influenced by Leopold Kohr, an Austrian political scientist he had met in Puerto Rico, and by Kohr’s student EF Schumacher (of Small is Beautiful fame). Modern institutions were characterised by what Illich called “paradoxical counterproductivity”, that is they frustrated the very purpose for which they were originally designed. So: formal education led to ignorance, modern transport caused gridlock and environmental despoliation, and healthcare was sickening. He elaborated these ideas in a series of books published between 1970 and 1975, including Deschooling SocietyTools for Conviviality and – most famously – Medical Nemesis.

This obscure, truculent priest found himself famous, and relished the attention. When he embarked on university lecture tours of the UK and Ireland in the 1970s he was mobbed. In Dublin, eight thousand turned up, and Illich’s lecture had to be relayed via radio linkup to all the other lecture halls. In Edinburgh in 1974, a young medical student called Richard Smith (later editor of the British Medical Journal) was transfixed: “The closest I ever came to a religious experience was listening to Ivan Illich. A charismatic and passionate man surrounded by the fossils of the academic hierarchy in Edinburgh …” At the same lecture, another student raised his hand: “But Dr Illich, I just want to help sick people,” to which Illich replied: “You’re no better than the Nazi doctors.” (I wonder if this student is now a fossil of the medical academic hierarchy.) In 1973, sixty-five reporters turned up to a press conference given by Illich in London. The Listener’s correspondent wrote: “His fluency with anecdote, aphorism, statistics (and word like ‘asymptote’) don’t disguise the lack in his talk and writing of any positive line of thought leading to group action.” At a conference in Australia the same year, Illich announced that he would no longer fly in jets or appear on television. (The conference was televised, and he had travelled there by air). Audience members posed such questions as: “Shall I have children, Dr Illich?” He enjoyed baiting them, but was occasionally caught out: when speaking about Medical Nemesis at the Harvard Medical School, the feminist Norma Swenson asked him: “Mr Illich, did you ever see a human body?” Illich mumbled: “No.”

The man who denounced the evils of modern transport criss-crossed the globe by jet. At a conference in Cyprus in 1971, he refused to take the bus from his hotel to the conference centre, and rose early to walk there, contemplating, no doubt, the delicious irony of a man who had travelled thousands of miles by jet to Cyprus, refusing to use a bus. Illich claimed to have learned Greek during the single week of this conference by talking to the hotel gardener. (What, I wonder, did they talk about?) He professed to be unimpressed by status, yet was flattered by the attentions of Pierre Trudeau and Jerry Brown. He refused to wear a watch, which he dismissed as a “gauge”, and which he believed placed an artificial structure on ordinary life: after his first trip to Puerto Rico he deliberately adopted a Latin American contempt for punctuality. Despite this he was often to be seen asking the time from “gauge-wearers”. He claimed to prefer simple food but after his death a friend wrote how Illich once went shopping for supper with him in Copenhagen and filled the shopping-basket with expensive foods and fine wines. Despite his contempt for institutional education, after the dissolution of CIDOC in 1976 he held visiting professorships in several German and American universities.

Illich was frequently dismissed by his critics as a “Jeremiah”, and there was indeed something of the Old Testament prophet in his persona. David Horrobin, the controversial doctor, pharmaceutical entrepreneur and publisher who wrote an entire book attacking Illich’s Medical Nemesis (Medical Hubris: A Reply to Ivan Illich), mocked him as “a classic Old-Testament spellbinder”. He regularly undertook solitary retreats into the deserts and holy places: in 1959, he spent forty days in the Algerian Sahara, on a rocky plateau near the summit of one of the highest Ahaggar mountains. (Did he experience any temptations there?) His 1961 solitary journey from Santiago to Caracas was crucial in forming his view on American missionary activity. In 1962, he was hospitalised in Frankfurt (for what, we are not told – nervous exhaustion?); he spent this period in thought and prayer, reading up to twenty books a day, “mostly speculative theology and great literature”. In 1964, he went to Mount Athos in Greece for a “period of reflection”. He regularly visited Benares, where he stayed in Hindu temples.

He spent the last decade of his life alternating between Bremen (where he shared a house with the sociologist Barbara Duden) and Mexico, where he lived in a mud hut, “aristocratically aloof, austere, absorbed but happy”, according to his obituary in The Times. His bloodymindedness, in the end, killed him. In his late fifties, Illich developed a facial tumour. Hypocrite though he was in many other matters, the man who thought modern medicine diabolical couldn’t bear to swallow his pride and put himself in the hands of a profession he despised. “I am not ill,” he insisted, “it is something completely different – a very complicated relationship.” He did, however, avail of meditation, yoga and opium. He died several years later, in Bremen, having (almost literally) cut off his nose to spite his face. He collapsed suddenly while at his desk in his study; “God gave him a beautiful death,” said a German friend.

Despite the impenetrable prose, the repetition and the endless footnotes (one thirty-nine-word sentence has eight footnotes), Medical Nemesis was a bestseller. The book opened with the famous assertion: “The medical establishment has become a major threat to health.” The lecture halls may have been filled with earnest duffle-coated students, but the establishment he was so contemptuous of dismissed Illich as a crank and moved on. He had grievously overstated his case and his proposed solutions were risible: he argued, for example, for “more public support for alpha waves, encounter groups and chiropractic”.

And yet, forty years on, much of the perceived evil that Illich railed against has come to pass. When Medical Nemesis was published in 1974, US spending on healthcare was 8 per cent of GDP: it is now 18 per cent. Healthcare makes up 10 per cent of the global economy, and has become, in Illich’s phrase, “a vast monolithic world religion”. Many health economists believe that spending on medicine in countries like the US has passed the tipping point where it causes more harm than good. Even meliorists such as Atul Gawande admit that the growth of healthcare is threatening other aspects of human life, such as education and housing. Iatrogenesis – the harm caused by medical interventions – is now acknowledged as a major societal problem in Western countries. The creeping medicalisation of old age and death (what Illich called “cultural iatrogenesis”) has continued unchecked. Hartch writes:

Also as he feared, the art of suffering has seemingly vanished from the world. Where once the great religious and philosophical traditions aided the sick and the dying in making sense of their pain and preparing for death, the medicalization of life has proceeded to such a degree that antidepressants and painkillers preclude even the asking of questions. The anesthetic cocoon has triumphed; pain and death have become merely practical issues rather than existential challenges demanding all the resources of human culture.

Having worked as a hospital doctor for over thirty years, I have come to accept the core arguments of Medical Nemesis; events since its publication have only strengthened Illich’s thesis. I have observed how “healthism” has emerged: how the worried well have been converted into “patients” by screening programmes and the pharmaceutical industry. Illich would have been wryly amused by Big Pharma’s invention of new diseases, such as social anxiety disorder (shyness), male-pattern alopecia (baldness), testosterone-deficiency syndrome (old age) and erectile dysfunction (impotence). Modern cancer care (oncology) has been labelled “a culture of medical excess” by its own leaders. Developments in stem-cell technology and fertility treatments are throwing up possibilities that Illich could not have imagined. I only wish he had written a shorter, more readable book: he later admitted that he felt he had to include all those references and footnotes if he was to be taken seriously by doctors.

Illich assumed that medicalisation was something doctors actively sought, to enhance their powers, but in this he was mistaken. Two doctors, Leonard Leibovici and Michel Lièvre, corrected this assumption in the British Medical Journal in 2002:

These aspects of medicalization make doctors miserable. The bad things of life: old age, death, pain and handicap are thrust on doctors to keep families and society from facing them. Some of them are an integral part of medicine, and accepted as such. But there is a boundary beyond which medicine has only a small role. When doctors are forced to go beyond that role they do not gain power or control: they suffer.

Many within medicine view with alarm the direction modern healthcare has taken. A growing resistance movement has taken root, with various strands to it, such as the Slow Medicine Movement and the British Medical Association’s “Too Much Medicine” campaign. The founders of the NHS naively believed that a free healthcare system would result in a healthier society and thus less demand for its services. Enoch Powell, who held office as a junior health minister, was among the first to point out the fallacy of this argument. Illich coined the term “Sisyphus syndrome”, meaning the more healthcare given to a population the greater its demand for care and he has have influenced such diverse contemporary commentators on healthcare as Iona Heath, Richard Smith and Zeke Emanuel. His hyperbolic prose carries some uncomfortable truths, but even if we acknowledge these truths, we must also recognise – as Illich did not − the unarguable benefits of safe and effective surgery, of asepsis, of antibiotics, of anaesthesia, of painless dentistry.

After his decade of fame, Illich maintained a loyal band of disciples, and lectured on his obscure pet enthusiasms, such as the twelfth-century writer Hugh of St Victor, the subject of his commentary In the Vineyard of the Text (1993). His books and articles became ever more obscure (H2O and the Waters of ForgetfulnessGender), consumed only by diehard Illichians and academics. “Many of his friends and supporters,” writes Todd Hartch, “longed for the day when he would produce a clear, direct, simple speech or text, but he never did.” As he grew older, he confessed to his close friends that his bestselling books weren’t really about schools, transportation or healthcare: all along, he had been really writing about the corruption of his beloved Church by institutionalisation. He told his closest confidant, Barbara Duden, that Medical Nemesis could just as easily have been about the postal service. He explained this as an example of “apophatic theology”. Duden was initially disturbed by this remark but over time came to understand it. In a preface to a new edition of Medical Nemesis (now retitled Limits to Medicine) in 1995, Illich wrote: “I used medicine as a paradigm for any mega-technique that promises to transform the conditio humana. I examined it as a model for any enterprise claiming, in effect, to abolish the need for the art of suffering by a technically engineered pursuit of happiness.” In an article for the British Medical Journal entitled “Death undefeated” (1995), Illich explained his purpose in writing the book: “I analysed the medical enterprise as a post-Christian liturgy that instilled a keen fear of pain, disability, and death in its devotees.”

A reader unfamiliar with Illich might not easily guess that the author of Medical Nemesis was a Catholic priest. Apophasis may be defined as a kind of theological or philosophical thinking that reveals its true subject by not mentioning this subject: the original Greek word means denial or negation. There is a long tradition of Christian apophatic theology, including Pseudo-Dionysius the Areopagite, Meister Eckhart and St John of the Cross. Illich told his close friend, fellow-priest and CIDOC colleague Lee Hoinacki that he was fascinated by the story of St Alexis. The saint lived as a beggar in fifth century Rome, and his sanctity was revealed only after his death, an example, writes Hoinacki, of “apophatic anthropology”. Hartch argues that Illich’s books about institutions were really about the corruption of Christianity:

To Illich, the history of the West was thus the tragedy of the institutionalization of Christianity, as the Church, truly the body of Christ, adopted the false and dangerous guise of an institution … If the Church had not succumbed to institutionalization, those other institutions would not have come into existence. Illich’s apophasis, therefore, had two levels. He denied that mandatory schooling was true learning or teaching, that modern medicine was true healing, and that economic development was true compassion; at the deeper level he denied that the Church was a bureaucracy, that the human body was a machine, and that death and suffering could be avoided.

His thinking could be summarised in his two favourite sayings: corruptio optima quae est pessima (the corruption of the best is the worst) and mysterium iniquitatis (the mystery of evil). Illich believed that the church had been taken over by the spirit of Dostoevsky’s Grand Inquisitor. This institutionalisation of the church had directly or indirectly caused also the institutionalisation of education, transport and healthcare, with the same paradoxical effects. Hartch writes: “In fact, Western modernity – technological, bureaucratic, liberal, regulated, global – was in almost every aspect a corruption of some Christian virtue.”

Illich, ever the classical scholar, used the examples of the brothers Prometheus and Epimetheus. Prometheus stole fire from the gods, and for his hubris suffered the eternal punishment of having his liver pecked out every day by an eagle (and also the indignity of being used as an illustration by liver specialists for every lecture on the remarkable capacity of that organ to regenerate itself). Epimetheus allowed Pandora to open her box of plagues, but held on to hope. Illich called for “The Rebirth of Epimethean Man”, whose guiding spirit was hope, rather than the Promethean spirit of expectation. Epimethean man stood in a humble, creaturely relationship to nature and his creator. Promethean man, with his institutions, regulations and predictions, expected to control his destiny and conquer nature. To Illich, this was blasphemy. Hartch takes the example of the Good Samaritan:

Instead of freely choosing to care for the bleeding man, the Church could choose, for example, to set up a committee to establish a house of care for bleeding men … When spun off in an independent secular version, first in the West and then into the rest of the world, institutionalized “caring”, Illich argued, was literally diabolical. That is, it maintained an air of great solemnity while directly opposing the original call of Christ.

In the last decade of his life Illich finally felt free to admit this apophasis. Addressing a group of Catholic philosophers in Los Angeles in 1996, he expressed relief that he could at last speak openly: “When speaking in Philadelphia or Bremen, I felt I ought to shroud my ultimate motive in apophasy. I did not want to be taken for a proselytizer, a fundamentalist – or worse, a Catholic theologian.”

Illich may have been an arrogant, petulant, self-regarding humbug, but his books on institutions contained a kernel of truth. Why did he disguise his message in the cloak of apophasis? And why did he admit this disguise only to his closest friends and disciples? The answer, according to Hartch, lies in his Catholic orthodoxy. “‘It is canonically correct,’, Illich said, “for a clergyman to divest himself of his faculties as soon as he becomes notorious.” Hartch writes. Thus, when Paul VI asked Illich to stop speaking to “groups of priests and nuns, he obeyed, going so far as to cloak almost everything he said about Christianity in metaphor and analogy until late in his life”. (Illich may have obeyed Pope Paul, but his relationship with most other senior Catholic clergy was characterised by a singularly unorthodox disobedience.) “He is best understood,” concludes Hartch, “as a Catholic priest of conscious orthodoxy grappling with the crisis of Western modernity.” The popular conception of Illich may have been that of a rebel, but he saw himself as an orthodox Catholic: “Intellectually and culturally I am rooted in the Church: I grew up in its traditions and I want to pass them on to the next generations.”

After his death in 2002, the psychiatrist and writer Anthony Daniels (Theodore Dalrymple) wrote: “My attitude to Illich was composed half of admiration, half of irritation. He had a distinctly prophetic quality, but he could also be very silly, and some of the things he said were destructive of civilization itself.” Hartch, too, is ambivalent: he concludes that Illich, with his “Promethean arrogance”, was wrong about missionary activity in Latin America, and speculates on what harm he might have caused: “We will never know what cultural treasures, not to mention simple lives of faith, were lost when newly urban Latin Americans surrendered to secularism, consumerism, and anomie because there was simply nothing Catholic in their desolate neighborhoods.” He concludes, however, that his thesis on institutions was right: “ … his proposal that the corruption of Christianity has infected all of the West at the very least deserves to be taken seriously and may in fact be the key to understanding the nature of Western modernity itself”. Hartch, in his title, describes Illich as a prophet, and has acknowledged (elsewhere) that Illich’s writings were an important factor in his own conversion to Catholicism. He argues that Illich’s “Catholic period” (1961-67) formed the ideas of his “Secular period” (1967-76). For secular readers, or, indeed, anyone familiar with Gibbon or the medieval papacy, the notion of a once innocent Church becoming corrupt does not persuade. His apophasis might be easily grasped by Catholic theologians, but for the many who still have a battered paperback copy of Medical Nemesis, it must be perplexing to learn that the book was not about medicine as such but was really a veiled parable about the societal consequences of the institutionalisation of the Catholic Church.

What are we to make of Illich now? Like Anthony Daniels, I am both admiring and irritated. The character that emerges from The Prophet of Cuernavaca is ambiguous and tricky. Illich was a romantic who looked back to an idealised pre-industrial past, when life was governed by community, family and religious ritual; he conveniently ignored the Hobbesian realities of pre-Enlightenment existence. I cannot quite accept his glib assertion that Medical Nemesis could just as easily have been about the postal service; he may have made this remark purely to shock, as was his wont. Similarly, I have difficulty with Hartch’s argument that it was an apophatic book about the corruption of Christianity. Although Illich wrote in Medical Nemesis about the existential problems of pain, suffering, and death, the book was, in the end, about medicine. He attacked institutionalised modern medicine because he saw it as a new religion, with its own rituals and dogma, and the medical profession as a new priesthood. Hartch reads him through the prism of his own Catholicism, but Illich wrote for a wider audience, and the enduring influence of the book has been on a secular readership. As for Illich’s supposed orthodoxy − the source of this alleged apophasis − he played this card when it suited him, when his own views happened to coincide with official Catholic dogma.

I grew up in the era of young priests and folk Masses; looking back from the Ireland of 2015, with its empty churches and apologetic bishops, I feel vaguely nostalgic for a time when lay Catholics had heard about controversialists like Illich and Hans Küng. He may be largely forgotten, but Illich had something valuable to say about modernity. He argued for the Epimethean concept of what might be called “creatureliness”: we are mortal animals, powerless in the face of nature; we must accept our frailty and cultivate the arts of living and dying. And creatureliness is for believers and godless alike. Our contemporary culture, however, is Promethean; Illich believed that we unwittingly traded our spiritual freedom for the material comforts brought by scientific knowledge, and correctly predicted – or prophesised, if you prefer – that the new technologies would enslave us: “Only within certain limits can machines take the place of slaves; beyond these limits, they lead to a new type of serfdom.”


Seamus O’Mahony is a consultant physician and a regular contributor to the Dublin Review of Books. His book The Way We Die Now will be published by Head of Zeus in May 2016.



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