My first reference and indispensable is a book published in 1975, Medical Nemesis (Medical Nemesis, Némédicale) by Ivan Illich. Ivan Illich, director of the CIDOC Institute of the city of Cuernavaca (Mexico), compiled and elaborated from 1966 great information about the structural institutions of the industrial society (school, health, transportation, etc. ). ). The book of Nemesis begins with these words: “Institutionalized healthcare has become a serious health threat.” Today, the phrase would seem crazy to us, and what it says, let's say it's not in any discussion forum. But interestingly, the book was a success in its time and translated into several languages.

A dozen years later, Illich himself made a kind of self-criticism, more surprising, more disturbing. “In developed territories, the obsession with perfect health has become the main pathogen.” Not medical intervention, as has already been denounced, but the “obsession of perfect health”. Is it wrong to take care of your health? Shouldn't it be our first concern for health?... Obviously, the word “perfect” is the key to the phrase.

Turning to those outrageous statements – and inviting you to hear them once again – let us start with industrialisation. The development of industrialization has made any other way of life impossible. The crumbs that are resisted are treated like the old heremites that retired to the desert: birds of bad luck that claim our conversion and our instant apocalypse. Today everything is “industry”: agriculture and travel, sexuality and art. And when we talk about industry we mean capitalist business activities: nothing is worth anything if it is not merchandise (“exchange value”). And that's where all the personal and community care comes in that demands disease, aging and death for us. Is it essential for all of us? The name of this industry is “Health System” and perhaps the medicalization of health is the most effective part of the process of global industrialization, as it affects us in the most intimate, the most vulnerable, in the most essential of the human condition, in our mortal condition.

The search for physical immortality has already become the “rational” fantasy of most, and not the delirium of senseless alchemists. As with the “right to happiness”, recognized in the Constitution of the new Arcadia of the United States, we will immediately proclaim immortality as a fundamental right that must be recognized by the new constitutions. We will look away at the fantasies of our dying eternity ancestors.

In his reflections of the 1970s, Illich distinguished three types of iatrogenesis – the harmful effects inherent to medical interventions –: the damage produced directly by clinical interventions or “clinical iatrogenesis”; the second is called “social iatrogenesis”, which incites a sick society, increasingly feeding the demands derived from its conversion into a patient; and finally, the “structural oppression” that achieves one’s own death.

What did Illich, the deepest and most coherent critic of modernity mean, according to Giorgio Agamben, with that surprising phrase that he pronounced twelve years later, “the obsession of a healthy body has become the main pathogen of the present”? In view of how these things have progressed, I think it is easier to understand them these days. During the decades that followed Illich's first statements, many tried to create face to face fronts in the areas of health and other structural institutions. It was common to speak of “Alternative Medicine” versus “Institutional Medicine”, but the bulldozer of industrialization soon destroyed those dreams as other fictitious fronts. And also those who tried to deal with medicalization, we gave in quite easily, and the benefits that came with it were inevitable: successful treatments against deadly diseases, increased life expectancy (survival), etc. The “alternative health systems” quickly became “complementary systems” capable of dealing with some involuntary effects of “authentic scientific medicine”, or at least to alleviate the stress, for those who could afford those luxuries – for the poor, there were junk food and outpatient consultations.

Are not among the most hypochondriacs many who question “Official Medicine” dancing in continuous “alternative therapies”? In this regard, Illich referred precisely to a “new pathogen” by the late 1980s: there are many ways to reinforce vulnerability, mortality of human nature or denial of body condition. And that's why it's perhaps so significant that, after so many serious alerts, like the ecological disaster, the refugee disaster or the unsustainable economic system that's coming, there's a pandemic that has put in direct contact with the Western Reality. This West begins today in China, capable of carrying out the strongest and most ruthless biopolitics.

Putting yourself to these questions is perhaps the most naive of occurrences. Given the situation of general panic that comes to mind to remember the proposals of Ivan Illich, there is nothing more urgent, in my opinion, than to discuss without limits on health and disease in an isolated and apocalyptic moment.

Juan Gorostidi Berrondo