Title: Health as One's Own Responsibility: No, Thank You! and Responses
Author: Ivan Illich
Date: Jan 1992
Source: The Ellul Forum, Issue #8

I am convinced that health and responsibility belong to a lost past and - being neither a romantic, a visionary, nor a drop-out - that I must renounce both of them. But only if I succeed in unequivocally articulating this renunciation of health and responsibility can I escape the reproach that I appear here as a mere rhetorical critic.

This presentation forms part of a larger joint project for the "recovery of askesis in higher education." My preparation included a close collaboration with Dirk von Boetticher. We discussed every sentence with a group of young friends. When, in what follows, I say "we," I mean only this group.

We are occupied with a reflection on contemporary certainties and their history - that is, on assumptions which seem so commonplace that they escape critical testing. Over and over we find that the renunciation of these very certainties offers the only possibility remaining for us to take up a critical position regarding that which Jacques Ellul calls la technique. And we want to free ourselves from it, not just run away. For that reason, my reaction to "taking responsibility for one’s own health" is an emphatic "No!"

But there is a risk here. Our "No, thank you!" in response to a suggestion for a new hygienic anatomy can be interpreted and used in five different ways to do exactly the opposite of what we intend:

1. First of all, the "No" can be understood as a call for the necessity of tutelage. Health, so it might be claimed, is too valuable, too sacred to leave to the discretion of lay people. I apodictically reject this arrogant disempowerment. For thirty years I have publicly defended the total decriminalization of self-abuse. And I continue to insist on the complete elimination of all legal statutes which regulate the consumption of drugs, and unconventional and/or irregular healing. Following Paul Goodman, I build my argument on the respect we owe to the dignity of the weakest.

2. Secondly, my fundamental "No" has nothing to do with the presumed scarcity of healing agents. Today, people are dying of hunger, not from a lack of medicine or surgical interventions. And the poorer people are, the more helplessly they become the victims of ever cheaper medicine. For two decades, I have defended the position that the consumption of medicine, just as of liquor, tobacco and lotteries, ought to be subject to taxation as luxuries. Through taxation of dialysis, coronary bypasses, and AZT simple medical procedures such as appendectomies could be financed for everyone.

3. I do not say "No" as a global thinker seeking an unobstructed channel for ecological dictatorship. I can imagine no complex of controls capable of saving us from the flood of poisons, radiations, goods and services which sicken humans and animals more than ever before. There is no way out of this world. I live in a manufactured reality ever further removed from creation. And I know today its significance, what horror threatens each of us.

A few decades ago, I did not yet know this. At that time, it seemed possible that I could share responsibility for the re-making of this manufactured world. Today, I finally know what powerlessness is. "Responsibility" is now an illusion. In such a world, "being healthy" is reduced to a combination of the enjoyment of techniques, protection from the environment, and adaptation to the consequences of techniques - all three of which are, inevitably, privileges. In the Mexican valley that I know, the blue com, under whose planting calendar the village still names its cyclical feasts, was wiped out fifteen years ago. And there is no money for the destructive techniques needed to grow hybrids. There is also no protection against the poisonous clouds blowing over from the agribusiness plantation. But new places of employment are opened up for the pedagogy of health, with sops thrown to barefoot green enthusiasts in the process. Therefore, my "No!" is certainly not a "yes" for a pedagogy of health which entails the management of poisonous systems.

4. And I particularly do not say my "No!" to a new ethics of responsibility for health because I see in modem sickness and dying occasions for finding oneself. The suggestion that we ought to accept the unavoidable epidemics of the post-industrial age as a higher kind of health is an impudence currently fashionable among pedagogues. But such instruction in suffering and dying is shameful. Care through bereavement counselling, education for dying, and the making of health plans aims directly at the destruction of the traditional art of suffering and dying, practices developed over hundreds of years.

What sickens us today is something altogether new. What determines the epoch since Kristallnacht is the growing matter-of-fact acceptance of a bottomless evil which Hitler and Stalin did not reach, but which today is the theme for elevated discussions on the atom, the gene, poison, health and growth. These are evils and crimes which render us speechless. Unlike death, pestilence and devils, these evils are without meaning. They belong to a non-human order. They force us into impotence, helplessness, powerlessness, ahimsa. We can suffer such evil, we can be broken by it, but we cannot make sense of it; we cannot direct it. Only he who finds his joy in friends can bear up under it. Our "No!" is thus a universe apart from every "Yes!" to the secondary accompaniments of progress.

5. And, finally, it would be either stupid or malevolent to label the "No" of which I speak as cynical indifference. Quite the contrary! In the forefront of our thoughts stand the many - innumerable people - for whom four decades of development destroyed the cultural, technical, and architectural space in which the inherited arts of suffering and dying were formerly nurtured. Today, the vast majority is poor, and becomes poorer. When we say "No!" to implanting health at home or abroad, we first of all speak about something which for me is unthinkable: four billions in new wretchedness. Only if we ourselves start with "No, thank you!" can we attempt to be there with them.

The ground of our ethical "no," therefore, does not place us in the service of any of these five: professional paternalism, the ideology of scarcity, systems thinking, liberation psychology, or the new "commonsense" which asserts that in the fourth world no grass has grown over the consequences of development But it grows, that grass; it is called self-limitation. And self-limitation stands in opposition to the currently fashionable self-help, self-management or even responsibility for oneself - all three of which produce an interiorization of global systems into the self, in the manner of a categorical imperative. Renunciation of health seems to us to be a starting point for conduct ethically, aesthetically, and eudaemonically fitting today. And I refuse to define self-limitation as responsibility for myself. With Orwell, I would rather speak of decency.

The concept of health in European modernity represents a break with the Galenic-Hippocratic tradition familiar to the historian. For Greek philosophers, "healthy” was a concept for harmonious mingling, balanced order, a rational interplay of the basic elements. People were healthy who integrated themselves into the harmony and totality of their world according to the time and place they lived. For Plato, health was a somatic virtue, and spiritual health, too, a virtue. In "healthy human understanding," the German language - despite critiques by Kant, Hamann, Hegel and Nietzsche - preserved something of this cosmotropic qualification.

But since the 17th century, the attempt to master nature displaced the ideal of the health of a people, who by this time were no longer a microcosm. This inversion gives the a-cosmic health created in this way the appearance of being engineerable. Under this hypothesis of engineerability, "health as possession" has gained acceptance since the last quarter of the 18th century. In the course of the 19th century, it became commonplace to speak of "my body" and "my health."

In the American Declaration of Independence, the right to happiness was affirmed. The right to health materialized in a parallel way. In the same way as happiness, modern-day health is the fruit of possessive individualism. There could have been no more brutal and, at the same time, more convincing way to legitimize a society based on self-serving greed. In a similarly parallel way, the concept of the responsibility of the individual gained acceptance in formally democratic societies. Responsibility then took on the semblance of ethical power over ever more distant regions of society and ever more specialized services for delivering "happiness."

In the 19th and early 20th century, then, health and responsibility were still believable ideals. Today they are elements of a lost past to which there is no return. Health and responsibility are normative concepts which no longer give any direction. When I try to structure my life according to such irrecoverable ideals, they become harmful I make myself sick. In order to live decently today, I must decisive^ renounce health and responsibility. Renounce, I say, not ignore I do not use the word to denote indifference. I must accept powerlessness, mourn that which is gone, renounce the irrecoverable. I must bear the powerlessness which, as Marianne Gronemeyer tends to emphasize, can perhaps rob me of my awareness, my senses.

I firmly believe in the possibility of renunciation. And this is not calculation. Renunciation signifies and demands more than sorrow over the irrecoverable. It can free one from powerlessness, and has nothing to do with resignation, impotence, or even repression. But renunciation is not a familiar concept today. We no longer have a word for courageous, disciplined, and self-critical renunciation accomplished within a community but that is what lam talking about. I will call it askesis. I would have preferred another word, for askesis today brings to mind Flaubert and Saint Antony in the desert turning away from wine, women and fragrance. But the renunciation of which I speak has very little to do with this.

The epoch in which we live is abstract and disembodied. The certainties on which it rests are largely sense-less. And their worldwide acceptance gives them a semblance of independence from history and culture. What I want to call epistemological askesis opens the path toward renouncing those axiomatic certainties on which the contemporary worldview rests. I speak of convivial and critically practiced disciplines. The so-called values of health and responsibility belong to these certainties. Examined in depth, one sees them as deeply sickening, disorienting phenomena. That is why I regard a call to take responsibility for my health as senseless, deceptive, indecent - and, in a very particular way, blasphemous.

It is senseless today to speak of health. Health and responsibility have been made largely impossible from a technical point of view. This was not clear to me when I wrote Medical Nemesis, and perhaps was not yet the case at that time. In hindsight, it was a mistake to understand health as the quality of "survival,” and as the "intensity of coping behavior." Adaptation to the misanthropic genetic, climatic, chemical and cultural consequences of growth is now described as health. Neither the Galenic-Hippocratic representations of a humoral balance, nor the Enlightenment utopia of a right to "health and happiness," nor any Vedic or Chinese concepts of wellbeing, have anything to do with survival in a technical system.

”Health" as function, process, mode of communication, and health as an orienting behavior that requires management - these belong with the post-industrial conjuring formulas which suggestively connote but denote nothing that can be grasped. And as soon as health is addressed, it has already turned into a sense-destroying pathogen, a member of a word family which Uwe Poerksen calls plastic words, word husks which one can wave around, making oneself important, but which can say or do nothing.

A political deception. The situation is similar with responsibility, although to demonstrate this is much more difficult. In a world which worships an ontology of systems, ethical responsibility is reduced to a legitimizing formality. The poisoning of the world, to which I contribute with my flight from New York to Frankfurt, is not the result of an irresponsible decision, but rather of my presence in an unjustifiable web of interconnections. It would be politically naive, after health and responsibility have been made technically impossible, to somehow resurrect them through inclusion into a personal project; some kind of resistance is demanded.

Instead of brutal self-enforcement maxims, the new health requires the smooth integration of my immune system into a socioeconomic world system. Being asked to take responsibility is, when seen more clearly, a demand for the destruction of meaning and self. And this proposed self-assignment to a system that cannot be experienced stands in stark contrast to suicide. It demands self-extinction in a world hostile to death. Precisely because I also seek tolerance for suicide in a society which has become a-mortal, I must publicly expose the idealization of "healthy" self-integration. People cannot feel healthy; they can only enjoy their own functioning in the same way as they enjoy the use of their computer.

To demand that our children feel well in the world which we leave them is an insult to their dignity. Then to impose on them responsibility for the insult is a base act.

Indecent demand In many respects, the biological, demographic, and medical research focused on health during the last decade has shown that medical achievements only contributed in an insignificant way to the medically defined level of health in the population. Moreover, studies have found that even preventative medicine is of secondary importance in this respect. Further, we now see that a majority of these medical achievements are deceptive misnomers, actually doing nothing more than prolonging the suffering of madmen, cripples, old fools and monsters. Therefore, I find it reprehensible that the self-appointed health experts now emerge as caring monitors who, with their slogans, put the responsibility of suffering onto the sick themselves. In the last fifteen years, propaganda in favor of hypochondria has certainly led to a reduction in smoking and butter consumption among the rich, and to an increase in their jogging. It has also led to the fact that the U.S. now exports more tobacco, butter, and jogging shoes.

But throughout the world, propaganda for medically defined health coincided with an increase in misery for the majority of people. This is how one can summarize the argument of Banerji. He demonstrates how the importation of western thought undermined hygienic customs and solidified advancement of elites in India. Twenty years ago, Hakin Mohammed Said, the leader of the Pakistan Unani, spoke about medical sickening through the importation of a western concept of health. What concerned him was the corruption of the praxis of traditional Galenic physicians, not by western pharmacopeia so much as by a western concept of health which sees death as the enemy. This hostility to death (sic!) - which is to be internalized along with personal responsibility for health - is why I regard the slogan of health as indecent

Life as blasphemy. The art of the historian consists in the interpretation of traces and texts of those long dead. In the course of my life as a medieval historian, there has been a fundamental change in this task. Before a recent radical transformation - roughly, in actio and passio -- it was possible for the exegete to relate substantives and verbs to things and activities which lie within the circumference of his own sensed experience. After this radical transformation, that capacity was lost. This watershed, separating the historian from his object, becomes particularly clear when the experienced body is the subject of historical writing. Dr. Barbara Duden presents this convincingly in reference to body history in the experience of pregnancy. And I myself am made dizzy. How deeply the ways of speaking and experiencing have been altered in the last two decades!

In a very short time, the representation of the substantive concept "life" has prominently emerged. During the Vietnam War, there was still a body count of the enemy; only the lives of Americans were saved. But soon after it was taken for granted that something called "a life" begins and then ends. Around 1969, the quality of life suddenly became an issue. Immediately, the physician was required to take over responsibility for life. Biomedicine discovered its competence over "life."

Studying the history of well-being, the history of health, it is obvious that with the arrival of life and its quality - which was also called health - the thread which linked what is called health today with health in the past was broken. Health has become a scale on which one measures the fitness for living of an immune system. The conceptual reduction of a person to an immune system corresponds to the deceptive reduction of creation to a global system, Lovelock’s Gaia. And from this perspective, responsibility ends up being understood as the self-steering of an immune system. "Responsibility" is a word that, as a philosophical concept, only appeared in German around 1920. As much as I might like to rescue the word for future use, to be able to use it to characterize my actions and omissions, I cannot do it. And this is true, not primarily because through this slogan for self-regulation of one’s own "quality of life" meaning is extinguished, management transfigured into something beneficial, and politics reduced to feedback - but because God is thus blasphemed.

I ask you to pay careful attention to my form of expression. I am a Christian, but when I speak here about blaspheming God, I want to be understood as a historian and not as a theologian. I can only claim solidity for an argument constructed by a historian. I accepted the invitation to speak in order to contradict the opinion of many I know. I hope I do this respectfully, but I cannot mince words.

I have outlined my thinking. Longing for that which health and responsibility might have been in recently arrived modernity I leave to romantics and drop-outs. I consider it a perversion to use the names of high-sounding illusions which do not fit the world of computer and media for the internalization and embodiment of representations from systems and information theory. Further, I consider the renouncing of these fictions a real possibility. And I call the practice of this renunciation an epistemic askesis. I believe that an art of suffering appropriate to contemporary life can grow out of this askesis.

What is important to the argument is to understand that all the central concepts that I discuss here are of profoundly western origin: health and responsibility, life and askesis... and God. They were put in the world and became powerful through beliefs that took hundreds of years to come into being. Only if one understands the history of health and life in their historical interconnection is there a basis for the passion with which I call for the renunciation of "life." I completely agree with Dirk von Boetticher when he quotes T.S. Eliot:

Where is the Life we have lost in living?

Where is the wisdom we have lost in knowledge?

Where is the knowledge we have lost in information?

The cycles of Heaven in twenty centuries

Bring us farther from God and nearer to the Dust

Eliot here inquires about life pertaining to God, about the life of which Christ says in John 11:25 "I am the life."

Aristotle did not know about this. Aristotle knew living beings which were different from all other things because they had "psyche." He did not know "life." As an appearance in the world, only in the 18th century did life acquire that dominant and exclusive significance which gave it the character of its own answer, not from God, but from the world. Lamarck and Treviranus, who around 1800 founded biology as the "science of life" in a conscious turning away from the classifications of natural history, were quite aware of the fundamental newness of their object This life, which owes its origin and definitions to the world is, however, profoundly influenced by western Christianity, and can only be understood as a perversion of the tradition in which the God become flesh describes himself as life, and calls everyone to this life.

This is mystery. And every person who occupies himself seriously with almost two thousand years of history must admit that not only individual mystics but great cultures between Novgorod and Santiago de Compostella, between Uppsala and Montreal, have honored this mystery. This is simply historical reality, even for a historian who has no concept and no sense of what it means. And just as plain and unquestionable is the derivation of the biological concept of life from the Christian mystery. When seen in this way, the concept of a life which can be reduced to a survival phase of the immune system is not only a caricature, not only an idol, but a blasphemy. And seen in this light, desire for responsibility for the quality of this life is not only stupid or impertinent - it is a sin.

Translated by Jutta Mason, edited by Lee Hoinacki, from a talk in Hannover, Germany, September 14,1990

Against Health: An Interview with Ivan Illich

Question: "Taking Responsibility for Your Health" is the theme of this conference. Isn’t this in accord with your way of thinking?

Illich: I didn’t know what to think, because I hadn’t intended to come here. I told the conference organizers that I have one single response to "taking responsibility for one’s own health": a hearty "No thanks!"

Q: Why?

I: Health and responsibility are concepts from the 18th century. Health in the sense of the health of the people, in the sense of something desirable, begins around 1760,1770, at the same time as the concept of happiness, the happiness that is inscribed by the Americans in the Declaration of Independence. This is a materialization of the right to happiness around which entire professions were formed whose duty is the happiness or the health of the nation. But even if I make fan of this concept which stems from the Enlightenment, it still made some sense at the time of my birth, 64 years ago. I was also able to give it meaning when I wrote the book Medical Nemesis, which begins with the sentence, "The biggest threat to public health is the medical profession." If someone were to say that to me today, I would say, "Well, so what?"

Q: What’s changed?

I: We have been deluged with information about it: ozone hole, greenhouse effect, radiation, chemistry, overuse of antibiotics, the destruction of what one now calls the immune system, genetic impoverishment, urbanization. This is not a concept of health. It is adaptation to noise, adaptation to gluttony, adaptation to the rhythms we are living with - and, above all, adaptation to inner destruction.

Q: Describe this inner destruction.

I: A few days ago I was having dinner in Philadelphia with some friends. A French-Swiss Colleague, Robert, is there. He is speaking to Tracy, wanting to give her a second mug of good apple cider, and she says, "No, my system can’t take that much sugar at once. I could be thrown off balance." This woman, now 27, had been in an elementary school in which she had been confronted in the second grade with pictures of the muscles, the nerves and the endocrine system. She projected them into her own self. She does not only think of herself but she experiences herself as something that is turned on and off, something to be regulated, something totally unreal.

Q: In other words, all the concepts of medicine...

I:... are disembodied...

Q:... and alienate us from ourselves...

I:... because we take them from medicine. And I see in the slogan "Health is your own responsibility" a really malicious pedagogical intention which says to us: look at yourself and experience yourself in the perspective of the system-theories which we preach. We tell you that you area temporarily surviving little immune system in the womb of the world system of the goddess Gaia. She is life and you are a life! And we define life — like a snake that consumes its own tail - as the phenomenon that optimizes the chances for its own survival. This excites the Greens who march in the streets and the systems analysts who babble about control of the world and the gentlemen whom I’ve heard at this conference - they all talk the same nonsense that I saw a few days ago in Washington, where thousands of school children marched in the streets and cried, "We are against the greenhouse effect, we don’t want the ozone hole!"

Q: But who wants an ozone hole?

I: The point is we’ve got one! We have no alternative but to say: I renounce health. It’s terrible. I refuse to delude myself with the possibility of an Enlightenment-like concept. I know that no path will lead me back into the Indian yoga or into the Chinese notion of a heaven and earth that correspond to one another and into which I would dissolve. I admit my powerlessness and experience it profoundly. One cannot do this alone - for this, friendship, the old philia, is the basis - it won’t work without it. But renunciation is possible. Renunciation which is self-aware, critical, exercised with discipline and for which there was once a name - asceticism.

Q: That sounds very monastic?

I: Yes, I’d prefer another word. One thinks only of the "No, thank you" to wine, women and song. But that has nothing to do with asceticism as I mean it. It is much more challenging. It is a "No, thank you" to the certainties that our society is built on.

Q: For example?

I: Every era is like a firmament, with its conceptual fixed stars, under whose direction the ideas, but also the material experiences of the era come into existence. These basic concepts I call certainties, I should rather say assumptions which sound so obvious that no one examines them. My friends and I have made it our responsibility to write the history of the certainties of the modem era, systematically, carefully and scientifically - and one of these certainties is health.

Q: You once said that health is a plastic idea.

I: I adopted this term from my teacher and colleague, the linguist, Prof. Uwe Poerksen of Freiburg. He says that there is a new category of words, which we use ceaselessly. They don’t refer to anything precise, but they carry great significance and seif-importance with them. They are like stones which one throws into a lake, when one can’t see where they end up, but they make big waves all the same. He calls these words plastic words, or amoeba words. I believe that conversation in amoeba words is the reason for our difficulty in getting to the heart of the matter, for example, of my "No-to-health," of my demand for renunciation. It can either be called nonsense, and it is necessarily called that by most people, or it can be seen as vanity: where do you stand, when you pronounce such a renunciation? My point of comparison is historical. For example, in the 19th century "health" meant primarily fewer lice, fleas and mice, larger windows, bandages, access to doctors. Aspirin didn’t exist yet. In the medical practice of a doctor of that time - the historian Barbara Duden examined his notes - the word health hardly appears.

Q: What did people complain about then?

I: They were tired. Something has gone to their head. They hurt themselves. Their heart was broken .... I would go so far as to say that to propagate "Taking responsibility for your health" is politically insolent. It is asking people to look for something that they should know is not attainable.. I am disgusted by experts who can look back 30 or 40 years and know that world health has deteriorated incredibly in the last 20 years and wash their hands of it and beat up on the victims. I angers me that health refers nowadays to me as a system, as "a life." A crazy propaganda has been perpetrated by the concept that each of us is "a life."

The concept "a life" is a Christian-Western concept. It is Jesus’ answer to Martha: "Yes, I am the life." For 2000 years Christians have believed that to become one with him is to enter into life. This was the only life one knew. The inventors of biology the word comes into existence around 1801 or 1802 knew full well that they had created something new with their life-on-earth, for which there is now a science, biology. This life is increasingly presented as a system, a delicate immune system, to be treated with care, which should always be property kept in balance. To imagine health as "quality of life" is a further total dehumanization, a radical abstraction and to propagate it seems to me nonsensical, because it is a-sensual, but finally also because, given the Christian connection to this concept, it is even blasphemous.

And "responsibility" in a world in which one cannot even cast a ballot reasonably! In a world in which increasingly that which one earlier called "democratic freedom" has become symbolic conformity. In a world in which you are asked: what kind of birth do you want, c-section, vaginal or maybe even with a surrogate mother? In a world in which you are seemingly given a choice, but in which in reality you only endorse what a given profession has decided to do with you. To trumpet responsibility in such a world instead of saying: People, friends, we are powerless, we must accept our powerlessness to speak of one’s responsibility for one’s health publicly and normatively is profoundly annoying and offensive.

Q: You have sketched a depressing scenario. Do you also see a hope there?

I: Yes. And it is not only strong, it is also often fulfilled. This scenario of which I have spoken, in which we are very isolated if we seek and preserve meaning, is also an occasion for an intensity of friendship which would hardly be imaginable in a world of inherited ties, familiar culture, middle class values, wealth and security. This is my hope. Otherwise I have none.

Translated by Stephen Lehman
from the Berlin newspaper TAZ (23 October 1990)

Reflections on "Health as One's Own Responsibility"

Lee Hoinacki

In the last several years, Illich has begun to talk and write about askesis in higher education. To understand the sterility and confusion in the West’s institutions of higher learning, one can examine the division of reading which occurred in the 12th century. At that time, monastic reading was split into scholastic and spiritual reading, the former coming to characterize the universities, leading to what today is called "critical thought." Previously, Illich had asked for research into askesis in learning. In "Health," he calls for the convivial practice of askesis. Further, he maintains that to exercise this kind of disciplined "No" today, one needs friends. A striking feature of this piece, then, is the apparent distance between its "positions" and Illich’s previous writings. I shall note other instances of this below.

In earlier writings, he has said that modem certainties - the unexamined axioms on which the West rests - must be questioned and, in various books, tried to show how this can be done. Now, for the first time, he baldly states that the certainties must be renounced, and begins with a denial of health and responsibility. Of course, these are not the only modem certainties for Illich. But this is an appropriate place to start.

The renunciation of these certainties is necessary in order that one might be able critically to confront what Jacques Ellul some years ago called, la technique. This is the first time in his writings on industrial society that Illich explicitly takes up Ellul’s concept. In "Health," la technique is seen as the mode in which contemporary society is organized and managed, or rather controlled, as a system.

In The Technological Society, Ellul attempted to analyze modem society, and concluded that because of the necessary character of la technique, people could not hope to exercise control over their inventions. "Health," taking la technique to mean the set of interlocking and coordinated systems in which society is structured, proposes a similar assessment.

Looking around, Illich finds that people today are in a situation of utter powerlessness. Since this is true, no social or political action is any longer possible... it is too late - assuming that such action would be aimed at genuine change. All social action can only work to reinforce the existing systems. Indeed, the more sensible, more rational, more ethical - the better such action, the worse the result, for the action can only serve to give greater legitimacy to one or several of the systems in place. This will happen because of the character and power of the various contemporary systems.

And this occurs in spite of the fact that modem systems - as a form of order and control - lack legitimation in any traditional rite, image, or custom. They are newly constructed and in a constant process of being up-dated. Hence, reform initiatives - serious or frivolous - distractions, highly developed specializations, are all welcomed warmly. It appears impossible to find any activity which cannot be appropriated by one of our abstract systems.

In the past, human beings acted through ideas, war-making, law-giving, and social movements to change their respective societies. The insights of "Health" reveal that such is no longer possible. But although I find myself in a position of total helplessness, there remains something I can do: Say "No." And Illich clearly states the specific sense in which he must say "No." This is the situation of a person who accepts the possibility of blasphemy. And it is Illich’s position that blasphemy is the characteristic of contemporary society, that is, in its fundamental structure. Our world is built on blasphemy.

Blasphemy is to attribute something to God that does not pertain to the divine goodness, as the denial of that which does so pertain, usually accompanied by an attitude of contempt But that which is most properly constitutive of the modem project - the attempt to conceptualize and manipulate reality as a system - is just such an attribution and denial, colored by a peculiarly modem arrogance. This modem project attributes a systematic character to what is while denying its created nature.

Ultimately, blasphemy is a sin against faith. Through faith, what I see and feel I know to be creation. What I see as real exists only by participation, through faith I know that the world is only contingently. But the world in which I am placed today is an artificial world, "a manufactured reality ever further removed from creation." This construct, issuing from the inventiveness of human experts, denies creation. In a kind of final hubris, they wish to assume responsibility for what was traditionally understood as creation.

Formerly, whether people acted humbly or arrogantly, trustingly or fearfully, all accepted creation as a gift, as the primary gift, the original expression of the divine goodness. But the world viewed as a global system, with the human being seen as an immune system responsible for maintaining order, is to deity this ancient belief.

Aquinas teaches that blasphemy is the most serious sin because it attacks what basically establishes us in the world - through faith we place ourselves in creation. Illich holds that to live in blasphemy is to live in "a bottomless evil," a place where "elevated discussions of the atom, the ge.se, poison, health and growth" take place. Some years ago, when lu was invited to participate in such a discussion, he insisted on "the right to dignified silence/ and stood mute on a street comer in Germany to protest, by his "silent scream," the stationing of American missiles on German soil. His action was a step toward the unequivocal "No" about which he writes in "Health."

For the person of faith in today’s world, the very first question is: How shall I act, vis-S-vis the systems construct? This is precisely where the denial of faith occurs. Illich believes that one must begin with "No," with a renunciation - of health. This seems fitting, since health is often viewed as the unquestioned "good" of modernity. And modem medicine is said to produce miracles of healing. But, Illich claims, "the flood of poisons, radiations, goods and services which sicken humans and animals more than ever before" is a more accurate characterization of contemporary reality. Here also he is much more explicit than in his earlier writings.

In a strange irony of history, those things for which men and women in the labor movement fought and died must now be recognized as equivalent to deadly poison and radiation. But this can seem a terribly extreme judgment. How is it to be understood?

Today, the planning, production and delivery of goods and services is accomplished in systemic terms. This means, ultimately, the infliction of a new kind of sickness, something far beyond anything previously seen or imagined in history. The contemporary project is nothing less than to structure society in such a way that no human act is possible.

In the West, we have come to see that a human act is one in which a person, recognizing alternatives, chooses one over another. But this is precisely what cannot be done if one lives in a system. For example, during a recent visit to Germany, I was startled to discover that in places where the public has access almost every door had been fitted with an apparently simple and innocent device: an electronic eye which automatically opens and closes the door. For me it was immediately evident that this is an image which truly illustrates the structure of modem society. One can no longer choose to open the door for someone burdened with packages. One can no longer carefully and quietly close a door, or thoughtlessly - perhaps deliberately - slam it in another’s face. One can no longer thank a stranger for courteously holding the door. In a word, one can no longer practice virtue - the comeliness and joy of living have been removed.

The world of interlocking systems - always being multiplied and perfected - annihilates the moral beauty formerly shining out from lives illumined by the life-long practice of justice, fortitude, temperance and prudence. Such a mode of living no longer appears possible. The world of systems immerses one in "a bottomless evil" because its structure of society is such that it eliminates the setting in which one can love another. In place of opportunities to create beauty and experience joy, one is locked into the delivery of goods and services. All that which is supposed to establish a high quality of life actually sickens one to death.

Why is it that so few have said so little about these matters? - if the situation is as Illich claims. One might begin to answer by suggesting that our world is, indeed, as it is described by Alasdair MacIntyre at the beginning of After Virtue. Historically, we may have lost the ability to make moral judgments, to recognize ugliness. Further, Illich’s discussion of reading in the 12th century can help one to see the situation. Prior to the division into two kinds of reading - scholastic and spiritual - one simply entered the book in the act of reading, and the book entered the reader. There occurred a real transformation in one’s being, taking place over a lifetime, and made possible through the discipline of a continual askesis. The various ascetic disciplines, developed over centuries, were designed to enable one to read in this way, namely, to be transformed through the reading with the result that one came to see - in charity. Over and over again in the medieval texts one meets the concept, lumen light. One was not the same person, before and after the act of reading. And the text was one of substance, eminently suited to invite a person to be incorporated into it.

Over the centuries the scholastic mode of reading - in which one could imagine an abstract text independent of both the page and oneself - developed into a kind of lifeless intellectual critique which, in its most extreme form today, finds its ultimate end in the critique, not in the original text, nor in the person of the reader. Contemporary academic specialization distracts one from seeing the world as it is. But contemporary reading vitiates the very act of seeing, that is, seeing as occurred in monastic reading. It is not surprising, then, that the character of our age is recognized, not by academic philosophy, but by those inspired by poetic imagination - persons such as Czeslaw Milosz, Flannery O’Connor, T. S. Eliot, and Mark Rothko. And it seems quite fitting that Illich, sometimes called a philosopher, does not express himself in the logical arguments generally found in philosophical discourse, but finds his own voice in stories and images.

In "Health" there is scant systematic progression of thought; one might have trouble tracing the line of the argument. He proceeds here and elsewhere — in a manner similar to what occurs when one is under the influence of the Gifts of the Holy Spirit, here, specifically, the gift of understanding (donum intellectus). Through this gift, one knows through the apprehension of spiritual goods, subtly penetrating their intimate character. With a clarity of vision, one simply sees... what is there, having first sensed some of the outward aspects. According to Aquinas, the gift is opposed to blindness of mind and dullness of sense. These obstacles originate in the distractions resulting from the sensual delights of venereal and food/drink pleasures, respectively. Today, however, I think that additional, powerful, distractions are also at work.

Why, for example, do so few intellectuals - secular or religious seem capable of penetrating the darknesses of our age? I strongly suspect that the luxuria and gula of the middle ages do not nearly exhaust contemporary obstructions to seeing. Traditionally, two areas of experience contributed to the sharpening of one’s intellectual vision: the very precariousness of existence and the various ascetical exercises practiced throughout one’s lifetime in order to purify the external and internal senses. Contemporary religious and secular academics are the most protected and privileged persons in society. They are the ones who most benefit from the securities and perquisites which the various social systems offer. And they seem to be singularly unaware of the need for a moral askesis, that is, the complex of disciplines traditionally designed to affect and transform various aspects of one’s being and faculties or powers with a view toward reaching a clear vision, a pure insight In this sense one can recognize that the goods and services of modernity are a poison, sickening one, making one blind.

Now one can focus Illich’s call for an askesis beginning with a renunciation of the principal illusion, health, that is, survival in a technical system. And such a renunciation can lead one toward the reality of precariousness. The world today is drearily lacking in the sensuality known to the middle ages, but inundated with the abstract fictions of disembodied systems. If one wants to see, it is necessary to free oneself from these systems. Further, faith in these institutionalized guarantees is yet another form of the current blasphemy. In this sense, blasphemy is the source of the darkness in which we stumble.

There is a final point, the most important one in Illich’s call, and here it is clear that he proceeds according to insight or gifted vision, not according to discursive argument. This occurs in the discussion of Life... and... life.

The founders of biology sensed something which they believed could be the subject of their science. They named this "life," a concept available to them in their culture, They did not create their subject ex nihilo. And they had to give their subject meaning from this world, for they wished to found a science, a discipline of this world. But, over the years the subject became more and more abstract, totally removed from soil and slime, indeed, finally removed from creation. Their "life" came to get its meaning only from the internal demands of a system today, of an immune system. And this transformation, from a divine gift to a man-made abstraction, constitutes the principal blasphemy of the age.