The Rivers North of the Future: The Testament of Ivan Illich

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Please note: there is only one story and only one point; but these two entities, being reciprocally like the whole and the part, are never coextensive. However, the assumption of an anti-institutional attitude and the choice in favour of powerlessness are explicit in both cases, which has not always been captured by the activistic audience of the Illichan word. In fact institution is refused by Illich as aimed at nothing but power; and power is by its very nature counter-productive , as aimed at itself, at its own maintenance and growth, which, once beyond some critical thresholds, cannot but enter into collision with the goal it claims to be the means to.

Fortunately, the powerless are always with us — they are, as the old comforted Illich will say, the great majority of mankind contemporaneous with us. Moreover, we are required to put forward context-related reasons for the evolution of Illichian thought.

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And we could go even further, in badly lit territories, placed on the crossroads between history and psychology. A fissure to reach these recesses is opened by the letter to Hellmuth Becker, which served ten years later as an introibo to the funeral of Illich himself. That world has passed, into which our generation was born. Not only to the young but also for us, the old, it has become incomprehensible, impalpable. The old have always remembered better times, but that is no excuse for us, who were alive during the regimes of Stalin, Roosevelt, Hitler and Franco, to forget the farewell to the world we lived through [ We old ones belong to the generation of pioneers of that non-sense.

We are the last of that generation who helped to transform the systems of development, communication and services into a worldwide need. Shouldn't we at least wait for him to dramatically get in contact with the earth again, for an ultimate face-to-face encounter?

Perhaps on a sheltered patch of earth. As a historian and philosopher Illich is, in the '80s, most promptly a protagonist of the debate on Modernity, which rose up at sunset, when a famous report by Lyotard to the government of Quebec had already filled out the death certificate. For Illich it consists in a knowledge that proceeds from a revelation. It is the news, received by faith, of an original fracture that makes all the following ones possible, assigns them a sense, allows them to be judged: the Incarnation of the Word.

It has a beginning. It is not by chance if the core of the Gospel seems to him to be the crucifixion, intended not as the restorative sacrifice of a perturbed order, but on the contrary: the elevation of Jesus, his exclusion from the earth and the community, from the ethnos and from its ethos — the break of every order and the imitatio of this anarchic as well as tightrope-walker Christ is probably the secret cipher of his spiritual biography.

Desecration and liberation : this is precisely Illich's Gospel, and here lie the roots of the extraordinary seriousness of existence the way he perceives it at the light of Incarnation — one eye on the Guardini of his graduation thesis, the other on the Bonhoeffer of his own maturity. In fact, on the contrary, those speculations seem to be reparative and belated, suggested more from the urgency of understanding how and why the evangelical message failed in Western History, when by that time the triumph of technique had shown an enigmatic hetero-genesis of ends at work.

His topic was rather the invisible in Mary's womb, and the whole horizon of human history in all its dimensions, in their reciprocal relationship. It is not the free, gratuitous convenientia in the relationship with the transcendent as well as among human beings, on the model of incarnation of the Word, that Illich recognizes but, on the contrary, the radical breakdown of every proportio. So that contemporary reality seems summarizable in him by the image of the blind techno-bureaucratic power directly commensurated with the quivering flesh of the Haftling , this latter deprived of everything and ready to receive, with the serial number, the seal of an accomplished subsumption into the system.

Hence a tactical retreat, in Illich's late anti-modern preaching, almost with the intent to restore the mechanisms and the structure of classical soteriology, in whose language, notwithstanding, the problem he poses can't actually be formulated, and the mysterium iniquitatis is found to be still intact in the provocative quality of its primeval appearance.

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How indeed is the counter-productivity of a gift of grace to be conceived? How is a history of salvation to be told, when at the end of modernity it results in the specularly opposite outcome — the anti-christian one — with respect to the evangelical promises? It is the Church that Illich indicts for treason: partly the Constantinian Church, then mostly the Gregorian one, finally the Tridentine one and last but not least the contemporary one, pre- as well as post-conciliar — recognizing in it the nest from which the Antichrist took his conquering flight.

Nevertheless, having repeated this once again, we are certainly not at the solution of the mysterium , as it is evident for Illich too, but only in the presence of a different and more internal facies of it. Ivan Illich, social critic and philosopher, was at the forefront of arguing for a collective health approach and challenging medical hegemony.

His theories of institutional counter-productivity, proportionality and his critique of the medical model which he argued was entrenched within an economics of scarcity are as relevant today as they were at their height of popularity, in the s. Applying his analysis to current trends in health approaches I conclude, as did he, that beyond a certain institutional scale or intensity more medicine is making us sicker.

Therefore public health requires a dramatic shift away from a focus on individual deficits, lifestyle diseases, behaviour change and health promotion approaches towards genuine community building and significant political investment in the health creation of local communities. Moreover, there is need for more resolute regulation of the marketplace to prevent the health-harming behaviours of industrial and other institutional interests, including public sector and third sector organisations engaged in institutional overreach..

Public health is not solely a medical issue; it is primarily a social and political one. I acknowledge that this is not a commonly held perspective, but I wish to challenge the enduring assumption that better medicine equals better health. In support of this challenge I will revisit the thinking of a well-known philosopher and critic of the medical system: Ivan Illich.. Ivan Illich was a historian, and critic of contemporary institutions.

His iconoclastic views enjoyed wide public interest in the s and 70s, his popularity waned in the s, and his interest shifted from direct critiques of institutional hegemony, towards medieval history and its influence on the modern world.. In Illich's assessment, the existing medical paradigm suffers from three structural flaws, they are: 1 institutional counter-productivity; 2 lack of proportionality; and 3 the economics of scarcity. The principle of institutional counter-productivity acknowledges that beyond a certain scale or intensity, institutional responses to health and other societal challenges displays a form of what the medical community refers to as iatrogenesis physician or medicine induced harm , where the opposite of what was intended is created.

It is Illich's simple claim that beyond a certain scale or intensity, not alone can care not be sustained by institutions, but that harm can be caused by their effort to help. The iatrogenic phase occurs at the point when Illich's scale or intensity is exceeded; the iatrogenic phase is preceded by two other phases, the first phase occurs in the early life of an institution when it is small in scale, and is marked by a period of modest productivity..

In the second-phase, as the organization grows beyond a certain threshold, its productivity begins to level-off, during which time there will typically be a neutral-impact, which is to say institutions are neither helpful nor harmful; they are in effect non-productive, relative to intended outputs..

Notwithstanding such harm can be anticipated and potentially mitigated against, by committing to small, localized and proportionate solutions that begin outside institutional systems in the civic realm. Illich's critique was not confined to medicine-induced harm to health; he challenged similar trends in other institutions devoted to improvement and development: in Deschooling Society he contended that schools can become places that stupefy their pupils, functioning more like factories than families: and in Disabling Professions he described how prisons, erstwhile centers of behavioral reform became academies of crime.

In one of his most influential pamphlets, on the expropriation of health, Medical Nemesis, he contends hospitals that claim sole dominion over health, at worst accelerate the demise of the sick, and at best create disabling factors that slow up recovery. Rather his pamphlets challenged attempts on the part of institutions to monopolize functions related to the production of health and well-being, death, safety, wisdom and justice.

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Since, he contended, these social goods were not commodities unilaterally produced by institutional systems and thereafter consumed by individuals. He contended that an institutional inversion had taken hold in modern societies, through which the community role becomes that which is left after the institutions and their professional helpers have done what they think they can do better or more expertly. Illich contested this inversion, and argued for its reversal whereby the institutional and professional role should be defined as being that which is left after the community has done what it can and wants to do..

Increasingly industrialised countries are recognising that loneliness poses as significant public health challenge to respective populations. In seeming disregard of the evidence of impact of community oriented public health approaches, the investment priorities around the world are still largely, some would argue disproportionately, directed toward acute medical care; not preventive approaches.. According to Illich, institutions, rather than supporting social capital, through managerialism and professional overreach tend to inadvertently undermine, displace and eclipse the associational capacities of citizens, eventually rendering them individualized, passive and dependent on acute forms of intervention.

Hence as specialisation and technocracy becomes more dominant and domineering, citizenship retreats in the face of the ever-increasing professionalization of civic functions including the function of health production.

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  5. Mindful of the afore-mentioned dangers, for Illich, all institutional progress should be contingent on understanding the limits of institutional reach and the potential dangers of overreach.. Another of his theories relates to proportionality, which essentially addresses the question of how local, home based communities and institutions can get in right relationship with each other.

    While this concept is important, it is not as significant as institutional counter-productivity. Notwithstanding, proportionality features strongly in Illich's thinking —when combined with his insights on institutional overreach— and provides a powerful theoretical lens through which to further consider the question: does more medicine make us sicker?. Illich did not believe that proportionality could be attained through institutional reform, rather he saw the key pivot point for authentic progress as residing within civic life, beyond the limits of the institutional world.

    He believed that if we could restore or reclaim the commons that this would foreground a cultural revolution, which in turn would push back against the overreach of institutions, resulting in more proportionate and democratic relationships between citizens and institutions. Examples of the sort of proportionality that Illich was advocating for are uncommon, yet they do exist, and one of the finest examples comes in the guise of Dr.

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    5. Robert Mendelsohn. Robert Mendelsohn, was a self-proclaimed medical heretic. They are simply making a different, new set of mistakes. Following such realisations regarding the iatrogenic effects of some of his interventions, Mendelsohn came to understand that his primary role as a health practitioner was to ensure he did nothing to displace the health producing capacities of the people he served and that of their home or natural communities and personal networks..

      He also understood and skillfully used the power he had as a nationally respected pediatrician in protecting the health producing capacities of local communities.

      The Rivers North of the Future: The Testament of Ivan Illich

      He supported the movement by engaging in rear guard action against the naysayers in the formal healthcare systems, both as a medical authenticator of the health producing capacity of breastfeeding, and as the chief heckler of anyone from the medical fraternities who attempted to undermine or devalue the efforts of this mother-led, lay person movement.. Here he illustrated that the core functions of a community-friendly doctor are: a proscription: do no harm; and b ethical medical prescription.. While these two domains are co-terminus, they are fundamentally different, and perform different functions when it comes to learning, justice, safety, and wellbeing.

      Some social policies and the institutions that implement them, demonstrate understanding and respect for these differences, and work to keep the two domains in right relationship with each other, but most do not.. Notwithstanding at a macro level the state has a wider role to play in minding the gap between the civic realm and the sometimes, predatory interests of the marketplace that cause so much illness.

      Gabriel Scally, in his recent paper Whose behaviour needs to change? There is an urgent need to return public health back to its origins, toward the commons, and away from the clinical, individualistic, behavior change and lifestyle choice narratives, that tends to place the blame for health maladies on individuals. A fresh narrative is needed that once again places the emphasis on collective health and political change. Doing so is not just about mobilising communities at the grassroots level through effective community building processes, but also ensuring that state support and investment some of which needs to be repatriated from downstream acute interventions toward up-stream preventative work forms a dome of protection around communities, protecting them from the overreach of predatory market forces but also from any institutional counter-productivity emanating from some public sector or third sector interventions..

      As noted above not all institutional advocates respect the integrity of the community domain, their primary agenda being to treat perceived problems with institutional solutions; not to precipitate and defend community capacities. Order by , and we can deliver your NextDay items by. In your cart, save the other item s for later in order to get NextDay delivery. We moved your item s to Saved for Later. There was a problem with saving your item s for later. You can go to cart and save for later there. Average rating: 0 out of 5 stars, based on 0 reviews Write a review.


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