A Saved Life
A seventy-year-old woman whose tongue, part of her throat, and jaw were amputated scribbles hastily on an electronic pad: “Bad news. I am in a situation of life and death... I will have to have radiation.” She has been on a liquid diet since 2015. It is 2022. She just had another round of surgeries to reconstruct her jaw. The tissues in the surgical site died and got infected. She does not hear well nor can speak. Her only hope is to have a sip of ice tea. She cannot. Surgeons guard their work.1
What does it mean to save a life?
Disease In Vacuum
Jaw tumors are relatively rare growths or lesions that develop in the jawbone or the soft tissues in the mouth and face. These growths are usually benign (noncancerous), but they can be aggressive and expand, displace or destroy the surrounding bone, tissue, and teeth. Many times, jaw tumors do not have symptoms and are typically discovered on routine screening X-rays done for other reasons. Treatment options for jaw tumors vary, depending on the type of growth or lesion you have, the stage of growth, and your symptoms. Mouth, jaw, and face surgeons can treat your jaw tumor. If you are diagnosed with or suspected of having a jaw tumor, your primary care provider can refer you to a specialist for diagnosis and treatment.2
Man who finds a lump growing on his jaw faces many difficult questions. The questions the man asks depend upon who the man is, what kind of people he comes from, what kind of culture and tradition he embodies (lives out in daily habits and actions in the flesh).3 The very moment the man is divorced from the lump on his jaw by the ritual of diagnosis, the lump acquires a life of its own. A philosophical entity of diagnosis emerges with the intent to match a treatment to it. Medical researchers come up with optimal treatments through statistical method of research that evaluates arbitrary outcomes in a population with this diagnosis.4 A physician who attends to a suffering man in a measured proportion within reason and limit to relieve suffering without inflicting harm is not a physician who calculates the benefit and risks of therapy tethered to a statistical outcome of treating a population of diagnoses.
Ivan Illich was a contradictory figure - a sophisticated and quintessentially modern man who wanted to be “a remainder of the past”, a highly educated apostle of deschooling, a jet-setter who advocated limits to speed, an aristocrat who tried to revive the vernacular, and a subtle intellectual who preached simple faith. Illich was a Christian, a man deeply imbued with the traditions of the Church. Among these, the most important is that derived from Scripture.
The pain he suffered from his lump made him acutely aware of his body… he could never forget it. Because of the heightened experience of his own body, he may have sensed an essential truth, a truth needed by every believer: I too needed to feel my body in order to believe in Christ’s body. Every artifact that removes me from an available sensation of direct touch, seeing, hearing, tasting, and smelling must be regarded with suspicion; it might be dangerous in a hidden way difficult to discern. As a Christian, needing the physical experience of my body, I can never know when I cross the threshold dividing my self from my body, leaving me a helpless time-bound hypothesis. According to one tradition, my self, made up of body, soul, and spirit, is a composite, not a unified whole. Only God is simple, not made up of parts; everything in creation is a composite. If through technological artifacts I have become disembodied, that is effectively losing my body, I am left as an abstraction but am still absolutely mortal. The immortality of a Christian rests on belief in the resurrection of the body. Without sensing the reality of one’s body, the believer exists only as a rational subject doomed to despair.
Antiquity knew no yardstick for disease
The French Revolution gave birth to two great myths: one, that physicians could replace the clergy; the other, that with political change society would return to a state of original health. Sickness became a public affair. In the name of progress, it has now ceased to be the concern of those who are ill.
For several months in 1792, the National Assembly in Paris tried to decide how to replace those physicians who profited from care of the sick with a therapeutic bureaucracy designed to manage an evil that was destined to disappear with the advent of equality, freedom, and fraternity. The new priesthood was to be financed by funds expropriated from the Church. It was to guide the nation in a militant conversion to healthy living which would make medical sick-care less necessary. Each family would again be able to take care of its members, and each village to provide for the sick who were without relatives. A national health service would be in charge of health care and would supervise the enactment of dietary laws and of statutes compelling citizens to use their new freedoms for frugal living and wholesome pleasures. Medical officers would supervise the compliance of the citizenry, and medical magistrates would preside over health tribunals to guard against charlatans and exploiters.
In the public rhetoric of the 1790s, the idea of using biomedical interventions on people or on their environment was totally absent. Only with the Restoration was the task of eliminating sickness turned over to the medical profession. After the Congress of Vienna, hospitals proliferated and medical schools boomed. So did the discovery of diseases. Illness was still primarily nontechnical. In 1770, general practice knew of little besides the plague and the pox, but by 1860 even the ordinary citizen recognized the medical names of a dozen diseases. The sudden emergence of the doctor as savior and miracle worker was due not to the proven efficacy of new techniques but to the need for a magical ritual that would lend credibility to a pursuit at which a political revolution had failed. If "sickness" and "health" were to lay claim to public resources, then these concepts had to be made operational. Ailments had to be turned into objective diseases that infested mankind, could be transplanted and cultivated in the laboratory, and could be fitted into wards, records, budgets, and museums. Disease was thus accommodated to administrative management; one branch of the elite was entrusted by the dominant class with autonomy in its control and elimination. The object of medical treatment was defined by a new, though submerged, political ideology and acquired the status of an entity that existed quite separately from both doctor and patient.
We tend to forget how recently disease entities were born. In the mid-nineteenth century, a saying attributed to Hippocrates was still quoted with approval: "You can discover no weight, no form nor calculation to which to refer your judgment of health and sickness. In the medical arts there exists no certainty except in the physician's senses." Sickness was still personal suffering in the mirror of the doctor's vision. The transformation of this medical portrait into a clinical entity represents an event in medicine that corresponds to the achievement of Copernicus in astronomy: man was catapulted and estranged from the center of his universe. Job became Prometheus.5
It is not a successfully treated jaw tumor that cries. A seventy-year-old man weeps when he sees himself after a jaw surgery in the mirror. When part of your jaw, mouth, or tongue are cut out “to treat jaw tumor”, you (not the tumor!) may not be able to breathe, talk, eat, or drink. Your head will hurt and ooze blood and gunk from the remaining wounds. “People don’t know what they sign up for...”6
It is incomprehensible today that it is not a tumor that stands before you. A pathology report in front of you is not a suffering man. Somewhere between a growing facial lump or the abnormal cells in a pathology report there is man. If he does not stand in front of you, imagine him. Better yet, locate him and stand before him. Look into his eyes. Do you see any tumors there?
It is equally incomprehensible that “life”, in the common sense meaning of this word, takes place now. Not in the prognosis. Not in the statistics that captured the past. Not in life-years not lost. “Life” is not years. “Life” is not in the future. “Life” is not a wavy line accompanied by a beep on a monitor. “Life” is living. It means man breathes, walks, eats, drinks, laughs, and does sensible and foolish things that make up his life. Exuberant mischief! You can write a story about your life. Not a medical history.7
“Saving a life” is a chimera, a monstrous slogan made up from different parts of sacred text interpretations, religious law unrelated to medicine, piggy-backed onto the political arithmetic of fiscally prudent population management, wrapped in an explosive mixture of greater good amidst evil, benefit, risk, prognosis, diagnosis, duty, and zeal for heroic action.8 The idea of “saving a life” plugged into algorithmic workings of “health-care” (or is it life-care?) gives out an unambiguous imperative “cut the tumor out”/”do not cut the tumor out”. We forgot it was man that we cut.
The insanity of modern medical practice does not come to light until you witness how abstract concepts, theories, and calculations materialize in the reality of what happens to man when we apply those to him. The beginning of a journey is a question. What is good to do here and now for this man that stands before us, in whose eyes we are looking? The question that creates a boundary for this deliberation is another question - what is truth? How does truth come to be?9 How does truth guide us to do good here and now?
Whole To Be Healed
The reality of the two stories outlined in the polls above are in reverse to the majority opinion about the appropriate course of action. Why? The second of the two questions in the poll refers to the story of Ivan Illich, who developed a growth on the side of his face some time in the early 1980s. It is common knowledge that he decided to avoid being diagnosed with a disease, much to the modern incomprehension of what seems to be a sign of un-reason.10
Medical Nemesis goes too far, as is often the case with Illich. Modern medicine obviously saves lives. Most would prefer, say, to have a tumor professionally removed than to leave it untreated—as Illich did with a growth on his cheek that first appeared in 1980, and that left him so pain-wracked late in life that he started smoking raw opium to ease the agony.11
The story of Ivan Illich is complete. He lived a good life until he died peacefully at home. Saved. “God gave him a beautiful death.”12If we were to remove the legal and professional structure that governs the practice of modern medicine, the compulsion to diagnose a disease to deliver treatment becomes questionable. If you were to face the man Ivan Illich was, to look him in the eyes, it would become a compulsion to ask the question “what is good for this man”, not “what algorithm must I follow to fulfill the fantasy of my own salvation?”
Ivan Illich saved a physician from making a grave error to diagnose a disease, to treat it, and leave Ivan Illich to suffer in the wreckage of it all, as a transformed man he was not. His story reveals what it means to live as a man unlike any other, what it means to feel, and the meaning of living. The meaning of “a saved life” is essential to understanding Ivan Illich’s story. It is not the preservation of physical existence, freedom from “disease”, or anesthesia from any feeling. Ivan Illich’s understanding of what it meant to be healthy as whole or holy was not in line with the modern definition of health as the absence of disease as evidenced by a clean body scan.13
What an onlooking physician saw as a potential malignancy to diagnose, for Ivan Illich was a gift and an act of grace albeit painful one. To diagnose him would be a violation of his wholeness/health as a man who feared the Lord passing him by; who said “to hell with the future; it is a man-eating idol” and “I do not care about health”; who knew “only one way of transforming us, us meaning always those I can touch and come close to, and that deep enjoyment of being here alive at this moment, and a mutual admonition to do it - please, do not misunderstand me, I am not a touchy-feely man - in the most naked way possible - nudum Christum sequere, nakedly following the naked Christ, which was the ideal of the medieval monks whom I read’;14 who praised his own sobria inebritas (drunken sobriety) and joyful austerity; whose "only hope for the life which I'm seeking rests upon rejection of sentimentality and openness to surprise", "to have a sarcastic readiness for all surprises, including the ultimate surprise of death."15
Yes, we suffer pain, we become ill, we die. But we also hope, laugh, celebrate; we know the joy of caring for one another; often we are healed and we recover by many means. We do not have to pursue the flattening-out of human experience. I invite all to shift their gaze, their thoughts, from worrying about health care to cultivating the art of living. And, today with equal importance, the art of suffering, the art of dying.16
***
Illich came to respect one Unani practitioner, Hakim Said Mohammed. After examining Illich, he told him that the still small bump was a part of him, it belonged to his person. If he were to do something about it, he would throw himself out of balance. […] Illich had always placed importance on achieving and maintaining balance, and towards the end of his life concentrated more and more on the idea of balance contained in the notion of proportion. Interested in the history of medicine, Illich pointed out that “hakim” means one person who is a scientist, philosopher, and healer.
Diagnosed To Be Cured
The full meaning of what it means to live as a whole/holy/hale/healed/healthy man becomes visible in the obvious absurdity of the first question. The family of a 70-year-old male in a vegetative state, status post anoxic brain injury, secondary to successful resuscitation for respiratory distress and subsequent cardiac arrest, following an administration of an opioid analgesic post successful surgery, receives a diagnosis of an unspecified jaw cancer.17 It is obvious to some of the family that the patient must receive treatment for cancer to save his life despite the recommendation of every physician. A father, not a patient, is alive. He has a tracheostomy, and receives feeding through the tube in his stomach. All the usual concerns of the suffering that follow a jaw surgery are thus removed. The patient is in the state of preparedness to be saved because all the necessary devices are already in place. Since the patient himself cannot communicate nor is in any perceptible suffering from the jaw tumor, it is a family member that becomes the medium for paranormal communication with the patient.
The way a man is transformed into a diseased body by the application of diagnostic techniques, makes it logical to treat an abstract diagnosis of cancer. To withhold treatment, based on the rational evaluation of prognosis, becomes unethical because this man is alive thus a life. A life must be saved. Medicine saves lives. If we do not administer treatment, a life will be lost. Misapplication of religious discernment within the context of medicine cannot be based on statistical prognosis. Truth resides here and now. A life is a life thus treatment of this patient is morally imperative. Poor prognosis anchored to financial sense does not factor into it. It is the probability of a statistical salvation that matters. The obvious cruelty of cutting up a patient who does not suffer from a diagnosis is turned topsy-turvy. It becomes cruel not to treat a diagnosis.
Whom or What?
The stories of Ivan Illich and a nameless male illuminate the tragedy of modern medicine. A physician does not attend to the truth of a suffering man but occupies himself with a diagnosis and treatment of a discovered disease. Self perception of a patient's own suffering is replaced by a technologically imaged and measured disease. Treatment becomes a mechanical application of a technique to a universal, un-sensed by a physician or patient, un-felt, theoretically constructed malfunctioning, abstract body. Or worse - a diagnosis, a disease outside of any body. The nameless patient had lost his body to a diagnosis. The suffering flesh of Ivan Illich was not a disease in the pathology report.
Deliberation to diagnose and treat in both cases happens in relation to man’s (or their caregiver’s) understanding of self, body, suffering, life, and the purpose of medicine. In both cases, reality bears out abstract concepts into practice. Ivan Illich goes on to live another two decades until he dies peacefully. The family of the nameless male finds a surgeon to cure the man of a diagnosis.
What is truth?18
-You have a lot on your plate. -God fills my plate and for that I am grateful.
In the process of diagnosis, man is transformed. Your life as you know it will never be the same. You are drawn into a way of being that is guided by a diagnosis towards some outcome. The outcome is usually a metric, an abstract idea. There is a discrepancy between common sense understanding of words and how this word takes shape as a number in statistics. What you think of being alive is not the same as a saved statistical life. What you imagine as the usual way of living, in reality, can be existence in a hospital as a project to be fixed that never leaves the hospital. What does it mean to live? How is suffering from illness different from suffering from a treated diagnosed disease?
Mayo Clinic. Jaw tumors and cysts. Accessed January 21, 2023. (redacted).
The language of this excerpt from a medical website is devoid of emotion and presents a tumor as a technical problem in need of a solution. It appears “fixable”. Notice the existence of the diagnosis outside of any body. In academic literature this transformation of a suffering or non-suffering some-body is called disembodiment. Where do diseases come from? Are they value-free, natural phenomena to be discovered in the world out there, or are they man-made, value-laden artifacts? Ivan Illich maintained that the practice of allopathic medicine did not lead to the truth of what occurs in some-body. That body was not a constant entity in the feeling sense of it. A body is a subjective experience, an incarnated historical moment. How a body is felt by you is connected to some ideas about a body, health, illness, and disease specific to where you are now and some history of yours. It means that the way you perceive yourself as a feeling or imagined body is not the same as another man at a different place at a different time. Today, man in the West in an incarnated book of anatomy and physiology.
The way modern knowledge of a body is constructed flattens out how we feel. It explains why most of the elderly Americans felt compelled to be vaccinated while the majority of the elderly in Ukraine did not. In the imagination of a utilitarian Master of Public Health, who shall remain unnamed, all the old people are the same and must be vaccinated.
Barbara Duden. The Quest for Past Somatics. In Lee Hoinacki and Carl Mitcham. (2002). The Challenges of Ivan Illich.
Illich I. Death undefeated. BMJ. 1995 Dec 23-30;311(7021):1652-3. doi: 10.1136/bmj.311.7021.1652.
Willemijn Ruberg.(2020). History of the Body.
What kind of treatment do I need to pursue to live as long as I can? How do I want to live now that I have this lump? There are two different questions. The former is most common in the west, the latter almost never occurs to anyone.
Most common outcome is survival (that is not necessarily how long you will live, but can be defined as living for five years from the time of diagnosis). It tells you nothing about the way you lived these five years.
Ivan Illich. (1975). Medical Nemesis. Chapter 4.
Sickness was still personal suffering in the mirror of the doctor's vision.
Medical historians, sociologists, anthropologists, and philosophers study the phenomenon of disease diagnosis.
Ivan Illich. Translated by Antonio Cerella. (2017). The Obsession with Perfect Health. Journal For Cultural Research, 21:3, 286-291.
Street, A., & Kelly, A. (2021). Introduction: Diagnostics, Medical Testing, and Value in Medical Anthropology. Medicine Anthropology Theory, 8(2), 1-16. https://doi.org/10.17157/mat.8.2.6516
Kazem Sadegh-Zadeh. (2015). Handbook of Analytic Philosophy of Medicine.
John Coggon. (2012). What Makes Health Public? A critical evaluation of moral, legal, and political claims in public health.
Elizabeth Fee. (2016). Disease and Discovery. A History of the Johns Hopkins School of Hygiene and Public Health, 1916–1939.
A quote of a colleague of mine upon contemplating the suffering of one of the patients. Many patients think or imagine they will be restored to some original health they enjoyed before diagnosis. They do not fathom that they could end up in a state worse than before diagnosis and/or treatment. Often, it is not explicitly spelled out. People do not understand words well and have poor imagination. It would be more merciful to show rather than tell.
For Ivan Illich’s critique of the preoccupation with “life” unrelated to the reality of a living man see
Ivan Illich.(1992). The Institutional Construction of a New Fetish: Human Life. In the Mirror of the Past. Lectures and Addresses 1978-1990.
Ivan Illich. (1992). Life as Idol.
The meaning of “saving a life” can be anything from not killing someone, not sentencing someone to die for a crime they committed, or preserving the bodily integrity or function of a body by the means of medical treatment. Saving a life within the context of a faith will take on a meaning different from a secular context of science, public health, medicine, law, war, or politics. What it means to be saved as man or a body is different. A slogan is a political tool that is unrelated to any man. Blind indiscriminate application of a slogan in the absence of any other directional striving or boundaries, taken out of its proper context, leads to cruelty. “Good taken to a limitless extreme reveals the mystery of evil.”
The William Davidson Talmud. Sanhedrin 37a.
King James Bible. Luke 9:23-25.
Giorgio Agamben. (1998). Homo Sacer. Sovereign Power and Bare Life.
Ulrich Beck.(1992). Risk Society.
Theodor M.Porter.(2020). The Rise of Statistical Thinking, 1820–1900.
Samuel, S., Dirsmith, M. W., & McElroy, B. (2005). Monetized medicine: from the physical to the fiscal. Accounting, Organizations and Society, 30(3), 249–278. doi:10.1016/j.aos.2004.02.001
Jacob Stegenga. (2017). Medical Nihilism.
Epistemology is concerned with knowing. Here I would like to focus on two specific modes of knowing - faith as knowledge and science as knowledge for the purpose of answering the question what truth is. Within the realm of scientific knowledge, we would focus on the philosophy behind the types of medical knowledge and truth as it arises within specific medical context. Consider how science operates independently of faith as knowledge. Then think how science may be bound by faith as knowledge. A pertinent question is “Who gives life? Who saves?” The locus of truth is of importance here as well. Where is truth located? What limits does faith impose on the practitioners of science and medicine, if any? How is truth established? What is it guided by? Consider discernment within tradition of wisdom vs application of method and measurement.
Kazem Sadegh-Zadeh. (2015). Handbook of Analytic Philosophy of Medicine.
King James Bible.
A Hebrew Bible: A Translation with Commentary. (2018). Robert Alter.
The Message of the Qur'an: The full account of the revealed Arabic text accompanied by parallel transliteration (English and Arabic Edition). (2008) Muhammad Assad.
You can find one of the accounts about Ivan Illich’s life for twenty years after the growth on his face appeared in
Lee Hoinacki. (2006). Dying is not Death. Chapter 6. An Art of Suffering. Chapter 8. Timeo Dominum Transeuntem: Might I Miss the Lord’s Passing?
David Cayley. (2021). Ivan Illich. An Intellectual Journey. Epilogue.
Carl Mitcham. In Memoriam. Ivan Illich: Critique of Professionalized Design.
https://www.aislingmagazine.com/aislingmagazine/articles/TAM31/IvanIllichobituary.html
Ivan Illich. Pathogenesis, immunity, and the quality of public health. Qualitative Health Research, Feb95, Vol. 5, Issue 1.
Brian C. Anderson. The Genius of Ivan Illich. First Things. February 2022.
This quote shows complete failure to understand the kind of a man Ivan Illich was and why he lived the way he lived and died. Ivan Illich was a man of faith who lived what he believed. “Since Illich was a believer, a Christian, a Catholic, he went before all to this tradition to find his way. He knew other traditions, but he chose his own, the one in which he was born and died” (Lee Hoinacki, Dying is not Death, p. 117). It leads me to believe that the reviewer did not read the book, at least, he did not get to the last part of it, the epilogue.
Peter L Berger. Remembering Ivan Illich. First Things. March 2003.
There are several accounts about the details of Ivan Illich’s death. See Reference 8 for list of additional sources.
“Health is not unrelated to wholeness of haleness and holiness, either by name or in reality.” Healing as it arises within the boundary of faith is often unconcerned with a cure as much as restoration of the meaning of life. This meaning is often lost on the Western readers whose knowledge of themselves is shaped by universal biology. Triconsonantal Semitic root S-L-M carries the meaning of wholeness, wellness, health, peace, security in submission (to God). It is a qualitatively different and distinct conceptualization of health as compared to the biomedical definition of it.
Nature, the Physician, and the Family: Selected Writings of Herbert Ratner, M.D., 2nd edition, M.T. Baggott, editor. Bloomington, Indiana: AuthorHouse.
John J.Pilch. The Usefulness of the Meaning Response Concept for Interpreting Translations of Healing Accounts in Matthew’s Gospel. In The Social Sciences and Bibilical Translation. (2008).
Ivan Illich. David Cayley. (1992). Ivan Illich In Conversation.
David Cayley. (2005). The Rivers North of the Future. The Testament of Ivan Illich.
David Cayley. (2021). Ivan Illich. An Intellectual Journey.
Ivan Illich. (1990). Health as One’s Own Responsibility - No, Thank You!
This description is typical for medical histories. It is devoid of anything that lets you know what kind of a man you are treating. It is a two-legged collection of diagnoses.
The following lines are the words of a dignified Black lady from the United States who was recovering from a disfiguring jaw surgery. Her wounds constantly oozed, making her uncomfortable. She was in pain. Yet she never complained. Her diagnosis and subsequent treatment transformed one kind of suffering into another. She did not necessarily become healthier or more saved. Her suffering had some meaning for her, independent of the outcome of the treatment she underwent. For health? For life? For God?
Compare it to the subtitle that resonates with the closing words. Ivan Illich once quoted to David Cayley the passage from the Epistle to the Colossians in which the apostle Paul says, “I rejoice in my sufferings for your sake, and in my flesh I complete what is lacking in Christ’s afflictions for the sake of his body, that is, the church.”
I don't know what's the problem with smoking raw opium to ease pain. Is it because it is raw? Is it because someone is losing money because opium is too cheap and too effective and less toxic than most synthetic drugs?
Some people seek manipulate so much that they fool even themselves.