Medicine, Therapy or Relational Revolution?
As Ivan Illich
medical establishment has become a major threat to health. The disabling
impact of professional control over medicine has reached the proportions
of an epidemic. ‘Iatrogenesis’, the name for this new epidemic, comes
from iatros, the Greek word for ‘physician’, and genesis,
meaning ‘origin’. A professional and physician-based health-care system
that has grown beyond critical bounds is sickening for three reasons: it
must produce clinical damage that outweighs its potential benefits; it
cannot but enhance even as it obscures the political conditions that
render society unhealthy; and it tends to expropriate the power of the
individual to heal himself and shape his or her environment.”
The real role of
medicine in the capitalist economy is to:
maintain the healthy ‘functioning’ of the labour force.
deny the relational dimensions of health and illness, physical
make up for the lack of deep relational health.
compensate for the fundamental sickness of human relations in capitalist
contain social symptoms of this sickness (drug abuse, family breakdown
ensure that these do not lead to total economic breakdown.
provide a profitable market for the corporate health and ‘life’
sanction and safeguard the dominant scientific and technological world
promote the military paradigm of a techno-biological ‘war’
professionalisation of psychotherapy, like that of somatic
medicine, has already become a case of what Illich calls”
reinforcing the split between psychotherapy and somatic medicine.
lending scientific authority to medical models of ‘mental illness’.
Adopting fashionable genetic and psycho-neuro-biological languages to
legitimise psychotherapy in ‘scientific’ terms.
of psychotherapy does not make it ‘unprofessional’ or mean giving up
high-quality training and supervision for therapists. On the contrary,
it means deepening and broadening the relational and spiritual depth
and socio-spiritual scope of that training and supervision. That in turn
requires that we cease to see individual problems in the psychoanalytic
manner - as the ‘private property’ of the individual or as symptoms of
character deformations rooted only in early childhood relations – but
recognise all symptoms as expressions of a general sickness of human
relations in capitalist society. It also means that we cease
to base ‘therapy’ on the ‘medical model’ of illness, but instead
understand it as one means to improving the health of human relations.
as a subversive spiritual practice, based on the recognition that the
human being is more than just a body or mind, a set of genetic
structures or energetic processes.
as an ethical and educational practice, challenging all forms of
medicine which reduce the inner dis-ease of the individual human being
to a mere ‘case’ of some generic ‘disease’ or ‘disorder’.
as an essentially relational and re-ligious practice: helping each other
to inwardly ‘re-link’ to the inner depths of our being and relate to
other human beings from them.
depth and richness of the therapeutic relationship is itself a challenge
to the superficiality of human relations promoted and sustained by
capitalist culture. All the more important then, that this depth and
richness is not kept within the confines of the therapeutic
relationship, But neither a satisfying personal relation nor a purely
professional relation to a client constitutes an authentic human
An authentic human relation is a relation in which every encounter with
the other is taken as an end in itself and not a means to an end
- even if this end be ‘healing’ or ‘therapy’. It is a relation in which
we recognise that in every encounter with another human being, we
encounter both a face of ourselves and a face of the other – and do so
quite independently of any processes of ‘projection’ or ‘transference’.
An authentic human relation is above all a relation in which we
acknowledge the other as more than just the face or faces they present
to us, more than just the role or roles they adopt in relation to us.
A revolution in human relations can only come about through a change in
the way in which each of us, as human beings, relates to ourselves and
others, to our inner being and to other beings. Its philosophical basis
cannot be a scientific psychology, biology or anthropology of the human
species. It must be grounded instead in a genuine human ‘ontology’ – a
phenomenology of the human being ( from Greek ‘ontos’).
The New Science
provides a new phenomenological and ontological foundation for both the
human and natural sciences. Its basis is fundamental distinction between
the human body and mind on the one hand, and the inner human
being on the other.
The inner human being cannot be reduced to an “It” of any sort: to a set
of cognitive behaviours or bodily characteristics, a set of unconscious
drives or archetypes, a set of energetic processes or neural networks,
environmental conditions or genetic blueprints. Biological and ‘energy’
medicine are based on the belief that it is bodies and brains that think
and feel, genes or energies that miraculously ‘produce’ aware human
beings. Human Ontology is
revolutionary science – turning this assumption upside down. It is
founded on the understanding that it is not bodies that see and hear,
think and feel, breath and metabolise, but beings. The body’s organic
functions are the
embodiment of innate capacities of being. Our genes the
expression of inner potentials and propensities of being.
‘Physical’ science is based on a belief in the miraculous emergence of
awareness from an otherwise non-aware universe. The New Science
is phenomenological rather than physical science: recognizing all
physical events and processes as phenomena arising (Greek phuein)
in fields of awareness. A phenomenological science of human
nature begins with the recognition that the inner human being is not a
‘soul’ or ‘psyche’ externally bounded by the physical body but an
inwardly unbounded field of awareness linking it with all other beings.
The human organism is not the physical body through which we
relate to other people’s bodies in space and time. It is the
felt body with which we relate directly to others as beings –
getting closer or more distant from them without physical movement,
touching or being touched by them without physical contact, feeling
their warmth or coolness, radiance or dullness in a way that bears no
relation to the physical temperature of their skin or the physical light
reflected by their eyes.
The New Science
is also the
foundation for a new noetic and phenomenological understanding of human
organism as a body of awareness, composed of qualitative states, flows
and movements of awareness. These in turn express our movedness as
beings – our ‘ontodynamics’.
Awareness as such is not consciousness of a pre-given world of light,
matter and energy. It is the field condition for our very experience of
the world – the light in which all physical phenomena – even light
itself – first become visible. Matter is not an expression of ‘quanta’
of electro-magnetic energy but of qualities of awareness or ‘qualia’.
‘Organisms’ are the embodiment of organized flows, forms and figurations
of awareness. The cell, for example, is not essentially an
‘orgone’ envelope but an envelope of cellular awareness.
Awareness as such however, is intrinsically relational –an
awareness of ourselves in relation to something other-than- self.
Physical body ‘functions’ such as respiration, digestion and metabolism
etc. embody the way in which, as pyschical organisms, we breathe, digest
and metabolise our awareness of ourselves and the world.
If it is ‘energy’ that links or relates things externally – as
bodies in space and time - then it is awareness that relates them
inwardly, as beings. ‘Energy’ is not a ‘thing in
itself’ independent of our own awareness of it. Instead awareness itself
is the very inwardness of energy in all its forms – and
the medium of our own vital, inner relatedness to things and
Much somatic psychotherapy is still wedded to a quintessentially Western
paradigm of organismic life as an outward movement of biological energy
from self to world. This contrasts with the Eastern paradigm of
life as an inward movement of awareness or from world to self. A ‘Third
Paradigm’ is the understanding of organismic life as a rhythm or
pulsation of outward and inward movements. The New Therapy is
based on a Fourth Paradigm – the recognition that the inward movement of
awareness from world to self is the condition for a genuine inner
relation to the world and other people. Vital relatedness to ourselves
and others is not, as Reich believed, the result of an outward movement
from an energetic core to an organismic periphery. Instead it is only
through the inward flow of awareness towards the core of being
that we can learn to relate to others from that core.
‘armouring’ that Reich saw as restricting the outward flow of energy is
in reality a substitute for authentic strength and depth of character –
the capacity to mentally restrain the outward flow of awareness and stay
grounded in our innermost being.
The old cultural
taboo on sexuality and emotional expression which Freud
challenged, has today been replaced by new, post-modern taboo – the
taboo on healthy spiritual contact with our inner being and deep
soul-spiritual intercourse with other human beings. For capitalist
culture essentially reduces all deep human relations and values into
mere means to an end - whether this be the satisfaction of personal
needs, the pursuit of profit, or the application of professional skills.
If psychotherapy is not to become a mere accessory to the culture of
capitalism, then the training of therapists must be grounded in their
innermost calling. This is the call for a characterological deepening of
human relations in all spheres of life - not just the consulting room
but the workplace and corporation.