A righteous scourge where progress is concerned. He fell foul of feminists in the Eighties on account of a book about gender that championed the old-fashioned way of doing sex. Traditional sex roles as a bulwark against undiluted consumer culture or some such gender complementarian red-herring. He was greeted at the college campus in Marburg where he was teaching at the time by a mob brandishing a giant papier-mâché phallus. His reputation never recovered. Up until then, he’d been something of a fixture in academic circles. A Roman Catholic priest-cum-anarchic theorist. A bit of a celebrity, even. An ascetic who never really called anywhere home. His final years of transitory earthly existence he spent refusing to treat a large, painful growth emanating from his neck. Reputedly self-medicated by puffing on opium instead.

The corruption of the best is the worst, a Latin Maxim he frequently cited. Illich was at war with the systematisation of charity. The systematisation of everything, in fact. His most famous book — Deschooling Society — is a denunciation of compulsory education, of the “specialised torpor” it can’t help but induce. “Giving” in the Christian sense should not always have to be broken down into rules. This was the essential message embedded in the parable of the Good Samaritan. You answered the call of a specific suffering. As in antiquity, you should not be bound by place or people, but free to love at will. With the institutionalisation of the Christian message, with its ascension to power, the inclination to force the hand of kindness took hold. The mystery was sucked right out of it, and with it went so much of the power and the glory. The church became the forerunner of the law-abiding modern state, the modern state whose incessant social engineering Illich heaps scorn upon from behind a wall of medieval scholarship.

However, it is a later Illich book, in which he turned the same line of attack onto modern medicine, that I find most provocatively stimulating in a 21st-century context. Written in the Seventies, Limits to Medicine — Medical Nemesis: The Expropriation of Health (catchy title) constitutes one of several blistering critiques of modernity and post-industrial alienation Illich produced in his heyday. The gist of it is that the more we lather ourselves in technology, the more of our autonomy we inevitably sacrifice, and the more technology we need just to get by in turn. Instead of enhancing nature, we attempt to step beyond it. A self-replenishing negative feedback loop ensues. The result: Nemesis, the envy of the gods. “Unbounded material progress has become everyman’s goal. Industrial hubris has destroyed the mythical framework of limits to irrational fantasies, has made technical answers to mad dreams seem rational…” I wonder what he might have made of Dignitas?

For Illich, anguish is a part of health, and the inner resources we acquire putting up with it are more precious than decent blood pressure, than the odd bit of surgery. They are fundamental to the building of community. What he calls the “art of suffering” is paramount. In all pain there is a question mark, he claims. To smother it out entirely is to prioritise one aspect of healing — treatment — at the cost of atrophying all of our cultural and spiritual strengths when dealing with agony. Pain-killing gone too far renders us little more than spectators of our own decay. If we don’t bother trying to turn suffering into meaning, we are left ever more dependent on “the machine”.

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The book is broken up into three sections. Beginning with clinical iatrogenesis, when pain and death are a direct result of medical procedure — most obviously, when myopic surgeons do things like amputate the wrong limb, and more obliquely through drug side-effects or antibiotic resistance. Here you’ll lumber into a swamp of footnotes, and far too many Seventies-born statistics, some of which have aged badly. For a start, treatment for cardiovascular disease has come a long way in the last 50 years. You can argue that medical practice sponsors a morbid society by inculcating slovenly lifestyles, but credit where it’s due, I’d far rather suffer this illness today than in 1973.

The sections covering social and cultural iatrogenesis in turn tackle what becomes of society when health policies reinforce an industrial organisation that encourages ill-health. He’s not wrong when he declares that the more energy invested in medicine as a commodity, the greater the delusion that society has a supply of health locked away somewhere. I’ve lived my entire life under this delusion, and will no doubt continue to do so. In fact I’m a prime candidate for an Illichian makeover. I’m depressive, over-ambitious, obsessive-compulsive, an addict and a complete neurotic. I’ve leapt under the knife at every available opportunity. Five times in all. As an adult I’ve had the tonsils out, despite being told it was non-essential. I’ve had two painless, totally benign lumps removed from my neck. Most recently I had a node sliced off of my right vocal cord. I’m the kind of person that starts hammering Solpadine Max the moment I get a sniffle. I expect industrial medicine to sort it, whatever it is, and in no time at all. No self-healing capacity whatsoever.

Illich claims that the negative function of money is the devaluation of that which cannot be bought and sold. The more we dismantle any natural ability to cope, the more we shroud ourselves in pseudo-divine scientist mystification. Obvious enough statements. What’s more interesting is Illich’s attempts to reach behind this dilemma. In his opinion, blaming Big Pharma for the abuse of proscribed chemicals is tantamount to blaming the mafia for the abuse of street drugs. Short-sighted and pointless. When the market for consumer goods reaches a critical level, civilisation convinces itself that the human condition can be remodelled without limit: this is his real gripe, what he considers the root of the problem. When we hit a brick wall, the same thing that birthed the problem is reached for. This cycle of over-consumption he sums up as a kind of compulsive nostalgia, a desperate hankering for yesterday’s progress. In a world unfit for human habitation, Illich’s notion of the “patient” becomes an accomplice to the lie that his failings are biological, as opposed to systemic.

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The lofty Catholic material really starts to sing once you get into old age and death in part three: cultural iatrogenesis. “From Stockholm to Wichita the towers of the medical centre impress upon the landscape the promise of a conspicuous final embrace…” Illich is very much in favour of old people being given a corner to die in at the family gaff as opposed to subjecting them to invasive and repeated medical procedures, and instead of outsourcing terminal decline to the old folks’ homes and the hospice. A cruel inversion here he points out: to die at home now is the preserve of the rich. Yet, the more wealth the country from which you hail globally has, the more likely the man in the street is to wind up surrounded by strangers in the closing chapter of his life.

From what I’ve seen, death in the mountains of Kabyle, where half of my family live, looks like more fun than death in working-class England. The intergenerational support network provided by the more “primitive” society is something most of us no doubt miss, subconsciously but bitterly. Have we shunned death? Illich certainly believes so. For us, death is crisis, instead of something to which we relate every step of the way, instead of that which informs and enriches our ability to fully live. Keep it out of sight. It spoils the utopian fantasy that everything is manageable, if we just hurl enough cold rationality at it. Shrouding it in an air of “crisis” justifies near limitless ineffectiveness where science is concerned, our replacement for religion. An excess of futile treatments in the dying embers being symbolic of this. As far as Illich is concerned, at the moment of demise, the insured are paying for participation in their own funeral rites and little more: “in an insidious way the doctor provides each citizen at the last hour with an encounter with society’s deadening dream of infinite power”.

In his antipathy for the industrial world, a lot of the time he goes way too far. He appears drunk on his own ideological fervour. On a botched suicide he writes: “I know of a woman who tried, unsuccessfully, to kill herself. She was brought to the hospital in a coma, with a bullet lodged in her spine. Using heroic measures the surgeon kept her alive, and he considers her case a success; he no longer has to worry about her ever attempting suicide again.” I like a bit of hardcore cynicism, it’s refreshing in a world which seems sworn to naïveté, but isn’t this beyond harsh where the medical practice in question is concerned? He’s not into birth control — I don’t agree but I can look past that, he’s a man of the cloth after all, it’s kind of to be expected — but what good does this statement do anybody? At one point he even appears to call for the scapegoating of doctors as a plausible solution to the overextension of medicine into human civilisation. That to me just sounds like sour grapes.

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You’ll often run into this problem reading Illich. Any remedy shy of some kind of Marxism-tinged, back-to-basics, Catholic revolution-cum-devolution is only furthering the grief, only enabling the torment of the species further. He attacks welfare as only deepening the problem, for instance. Unless people are downing tools entirely, they’re not doing enough. They’re complicit in their own damnation. I like the fiery tone, the austere biblical voice, but come on, let’s be pragmatic about this. At the end of the day, who’s going to remove your appendix, your uncle Abdul? Your gran?

That being said, prescribed medication is still the third highest cause of death globally. Some of this stuff has aged badly, but aspects of the underlying philosophical argument he hammers home are perhaps even more valuable today than at the time of writing. Overly radical yes, but Illich is also something of a seer. He’s maybe not your man for a solution, but through the prism of his very specific and expansive learning we can look at the mess of our current state of affairs with fresh clarity.

Both these competing visions of beauty have one thing in common: they are the result of many decades of the self’s extreme commodification. In other words, both are evidence of the fact that we have fundamentally lost our ability to see real beauty.

An intuitive sense of beauty should transcend trends. But our understanding of it fluctuates wildly. Just look at how the ideal woman’s body has varied in the last few decades: the fetishisation of heroin chic was en vogue in the Nineties, only to be replaced by the curvy Kardashianism of the early-2000s. Only in the last week, Kim herself has made headlines for having lost 10 kilos and “her signature curves” — heralding an era in which skinny is back.

This oscillation is the sign of a culture that has lost touch with the eternal. In its place, culture is now ruled by the narcissism of the individual — who, as Fromm put it, now “experiences his life forces as an investment which must bring him the maximum profit obtainable under existing market conditions”. The impact on interpersonal relationships has been drastic, and terrible. Fromm argued that one has to transcend one’s narcissism in order to see beauty in another, and so experience love — but society now precludes such transcendence, by seeing meaning-making as purely a question of economics. Community has broken down, and so we are forced to find meaning through marketing ourselves to the highest bidder.

The result is not beauty, but ugliness. Consider the marketed self that dominates social media: an exaggeration of sexual attractiveness which has, with the help of the beauty-industrial complex, become grotesque. Female bodies are made to appear hyper-fertile through Botox and butt lifts, and male bodies virile through calf implants or tummy tucks. A recent GQ article highlighted a man who spent $75,000 to have both of his femurs broken and his legs extended to increase his height by a few inches. “I noticed that taller people just seem to have it easier,” he said.

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Such comments hint at how ideas of beauty influence intimate relationships. In dating algorithm swipe culture, taller men get more engagement. So, instead of removing himself from a market in which his body lowers his chances of finding a date, this man chooses to alter his body to game the system.

As for women, almost every form of cosmetic surgery has been on the rise since the pandemic, including Botox, lip fillers, and nose reshaping. When we were forced into becoming avatars of our real lives, in both professional and personal settings, we increasingly saw ourselves as the image we projected. It inspired many to alter their bodies in ways that look good on screen but horrifying in person. Instead of resisting the urge to flatten our existence to how we appear on Zoom, we altered that appearance so that our avatars look younger and similar.

This is one form of ugliness: radically manipulating the appearance of the self in order to satisfy our sense of what beauty is. But there is another prevalent form, which is based on radically altering any shared sense of what beauty is — by declaring it to be a form of patriarchal oppression. This form is epitomised by the fat acceptance movement.

At their most extreme, fat-acceptance activists claim that health standards, let alone beauty standards, are a social construct that must be overthrown. The “health at every size” mantra of The Association for Size Diversity and Health is, in some ways, an understandable response to sometimes extreme pressures to be thin. But it goes even further,  completely detaching health from weight, despite strong evidence the two are fundamentally linked. Elsewhere, this group forgets that a plus-size model posing in a tiny bikini (inevitably sent by a sponsor) is simply an individual commodifying her appearance to gain status. Unlike other models, this status comes from playing the victim: fat activists often suggest that equating weight with health is discrimination or an affront to their disability.

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True and transcendent beauty, though, is not to be found in either status game: it lies neither in exaggerated sexualisation nor exaggerated victimhood. Quite the contrary: beauty depends on the eschewal of narcissism, and the practice of outward virtue within an interdependent community. Today, however, this is no longer possible.

The upshot is that we have begun to see ourselves as standardised products, to be compared across an image-saturated marketplace. This view is apparent in the statement ubiquitous on TikTok: “He/she is a 10, but…” By reducing appearance to a crude number, our sensual experience of someone’s being is reduced to the visual — it is completely flattened. We are losing, to use Ivan Illich’s phrase, “sensual praxis”: a way of living that appreciates the full extent we are able to experience the world.

Illich asked, “What can I do to survive in the midst of the show?”, before answering his own question with a proposed two-fold approach. First, he calls for “an ethics of vision”, which calls for us to “protect” our “imagination from overwhelming distraction, possibly leading to addiction”. Second, he suggests “ocular askesis”, a discipline by which we train ourselves to perceive the world as we wish to see it. Illich scholar L.M. Sacasas goes further: “Our task, then, would be to cultivate an ethos of seeing or new habits of vision ordered toward the good. And, while the focus here has fallen on sight, Illich knew and we should remember, that all the senses can be likewise trained.”

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Fromm says something similar about love, which, he argues, “isn’t something natural. Rather it requires discipline, concentration, patience, faith, and the overcoming of narcissism. It isn’t a feeling, it is a practice.” Love, like beauty, has been decoupled both from the context of interdependence and the wholeness of embodied experience. The decoupling has left us with a crisis of intimacy: even as we reveal more intimate details about ourselves on social media, we are losing our ability to be close to others in real life.

The commodification of beauty is at the heart of this crisis. Fromm argues that “the principle underlying capitalistic society and the principle underlying love are incompatible”. But we can overcome the idea that we are only beautiful if we can be marketed in specific, narrow realms. We can choose not to rate each other with numbers, or indulge the swipe culture of dating apps. Training ourselves to see the transcendent beauty of virtue is a way to open ourselves up to the expanse of human experience, to hone our “sensual praxis”, to restore our ability to be interdependent again, and to love.