Ivan Illich on The Age of Disabling Professions

In 1977, the itinerant theologian and philosopher, Ivan Illich, penned a book chapter on The Age of Disabling Professions. This age, he described, roughly started around the mid-20th century and persisted up till his writing and even into the present. One of the markings of this age is a discursive shift where we learned to apply the concepts of “problems”, “solutions”, “abilities” and “needs” to nearly every life situation. In the process, we have profoundly redefined personal relationships with our work, futures, each other and our own bodies. The neurosis—or repressed fear—of this age was towards the mortal specters of “ignorance, discomfort, pain and death” (p. 12). Where pre-modern societies sought some balance of appeasement and acceptance towards conditions that could not be changed, modern Professional societies sought to banish these apocalyptic horsemen by wielding an apparatus composed of its citizens contorted within layers of specialized training, administrative bureaus, licensing bodies, sanctioned research and the production of veritable knowledge through these channels.

The disabling aspects of this age come into focus when we recognize that new technologies not only enhance certain abilities but they also alter the ecosystem of needs, desires, beliefs, behaviors which were balanced in harmony with the old technologies. A simple illustration: the innovation of cheap, affordable air travel quickly introduced the possibility of leaving one’s area and travelling around the globe to exotic locales for relaxation. But now, the undertaking of a vacation holiday requires a panel of specialists: travel agents, airlines, hoteliers, tour guides. Beliefs about rest came to be associated with the desire to travel. Behaviors, which we were once capable of undertaking on our own terms, now required special license (e.g., vacation time), currency, and services from various, remote professionals.

Illich contends that this shift cuts across socioeconomic and political boundaries making this a truly global age. In our flight from ignorance, discomfort, pain and death, he saw ourselves running in “frenzied pursuit of impoverishing wealth…” (p. 13). There are two particular professional endeavors, diagnosis and prescription, which should illicit special concern. But more on that later. Concerning the vast reach of this layered apparatus, Illich says that it is “more deeply entrenched than a Byzantine bureaucracy, more international than a world church, more stable than any labour union…” Small wonder that conspiracy theories ranging from Hollywood blockbusters to political movements capture the public interest—we generally have a sense of a world order that is global and prosperous, but sanguinely restrictive. Unlike the feudal powers and trade guilds of history, this Professional apparatus not only supplies us with what we need and want but it also shapes the very nature of those needs and wants: “[T]hey claim special, incommunicable authority to determine not just the way things are to be made, but also the reason why their services are mandatory” (p. 16). Rather than compelling by force—say as a militant ruler might—the Professional compels using the discourse of ‘problems’, ‘solutions’, ‘abilities’ and ‘needs.’ They do this by simultaneously occupying three roles—the Trinity of authority—1) the gnostic authority to advise, instruct, and direct 2) the moral authority to make such advisement good, sane, conscientious etc. and 3) the charismatic authority to appeal to some “supreme interest” (i.e., Law, Mental Health, Education, Science; p. 18) that may veto personal conscience, common sense and even eye witness testimony. We freely assign to the Professional special access into our lives, bestowing them powers of guidance—a Virgil, or more apropos to our times, the master of our cookies. The price of noncompliance may be to fall on the wrong side of morality and incur the accompanying social and legal sanctions.

The Professional is also the product of an economy that is scaled for mass production and consumption. Beyond servicing an individual, the Professional caters to whole classes. What is sold is not primarily techniques or tools for singular problems but rather products for curating certain lifestyles. To neglect the professional is almost unconscionable. To neglect a tradesperson would be to go without a tool or service; to neglect a professional would be to live a socially deviant or incomplete lifestyle.

It is not so much that their goods and services require specialized knowledge to distribute or operate. But rather, it is the process of acquiring license over the provision of those goods and services that has become complicated. As Illich puts it, “[g]ravediggers become members of a profession by calling themselves morticians, by obtaining college credentials, or by increasing the standing of their trade by electing one of themselves president of the Lion’s Club…” (p. 19). Illich actually compares the Professionals’ exclusive hold on power and knowledge to that of established religious orders. In a sense, he is suggesting that society has never secularized. Similar to the incestuous courtship between Church and State, Professions are now copulating freely with Government and have produced offspring capable of overthrowing our basic freedoms (e.g., involuntary hospitalization, expert witnesses, remedial education). 

But even with these powers, the Professional cannot aspire to be as such simply in their own right. They require our willing cooperation; there must be a demand from the User. Thus, Illich says, we have learned to elevate neediness(i.e., reliance on experts) to virtue; a form of civic duty. As a simple example: whereupon childbirth was once considered a domestic activity it is now a professional duty. For an expecting parent to neglect the hospital, they had better have a damn good private doula available. Illich reminds us that the sudden proliferation of needs was not simply convenient; it was delivered on the promise of sound medical and technical discoveries such as sulfa and antibiotics.  However, the cost of innovation was not primarily the price of the drug or even its chemical side effects. Indeed, its true cost was prescription. Now, a person who felt ill had become a ‘diabetic’ ‘alcoholic’ ‘schizophrenic’ and had to be treated not only by a medical doctor but a particular kind—the specialist. The necessity for needs to be managed by multiple specialists—which Illich calls our “multidisciplinary problem”—also becomes good business. Thus, the marriage of specialists, multidisciplinary problems, and self-help services produces a major lifestyle industry of health. These industries take the place of pre-modern institutions such as religious communities or villages or craft guilds: “The [old] commons are extinguished and replaced by a new placenta built of funnels that deliver professional service” (p. 27).

Given the apparent problems and consequences of disability, Illich asks, “Why are there no rebellions against the drift into disabling service delivery systems?” (p . 28). To that he answers that there are certain illusions or assumptions that transform the participatory citizen into the disabled User. He outlines five such assumptions.

The Discounting of Use-Value

This is the illusion that people are born as consumers and that our life goals are attainable only though consumer activity i.e., purchasing, selling, trading. The activities that are not typically monetized (e.g., child-rearing, reproduction, friendship, tranquility) are considered secondary in value to the primary life activities of consumption (which can occur in any sector i.e., education, health, culture). Now Illich is not against the value of goods and services; roads, schools, TVs all serve important functions and generally enhance the quality of our lives. However, he also recognizes the ‘intrinsic limitations’ of these so-called staples or packaged commodities. He names two such limitations as congestion and paralysis. Congestion is a sort of saturation point at which the technology that is supposed to make our lives easier gets in its own way. He uses the example of cars that are supposed to speed us along the roads much faster than horse and foot, however beyond a certain point, the city becomes immensely sprawled and all movement is choked in the rush-hour gridlock. We continue to set new records in time spent commuting. Another example may be the proliferation of online learning technologies. Originally designed to save time and enable equitable access to learning; teachers and students now have to hurdle through multiple platforms to even enter the virtual classroom of pandemic learning. Paralysis is the accompanying problem of technology giving us a new option while surreptitiously removing the old option. The driver does not use her feet; the online learner uses the internet for work and play but rarely—if ever—to explore new views and information outside of what is within their scope. The modern, economic parlance for such ill-advised tradeoffs is ‘naïve interventionism.’ Illich advocates a careful and evolving balance between two systems of production: one that is other-directed and aimed at efficiency and mass production of commodities and another that is self-directed and in service of non-monetized activities that serve important personal, ‘use-values.’ One wonders what Illich might make of the internet, a global technology that offers all unparalleled access to a matrix of information, skills and ideas to use at one’s own interest and leisure.

Technological Progress

Some have suggested that Illich did indeed anticipate the internet in the form of what he called ‘learning webs.’ If writing today, Illich likely would have revised his opinion that such a technology would be used to ‘de-school societies’; we see precisely the opposite development. Schools today have fully embraced and coopted online technologies. Although, there may be something of the Illichian spirit recognizable in the act of self-discovery (e.g., through blogging) using these technologies. However, Illich again seems ahead of the curve in warning that technologies will eventually prove to be undemocratic in the sense that as they evolve, they will gather more data, control more operations, and we will to go through specialists, licenses and service packages to keep pace with the rest. Needless to say, technologies come to increasingly mediate our engagement with ourselves and with others—with reality itself. Think of the last time you checked your phone for the news, time, weather, location, or message. Would you now chance even leaving your bed without consulting this oracle at the bedside shrine?

Professional Grade

The third illusion concerns technologies bought to service domestic and recreational uses. We look to the experts to tell us what we need and how we need it. If one wishes to cycle, it is no longer acceptable to go to the department store and simply purchase a bicycle. We are now charged to look at magazines, bicycle shops and internet reviews to guide us towards the best bicycle.

The Scrambling of Liberties and Rights

Next, Illich looks at the pernicious discourse of rights that has pervaded our politics and global welfare institutions. He contrasts the idea of rights—which in reality marshals the decision-making power over access to commodities into the hands of the Professional elites—with the concept of liberties, which safeguard our ability to strive for activities and things outside of the production-commodity cycle. As an example, we may say that all citizens of a well-to-do, developed country have a right to healthcare. However, what does this mean? Does this entail the mandatory enrollment in routine tests, vaccinations, education, insurance, evaluations and treatments? Does this permit—or require—the involuntary and forcible sequestration of those that are judged seriously deviant in mental and/or physical health? Is the state of good health simply to be in compliance with the latest prescriptions or can we define health as something outside of the production-commodity cycle? What inquiries open up when we seriously discuss the liberation of health? Can we begin openly discussing the global impact that our dependency to drugs and hospitals have had on our collective wellbeing? Can we teach the social and environmental factors that contribute to our health? Can we calculate and assign the healthcare costs we all incur as a corporate tax on the industries that serve us beef, gasoline, and cheap electronics?

Certified Self-Helpers

Similar to the third illusion, Illich argues that the self-help industry—still in its nascent stages at the time of his original publication—was not geared to help people produce and create outside of the mass production-commodity cycle. Instead, it was geared to open new markets within it. The Betty Crocker cake mix is a perfect example of such a product. Instead of inspiring Users to discover the joys of baking, the cake mix offers some derivative accomplishment from making a cake but on the Professional’s terms. An uncanny pleasure, simultaneously personal and vicarious.

Post Professionals

Perhaps the most memorable passage in Illich’s prescient essay is his closing section on the post-professional ethos. Here,Illich opines—perhaps wishes—that the end of the Age of Disabling Professions may be in sight. He writes obliquely of encountering many “tribes” or small groups of people that are unhappy with how imbalanced our lives have become towards consumerist activities.  However, Illich notices that these citizen groups are generally quite disparate, apolitical and generally intolerant towards one another. He notes that if a change is to happen, it must be galvanized by political will. This can only happen, he suggests, if enough tribes can gather together and form agreement on which liberties must supersede our consumer-enshrined rights (and to what degree). He wistfully imagines that such a society will hopefully be “more colorful and diverse than all the cultures of past and present taken together.” This is not materialist Marxism but rather a utopian idea of socialism that we are perhaps still as far from. Perhaps the idea itself of a post-professional ethos is misguided. It is apparent—at present anyway—that rights, commodities, production systems and professionals are here to stay; the hope—and their promise—is, as Illich says, to also find space for liberties, purposes and inquiries outside of these consumptive activities.  

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