The dangers of industrialisation: why we need to rebuild a convivial society
BMJ 2024; 387 doi: https://doi.org/10.1136/bmj.q2577 (Published 17 December 2024) Cite this as: BMJ 2024;387:q2577
Experts have warned that artificial intelligence could lead to extinction of humans.1 In 1973 Ivan Illich, priest, thinker, and critic of industrial society, warned in his book Tools for Conviviality that “a tool can grow out of man’s control, first to become his master and finally to become his executioner.”2
Illich argued that widespread industrialism would destroy us. The book foresaw, and describes better than any contemporary book, our current global polycrisis of climate change; destruction of nature; pandemics; multiple wars; the prospect, even likelihood, of nuclear war; gross inequality; growing debt; mass migration; populism; and failing institutions, including health services. Illich writes about subjects that we discuss commonly now: post-industrial society and degrowth or “withdrawal from growth.” 3456
There is no disputing that growth, which took off with industrialisation in the 19th century, has brought benefits including increased life expectancy, a profusion of goods, better housing, and increased leisure. A high gross domestic product, writes the psychologist Steven Pinker, “correlates with every indicator of human flourishing.”7 Growth has also allowed politicians to avoid the difficulties of redistribution by growing rather than sharing the cake. “But,” points out the economist Daniel Susskind, “the very same technologies that we have relied on to maintain that ascent have been not only growth promoting but also climate-destroying, inequality-creating, work-threatening, politics-undermining, and community-disrupting.”5
Several books on growth and degrowth45689 describe well its benefits and harms, but it remains unclear how we might have an economy that provides the benefits of growth without the harms. At best, argues Susskind, there will be trade offs; and Illich, who like the others is better on the problem than the solution, argues that we should maximise “convivial tools” like the bicycle and minimise the use of “non-convivial tools” like cars. In healthcare this might mean much more emphasis on relationships; physical activity; meaningful work; a plant based diet; community strength; self-care; a wide range of healers, including nurses and GPs; and much less emphasis on hospitals, drugs, and tertiary care.
Convivial tools for a convivial society
Illich calls for a “convivial society,” whose fundamental values are survival, justice, and self-defined work. Currently our survival is threatened, the world is filled with injustice, and few have the privilege of being able to define their own work. In a convivial society “modern technologies serve politically interrelated individuals rather than managers,” Illich says.
“Convivial tools,” wrote Illich, “are those which give each person who uses them the greatest opportunity to enrich the environment with the fruits of his or her vision.” Convivial tools are easy to use, accessible to all, and use is not compulsory and does not impinge on another’s use of the tool. Examples are libraries, the alphabet, a pen, a spade, a knife, a guide to self-care, a bicycle, and even a phone. Everybody could have a bicycle without people being killed and the planet being polluted.
Industrial tools make us dependent, then kill us
Industrial tools, in contrast, are designed with predetermined meaning, cannot be used by everybody, and give one set of people power over others. Illich lists multilane highways, strip mines, compulsory school systems, intensive farming, mass media, and modern medicine as examples. “Destructive tools,” writes Illich, “must inevitably increase regimentation, dependence, exploitation, or impotence, and rob not only the rich but also the poor of conviviality.”
A car is a non-convivial tool: it has enslaved and killed many people. Most people in the world do not have cars, and most of those who do are dependent on them because of the distances they must travel. Around 1.19 million people a year are killed by cars, with 20 injured for every death.10 Cars are a major contributor to the outdoor air pollution that kills 4.2 million people a year prematurely and a key driver of climate change, an existential threat to humanity.11
“Health” systems and disposal of the dead
Illich gives the rise of undertaking as an example of an industrial tool replacing a convivial one. Once, families took care of their dead, organising the funeral, the wake, and “the dinner served to compose quarrels, to vent grief, and to remind each participant of the fatality of death and the value of life.” The only professional involved was the priest who blessed the body. Undertakers then arose in cities and eventually came to control cemeteries, until use of undertakers became widespread, and now people cannot imagine burying their own dead.
In his book Limits to Medicine, Illich describes a similar takeover of health and the care of the pregnant, abnormal, hurt, sick, or dying by health professionals.12 Non-professionals are excluded from care of their relatives and friends. Illich sees the business of doctors as “preservation of the sick life of medically dependent people in an unhealthy environment.” This seems an accurate description of the work of current “health” systems, which are “sickness systems” in that most of what the system does is manage people who are sick. Very little is spent on public health or “prevention,” which is in itself part of the “sickness system” in that it is concerned with preventing sickness or disease rather than promoting health. The dominance of health professionals leads to “social control, prolonged suffering, loneliness . . . and frustration produced by medical treatment,” Illich claims.
Yet, writes Illich, “people have a native capacity for healing, consoling, moving, learning, building their houses, and burying their dead. Each of these capacities meets a need. The means for the satisfaction of these needs are abundant so long as they depend primarily on what people can do for themselves, with only marginal dependence on commodities.”
Industrial tools upset the balance of life
Illich identifies six ways in which industrial, or non-convivial, tools upset the balance of life, lead to polycrisis, and may lead to the destruction of humanity.
Degradation of the biosphere
Illich was writing Tools for Conviviality a decade after publication of Rachel Carson’s 1962 book Silent Spring,13 which documented the environmental harm caused by indiscriminate use of the pesticide DDT during the second world war. The damage to nature that was alarming in 1973 is terrifying now. Illich thought that humans could find themselves totally enclosed in an artificial world “with no exit . . . Enveloped in a physical, social, and psychological milieu of his own making, he will be a prisoner in the shell of technology, unable to find again the ancient milieu to which he was adapted for hundreds of thousands of years.” That seems a prescient description of our world now, in which we have already heated the planet by 1.5°C compared with pre-industrial levels and are headed towards an increase of 3°C or more, making much of the world uninhabitable.
Radical monopoly
What Illich calls “radical monopoly” means not only that we must go to doctors to manage our sickness, to school to be taught, and to undertakers to dispose of our dead, but also that it is impossible for us to imagine not doing so. It’s unthinkable that we would decline to go the doctor when possibly dying, or decline treatment for cancer when it might possibly cure us. Illich declined treatment for the facial tumour that killed him in 2002.
Overprogramming
Compulsory schooling, an industrial tool, teaches “the accountant’s view of the value of time, the bureaucrat’s view of the value of promotion, the salesman’s view of the value of increased consumption, and the union leader’s view of the purpose of work,” according to Illich. Through overprogramming we are absorbed into the radical monopoly: we can see no other way. Illich is greatly in favour of learning, and many of those obliged to attend poor schools fail to learn and even develop a horror of learning.
Polarisation
Polarisation is the fourth factor that undermines our humanity. “The concentration of privileges on a few,” writes Illich, “is in the nature of industrial dominance.” Those who build and control the industrial tools become richer, while those who must use undertakers rather than bury their own dead are impoverished. The International Monetary Fund reports that about 10% of the world’s population owns 76% of the wealth, takes 52% of income, and emits 48% of greenhouse gases.14 The poorest half of the world’s population takes only 8.5% of income.
Obsolescence
Obsolescence is intrinsic to an industrial economy. Illich was writing long before smart phones, where a new one appears every year, but in his day cars were replaced regularly. “Renewal,” he writes, “is intrinsic to the industrial mode of production coupled to the ideology of progress.” We have come to think that new is better, including in medicine. But new clothes and medical treatments create new wants, most of which are not available to most people and add to the strain on the planet.
Frustration
Illich argues that all these realms must be kept in balance and failing to do so, as we clearly have failed, leads to the sixth problem of pervasive frustration. Britain, the first country to industrialise, is filled with frustration—with politicians and political systems, the NHS, the police, the polluted rivers, the education and criminal justice systems, everything.
Where now?
“Almost overnight,” Illich predicted 50 years ago, “people will lose confidence not only in the major institutions but also in the miracle prescriptions of the would-be crisis managers. The ability of present institutions to define values such as education, health, welfare, transportation, or news will suddenly be extinguished because it will be recognised as an illusion . . . People will suddenly find obvious what is now evident to only a few: that the organisation of the entire economy toward the ‘better’ life has become the major enemy of the good life.” (I wrote this article before the American election, but, as I correct the proofs, I observe that the election of Trump is a rejection of much of what many have held valuable for the past 50 years.)
The dangers of growth are increasingly recognised (although not by mainstream politicians, for whom it remains a panacea),45 but nobody, including Illich, can paint a clear picture of how degrowth might work or what a post-industrial society would look like.
Illich foresaw that “withdrawal from growth mania will be painful, but mostly for members of the generation which has to experience the transition and above all for those most disabled by consumption.” It should be easier for subsequent generations, if there are any.
Footnotes
Commissioned; not externally peer reviewed.
This essay is based on a blog post: https://richardswsmith.wordpress.com/2024/07/01/ivan-illich-foresaw-permacrisis-fifty-years-ago-not-least-in-health-care
I have no financial conflict of interest relevant to this article, but I heard Illich speak in 1974 when a disillusioned medical student and heard him again in 1978 when a junior doctor. His talks and writings have influenced my whole life.