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Nov 27, 2021Liked by Lee Trepanier

I was struck by these words: "bureaucratic institutions tend to act counter to their original, rational purpose, thereby undermining people’s confidence in themselves and their ability to solve their own problems."

I find this to be true in my world of medicine, but also in almost every endeavor. Bureaucracy has become a word synonymous with inefficiency, if not gross ineptitude. The current American congress is a prime example of an effete group of individuals. The quote attributed to Margaret Mead is the antithesis of bureaucracy: “Never doubt that a small group of thoughtful, committed citizens can change the world. Indeed it’s the only thing that ever has.”

While attending the U of Chicago School of Medicine in the 1960s, each medical student was asked to interact closely with a pregnant woman from the local community. Southside Chicago was essentially the ghetto of Chicago, populated with poor Black people, and with a high percentage of gang members (e.g., Blackstone Rangers, Devil's Disciples). Probably, 75% of the patients the med student encountered were Black. In those days, in contrast to so-called modern-day medicine, the patient's history was the foundation to a clear understanding of the individual's medical status. We actually spoke with patients and listened to them; imagine that? As a naive young student, I was shocked at the number of unwed pregnant women I encountered. I also did not understand why so many had started having children as soon as they reached puberty. I remember one patient in her twenties who had never had a menstrual period- she was always pregnant, and she had six children that she was supposed to care for, educate and provide love, affection, and inspiration. I also learned how the prevailing political party (at that time the Democrats) were rewarding unwed mothers with 600$ for each illegitimate child. What was done back then in the sixties led to multiple generations of children raised by a single person, in a context of crime, drug abuse, and lack of parenting. It was no surprise that our bureaucracy, in its flagrant ignorance, had passed legislation to create multiple generations of dependent individuals by rewarding them for all of the wrong reasons. You do not help people by making them dependent.

This tendency for bureaucracy to impede and not promote the cultivation of the mind and a work ethic has led to the widespread mess now evidenced in the USA. We have become a country of the lazy and obese. We are dependent on others with outsourcing of virtually every item vital to our everyday life. We have most of our computer hardware imported from China while at the same time we describe them as our enemy. Yet with cyber warfare high on the list of present-day worries, they supply our computers, hard drives, microchips, and even the toys for our children. This is not only the fox guarding the henhouse,but also the wolf, and the grizzly.

And now in the USA, there is a sparsity of workers, with virtually every business posting "help wanted." We have masses of immigrants wanting entry to the USA but our bureaucracy in its incompetence hasn't a plan to fast-track legal paths to citizenry.

So Illich was on spot, in my opinion, in citing the flaw in a bureaucratic government, and how the inherent laziness of H. sapiens becomes manifest in a context of a political element that promotes dependency. Our nation and its people are diametrically opposite to the concept of self-sufficiency, and with that comes a side order of lack of confidence.

I would add to this that human nature evolves when an individual has to expend effort, work, passion, and focus on any sort of project. This commitment then raises confidence and is an impetus to go further and deeper into solving problems. In medicine, a system weakens, atrophies, and eventually dies when it is not used. It is the biological equivalent to "no pain, no gain" and to the sociological maxim of "The only place where success comes before work is in the dictionary." It is also what I have seen in patients who are successful in beating serious illness insofar as these patients being the ones that put in the cognitive work of learning about their illness and interacting with confidence with their medical team vs. being led down the garden path with the typical pablum fed to patients.

Illich was in the right locale, but perhaps he did not develop his premise with the actual experiences and examples of how bureaucracy has spoiled the child and led to a dysfunctional family.

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