The history of institutes is all too full of examples of institutes that were originally designed and founded precisely to foster healing, but that actually ended up causing harm to those they were designed and founded to help. The global society in which we all live today is in fact filled to overflowing with such institutions become specifically counterproductive—to use a term made famous in the 1970s by Ivan Illich in his book Medical Nemesis.*
In the sixth chapter of that book, entitled “Specific Counterproductivity,” Illich definitively characterizes the phenomenon at issue as “something other than either an individual or a social cost.” In addition, he adds, “it is distinct from the declining utility obtained for a unit of currency and from all forms of external disservice.” That is, it is no mere matter of reaching the saturation point called that of “diminishing returns,” where the profit derived from the sale of something begins to decline relative to its cost of production; nor is it a matter of some undesirable side-effect of some process or combination of processes, such as global warming as a result of the combination of industrial, transportation, and food-production processes.
Rather, writes Illich, specific counterproductivity sets in “whenever the use of an institution paradoxically takes away from society those things the institution was designed to provide.” That occurs in the case of the institutionalization of medical care that is Illich’s focusing concern in Medical Nemesis when the very institutions designed to provide health-care to the members of a society begin actually to make the population as a whole sicker, rather than healthier—through iatrogenic (“doctor-caused”) illnesses and other factors. Such specifically counterproductive “health care,” argued Illich, was not to be pursued. Rather, it needed to be completely dismantled—or at least disregarded, if dismantling it proved not to be possible.**
Reaching such a point of specific counterproductivity also occurs in a wide variety of other, non-medical cases of institutionalization, some of which Illich examines in his other books. It is a phenomenon that is not at all confined to medicine, most especially in the limited sense that we typically give to the notion of medical practice.
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The final outcomes of intentions processed through institutions are determined by the whole concrete, historical context in which the institutional processing occurs. Those outcomes are not determined by anything internal to the institutions themselves. Most especially, they are not determined by the intentions of those who establish and maintain them.
Accordingly, whether the creation of trauma institutes—that is, institutes founded in order to address the needs of the traumatized, such as institutes for PTSD victims, rape victims, accident victims, or whatever—will actually serve to limit the negative effects of trauma at the overall societal level is above all a matter of whether such institutionalization has reached the point of the onset of specific counterproductivity. If it has, then irrespective of the intentions of those who found or operate the institutes at issue, or even of how beneficial being treated within those institutes may appear to be to the inmates themselves, founding and maintaining trauma institutes will inevitably significantly increase the general level of the repression and compulsive repetition of trauma in the society as a whole. The trauma institutes that have passed that point will themselves become traumatizing institutes.
Beyond the point of the onset of specific counterproductivity, in fact, trauma institutes can only become part of the global infliction of the very “gentle terror” I discussed in my post of that title two weeks ago. Trauma institutes then become part of an ongoing societal institutionalization of trauma itself—a process of great service to the powers that be, but of utter disservice to those it pretends to serve.
*First published in 1975 by Calder and Boyars in London.
**Illich was always a person of principle. He lived in accordance with what he saw and said to be true. At the end of his life, he died that way, too—refusing medical intervention for the cancer that eventually killed him.