GEORGES CANGUILHEM: THE NORMAL & THE PATHOLOGICAL

William Booth, on 5 October 1999

Canguilhem (1904-1995) was born in Castelnaudry, S.W. France. He was of peasant stock but his academic achievement saw him on his way to study at the Lycée Henri IV in Paris and on to philosophy at the École Normale Supérieure, switching to medicine in Toulouse and Strasbourg.

His life paralleled academically and in the Resistance that of his friend Jean Cavaillès, whose execution by the Gestapo saw Canguilhem turn in on himself, ending up as professor at the Collége de France.

History and Philosophy of Science
Canguilhem is clear and adamant that even though philosophy had lost its sovereignty and its autonomy, it still had important work to do. Unlike the task of the scientist, the epistemologist's problem is to establish "the order of the conceptual progress that is visible only after the fact and of which the present notion of scientific truth is the provisional point of culmination."

Truths are found in the practices of science: philosophy analyses the plurality of these truths, their historicity, and consequently their provisionality, while affirming their normativity. Epistemology is a rigorous description of the process by which truth is elaborated, not a list of final results and this assumption is the cornerstone of the house of reason inhabited by Canguilhem. For him, science is "a discourse verified in a delimited sector of experience." Science is an exploration of the norm of rationality at work. Just as firm as the belief in science is the belief in its historicity and its plurality. There are only diverse sciences at work at particular historical moments; "physics is not biology; eighteenth century natural history is not twentieth century genetics." (Rabinow). Hence for Canguilhem, "the history of science is the history of an object...discourse...that IS a history and HAS a history, whereas science is the science of an object that is NOT a history, that has NO history."

Science, through its use of method, divides nature into objects. These objects are secondary, in a sense, but not derivative; one could say that they are both constructed and discovered. The history of science performs a similar set of operations and the truths derived are always contestable and in progress, as it were, but no less `real' on account of their contingency.

The Normal and the Pathological
The Normal and the Pathological is Canguilhem's greatest work.

Canguilhem is concerned about the distinction between the normal and the normative, and their relation to the definition of health and disease; and in so doing he asserts the biological primacy of the normative over the normal. The following is a summary of his position: the term `normative' is applied in philosophy to any judgement which assesses or qualifies a fact in relation to a norm, but at bottom this mode of judgement is subordinate to the person who institutes the norms, and it is in this sense that we propose to speak of a biological normativity.

Man does not feel in good health....which is the definition of health...except when feeling normal...adapted to one's milieu and its demands... but normative, capable that is of pursuing new norms of life. The ill person is ill by incapacity to tolerate more than a single norm....abnormal not because of absence of a norm, but because of the incapacity to be normative. It is like life itself, and not medical judgement, which makes the biological normal a concept of value and not a concept of statistical reality.

Canguilhem's book marked a signal reversal in thinking about health. Previously, medical training in France had privileged the normal; disease or malfunction was understood as a deviation from a fixed norm, which was taken to be a constant. Medical practice was directed towards establishing scientifically these norms, practice following theory, towards returning the patient to health, re-establishing the norm from which the patient had strayed.

Canguilhem launched a frontal attack on that `edifice of normalisation' so essential to the procedures of positivist science and medicine. He reposed the question of the organism as a living being that is in no pre-established harmony with its environment. Suffering, not normative measurements and standard deviations, establishes the state of disease. Normativity begins with the living being, and with that being comes diversity. Each patient whom a doctor treats presents a different case: each displays its own peculiarity... "An anomaly is not an abnormality. Diversity does not signify sickness." With living beings, normality is an activity, not a steady state. Normality means the ability to adapt to changing circumstances, to variable and varying environments. Illness is a reduction to constants, the very norms by which we measure ourselves as normal. Life is not stasis, a fixed set of natural laws, set in advance and the same for all, to which one must adhere in order to survive. Rather, life is action, mobility and pathos, the constant but only partially successful effort to resist death ..."Life is the collection of functions that resist death." (Bichat).
Error
Analysing the contemporary revolution in genetics and molecular biology, Canguilhem places Watson and Crick's discovery of the double helix as an information system, one in which the code and the milieu are in constant interaction. There is no simple, unidirectional, causal relation between genetic information and its effects. The new understanding of life marks a shift from mechanics to information and communication theory; it lies not in the structuring of matter but in a shift of scale. Yet the' telos' of life most commonly proposed today is more an ethological one, seeing behaviour as determined and humans more as animals, than a contemplative one involving reflection and uncertainty. The Code has become the central dogma.

Canguilhem reject this. If homo sapiens is as tightly programmed as the ethologists/molecular biologists suggest, then how can we explain error, the history of errors and the history of our victories over error? Genetic errors are information errors. Most arise from a mal-adaptation to the milieu. Mankind makes mistakes when it places itself in the wrong place, in the wrong relationship with the environment, in the wrong place to receive the information needed o survive, to act, to flourish. We must move, err, adapt to survive....the fundamental form of life.

W. Booth