Georges Canguilhem

From The Normal and the Pathological

"To act, it is necessary at least to localize." (39)

"The history of ideas cannot be superimposed perforce on the history of science. But as scientists lead their lives as men in an environment and social setting that is not exclusively scientific, the history of science cannot neglect the history of ideas. In following a thesis to its logical conclusion, it could be said that the modifications it undergoes in its cultural milieu can reveal its essential meaning." (46)

"As if one could determine a phenomenon's essence apart from its conditions! As if conditions were a mask or frame which changed neither the face nor the picture!" (106)

"Because physiology stands at the crossroads of the laboratory and the clinic, two points of view about biological phenomena are adopted there, but this does not mean that they can be interchanged. The substitution of quantitative progression for qualitative contrast in no way annuls this opposition. It always remains at the back of teh mind of those who have chosen to adopt the theoretical and metrical point of view. When we say that health and disease are linked by all the intermediaries, and when this continuity is converted into homogeneity, we forget that the difference continues to manifest itself at the extreme, without which the intermediaries could in no way play their mediating role; no doubt unconsciously, but wrongly, we confuse the abstract calculation of identities and the concrete appreciation of differences." (111-12)

"It is impossible for the physician, starting from the accounts of sick men, to understand the experience lived by the sick man, for what sick men express in ordinary concepts is not directly their experience but their interpretation of an experience for which they have been deprived of adequate concepts." (115)

"In the final analysis it is the patients who most often decide -- and from very different points of view -- whether they are no longer normal or whether they have returned to normality. For a man whose future is almost always imagined starting from past experience, becoming normal again means taking up an interrupted activity or at least an activity deemed equivalent by individual tastes or the social values of the milieu. Even if this activity is reduced, even if the possible behaviors are less varied, less supple than before, the individual is not always so particular as all that. The essential thing is to be raised from an abyss of impotence or suffering where the sick man almost died; the essential thing is to have had a narrow escape. [...] The sick man mantains that he is not in any obvious sense disabled. This notion of disability should be studied by a medical expert who would not see in the organism merely a machine whose output must be calculated, an expert who is enough of a psychologist to appreciate lesions as deteriorations more than as percentages." (119-20)

"To be sick is to be harmful or undesirable or socially devalued, etc. On the other hand, from the physiological point of view what is desired in health is obvious and this gives the concept of physical disease a relatively stable meaning. Desirable values are 'life, a long life, the capacity for reproduction and for physical work, strength, resistance to fatigue, the absence of pain, a state in which one notices the body as little as possible outside of the joyous sense of existence' [59, 6]." (121-22; quote from K. Jaspers)

"Physiological constants are thus normal in the statistical sense, which is a descriptive sense, and in the therapeutic sense, which is a normative sense. But the question is whether it is medicine which converts -- and how? -- descriptive and purely theoretical concepts into biological ideals or whether medicine, in admitting the notion of facts and constant functional coefficients from physiology would not also admit -- probably unbeknownst to the physiologists -- the notion of norm in the normative sense of the word. And it is a question of whether medicine, in doing this, wouldn't take back from physiology what it itself had given." (122-23)

"Since norma, etymologically, means a T-square, normal is that which bends neither to the right nor left, hence that which remains in a happy medium; from which two meanings are derived: (1) normal is that which is such that it ought to be; (2) normal, in the most usual sense of the word, is that which is met with in the majority of cases of a determined kind, or that which constitutes either the average or standard of a measurable characteristic." (125)

"We think that medicine exists as the art of life because the living human being himself calls certain dreaded states or behaviors pathological (hence requiring avoidance or c orrection) relative to the dynamic polarity of life, in teh form of a negative value. [...] We, on the other hand, think that the fact that a living man reacts to a lesion, infection, functional anarchy by means of a disease, expresses the fundamental fact that life is not indifferent to the conditions in which it is possible, that life is polarity and thereby even an unconscious position of value; in short, life is in fact a normative activity." (126)

"Normative, in philosophy, means every judgment which evaluates or qualifies a fact in relation to a norm, but this mode of judgment is essentially subordinate to that which establishes norms. Normative, in the fullest sense of the word, is that which establishes norms. And it is in this sense that we plan to talk about biological normativity." (126-27)

"The Greek nomos and the Latin norma have closely related meanings, law and rule tending to become confused. Hence, in a strictly semantic sense 'anomaly' points to a fact, and is a descriptive term, while 'abnormal' implies reference to a value and is an evaluative, normative term; but the switching of good grammatical methods has meant a confusion of the respective meanings of anomaly and abnormal. 'Abnormal' has become a descriptive concept and 'anomaly,' a normative one." (132)

"To the extent that living beings diverge from the specific type, are they abnormal in that they endanger the specific form or are they inventors on teh road to new forms?" (141)

"Taken separately, the living being and his environment are not normal: it is their relationship that makes them such. For any given form of life the environment is normal to the extent that it allows it fertility and a corresponding variety of forms such that, should changes in the environment occur, life will be able to find the solution to the problem of adaptation -- which it has been brutally forced to resolve -- in one of these forms. A living being is normal in any given environment insofar as it is the morphological and functional solution found by life as a response to the demands of the environment. Even if it is relatively rare, this living being is normal in terms of every other form from which it diverges, because in terms of those other forms it is normative, that is, it devalues them before eliminating them." (143-44)

"There is no fact which is normal or pathological in itself. An anomaly or a mutation is not in itself pathological. These two express other possible norms of life. If these norms are inferior to specific earlier norms in terms of stability, fecundity, variability of life, they will be called pathological. If these norms in the same environment should turn out to be equivalent, or in another environment, superior, they will be called normal. Their normality will come to them from their normativity. The pathological is not the absence of a biolotical norm: it is another norm but one which is, comparatively speaking, pushed aside by life." (144)j

"In other words, other conditions would give rise to other norms. The living being's functional norms as examined in the laboratory are meaningful only within the framework of the scientist's operative norms." (145)