Optional Reading: Canguilhem, The Normal and the Pathological

Canguilhem positions sickness not as the opposite of or inversion of health. If you walk away from The Normal and the Pathological with one thing, I would argue that it ought be that the pathological is not the absence of the normal, that it is itself another norm altogether.

(The second point to walk away with is that both the normal and the pathological are not given to society from medicine, but, rather, move from culture to medical perception, if we must describe it in a linear fashion. The pathological begins when the sick man walks into the clinic, indicating that the first perception of the pathological is an individual relationship to oneself.)

In what follows, I’ll introduce the relationship of the pathological to the transgression of the normal by first establishing a norm’s dependence on its transgression, then illustrate this with regard to the possibility of disease as inherent in life, the goal of which will be to move to the complicated relationship between vital norms and social norms that Canguilhem takes up in his addition to The Normal and the Pathological.

Canguilhem establishes the pathological, first, as not the absence of the normal. That is, the pathological is not the antithesis of the normal, only able to be thought because of the normal, but a norm in itself (and as a side note, Canguilhem echoes our class conversation of norms only being able to function with regard to other norms, so these brief hit-and-run statements do leave much to be desired). In fact, we are only able to study the normal through the pathological. Thus, Canguilhem, in his final three pages, asks, how can we understand the normal man’s disease, which has thus far remained unthought? That is, if the knowledge of life and the knowledge of society have always assumed “the priority of infraction over regularity” how can we sketch the “pathology of the normal man” (285)?

The healthy person is one who does not know he is so. That is, “the state of health is a state of unawareness where the subject and his body are one” (91). To be aware of one’s body is to experience the body at its limits. For Canguilhem, then, this means two things: first, to be sick is to live another life, another kind of life altogether (88); and, second, that the concept of normal depends on the possibility of sickness, of threats and obstacles to health. He spends a great amount of time asserting the ways in which physiology, which he eventually defines as the science of stabilized modes of life, and the sciences more generally can only be concerned about the normal because of the presence of the pathological. He writes, “It is the abnormal which arouses theoretical interest in the normal. Norms are recognized as such only when they are broken. Functions are revealed only when they fail. Life rises to the consciousness and science of itself only through maladaptation, failure, and pain” (209). Thus, the concept of the normal depends on the possibility of violating those norms, of transgressing them.

When Canguilhem begins his first chapter with an “Introduction to the Problem,” the opening lines seem far from a consideration of physiology and pathology: “to act, it is necessary at least to localize” (39). Stranger still, he continues, “we have only to remember that disease happens to man in order not to lose all hope” (ibid, my emphasis). The hope is at least two fold. The sick person has lost the capacity to establish itself within the normal. It is necessarily transgressive: “The sick man is abnormal not because of the absence of a norm but because of his incapacity to be normative” (186, my emphasis). Regression and dissolution of health bring about deprivation, but change, too. As disease is always a possibility in life, there is always the possibility of transcending a norm.

(There is a secondary form of hope in sickness that is nestled within the first half of the sentence—that disease is always a possibility in life. I won’t say much, as it would take a long explication and set up, since it really comes to fruition in the last three pages of the work, but let it suffice to say that disease itself haunts the organism, casting a shadow over our times of health. Thus, to see or experience a time of sickness restablishes the healthy—where healthy means to be able to fall sick and to be able to recover—or a person’s sense of health, to reassure that they can recover from the sicknesses they see all around them.)

As mentioned, to be sick, even to be cured, is to live a new life. The question becomes the relationship of vital norms to social norms. I think it is to stretch, but not to be incompatible with Canguilhem, to say that illness is indispensible for health as it is the measure of health, a weather vane if one is attentive enough. If health is the silence of life (as he says, but I’ve lost my page reference), then sickness is the noise. Sickness is shouting, an alarm going off. Sickness is the body protesting against something for its own sake. The hope—and perhaps the stretch—then, is that, when the body politic is ill, it protests. We protest. And in doing so we are to the social body what illness is to the corporeal body: a tool in the processing, the procession of life itself.

Life, itself, “gambles against growing entropy” (236). Muscular dystrophy (which we can also call political apathy) onsets because, in the social unlike the vital, we do not have the measure of establishing a new norm. That is, the body will find itself its own norm of healthy, to a certain degree (that is, to the best of its ability), and this is what is meant by saying the abnormal is another norm altogether. And, thus, malaise is the disease of the normal man.

(There is a lot more, of course, to say about the move from the vital norm to the social norm, a task I’m not sure I can accomplish with any brevity.)

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