Georges Canguilhem's The Normal and the Pathological

Here's my review of Canguilhem's The Normal and the Pathological. An old book, but deserving of new love.

This is a lovely and humane book which takes as its starting point the advent of something new in the empire of nature: the presence of pathology among the living. For if neither the hurricane nor the waterfall can fall sick or recover, strictly speaking, then the arrival of life-which-falls-ill marks a break in the continuity of things, the eruption of an interruption in the cosmic order. While what counts as the ‘living’ has been the subject of much healthy debate (the inclination to ‘finality’, the work of the gene, the capacity for reproduction, to list a random few), Canguilhem’s wager is to look for the singularity of life in the presence of exactly what threatens it: illness and disease. Accompanying life as its ever-present shadow, it’s just in plumbing the recesses of pathology that the living itself comes into relief.

Trained as both a physician and a philosopher, it was likely this unique paring that allowed Canguilhem to occupy the perspective of pathology, all the better to serve as an aperture upon the living. For the attention to health - the fact that the living being tends or strives toward a state of well being - marks life out at that which establishes itself not merely as a fact, but more importantly and more profoundly, as a norm. In other words, life is not indifferent to itself: it works upon itself and its milieu so as to lend itself powers of action, security from catastrophe, and the luxury of error. To this degree, life is a set of values, or better, that which can establish values (Canguilhem: “valerie, in Latin, means ‘to be well’”). Nietzsche was maybe more correct than anyone suspected!

While it’s very well to say this, the philosophical significance of life-as-norm lies in everything that follows. Subject to particular criticism by Canguilhem are efforts to establish health as a matter of measurements and thresholds: as if one could read disease off a barometer, and health by a gauge. Far from being immutable and given, to say that life establishes norms is to say that the normal itself is a relative matter: the normal, as anything but a statistical measure, is only ever normal with respect to the living being’s own capacities for action, its affordances of movement and desire. Anticipating, by half a century, the findings of developmental systems theory (c.f. the work of Susan Oyama), for Canguilhem, only life-in-an-envrionment can be considered normal or not, and never a living being taken in abstraction.

And what follows for ‘the normal’ follows too for ‘the pathological’. If health is a matter of capacity and function rather than a game of numbers, then the pathological is not a deviant health, but a different kind of living altogether. Or, in Canguilhem’s succinct phrasing: “the abnormal is not what is not normal, but what constitutes another normal”. It’s here that one can hear the notes of Canguilhem’s humanism ring loudly, a humanism extrapolated in the second half of this book, which extends his reflection on life to its uses and abuses with respect to social questions (eugenics, with its passion for biological measurement, is given particularly short shrift). Originally published in 1966, this is a book which has lost none of its animating power, and still calls for a readership interested in the most vital questions of all.