Victoria Margree “Normal and Abnormal”

Margree, Victoria 2002. Normal and Abnormal: Georges Canguilhem and the Question of Mental Pathology. Philosophy, Pshychiatry and Psychology 9(4): 299-312.

In the sphere of mental health, positivism is that which understands mental disorder on the model of physical illness (the „medical model“). […] This position is to be contrasted with anti-psychiatric positions […] which posit mental disturbances as originating in meaningful relations between people. (300)

If science is characterized by the periodic reinvention of its own norms, this is because science is something that living beings do, and life itself, at its most irreducible, is normative activity. (300)

Canguilhem defined life between vitalism and reductionism, as polarized activity. Life is fundamentally that which is not indifferent to its environment. […] As such, life is that which regulates its relationship to its environment through the adoption of norms of living, that is, patterns of behavior that express an evaluative relation to an environment, that judge a phenomenon to be good or bad for the organism’s survival. (301)

Health as such is a creative, propulsive, and dynamic state. It is fundamentally opposed to the adoption of a way of being that is fixed or static. […] For Canguilhem, tha state of health is of a necessarily indeterminate nature, being inherently uncontainable within fixed parameters. (301-302)

If sickness had no distinct being of its own but was merely a quantitative deviation from a set of constants, it was possible to convert the pathological back into the normal through knowledgeable human intervention. In this way the notion of the pathological itself began almost to disappear. To the extent that pathology existed at all, it was as a statistically abnormal state of affairs. (302)

As Canguilhem says, „The state of health is a state of unawareness where the subject and his body are one. Conversely, the awareness of the body consists in a feeling of limits, threats, obstacles to health“ (1991, 91).

„Wherever there is life there are norms. Life is polarized activity, a dynamic polarity, and that in itself is enough to establish norms“ (Canguilhem 2000, 351).

„Disease is a positive, innovative experience in the living being and not just a fact of decrease or increase“ (1991, 186). (303)

As such, whilst the pathological state is still normal in the sense that it prescribes and regulates ways of being according to a spontaneous valorization, it is not normative, in the fullest sense that refers to the capacity for continual revision and self-transcendence. Pathological norms are characterized by their conservatism and intolerance of change. If health is variability and flexibility – normativity – then pathology is defined as the reduction of these. (303)

This then is the radical import of Canguilhem’s thesis: the constancy and fixity that for the positivist tradition defined health, now define pathology. (304)

The immediate consequence of refusing the assimilation of pathology to biological abnormalities (in the statistical sense) is that the ascertaining of any particular phenomenon as pathological is never an objetive undertaking, in the sense of something that can be determined by measurement alone. […] The criterion for qualifying any biological fact as pathological is not then its deviation from the normal, but its reduction of the individual’s possibilities for interactions with its environment, which is felt as the experience og suffering and limit. (304)

First, if the same biological features can prove pathological under some conditions and healthy under others, then pathology is not located simply within the organisms, but in its reciprocal relationships with its environment. […] if no biological feature is inherently pathological, then the literal reference of even bodily illness is never, strictly speaking, the body. […] this is the same reference that makes physical pathology a concept of meaning and value. (305)

Second, we may say that in the human sphere, even the distinction between physical and mental illness is problematic once health and pathology are defined in terms of relationships to an environment. […] Therefore, both this environment and the human body itself are to some extent the product of social an psychological norms. (305)

For Canguilhem […] the pathological state is still normal in that it remains a regulation of behavior in response to vital values. […] The pathological norm is necessarily intolerant of infractions of its functioning. It buys the organism its continued existence but at the cost of its normativity. […] pathological mental phenomena such as psychoses can express an order, and […] this order is created by an attempt to make sense of an altered relation to the world.

First, this means that unusual or distressing mental states are, strictly speaking, never disorders. (306)

For Canguilhem, the antonym of pathological is not normal but normative. […] he establishes ilnness on the grounds of reduced capacity rather than social deviancy. (307)

[…] even when deviant or anomalous behaviors correspond to distinct biological abnormalities, these still are not sufficient to establish such behaviors as illnesses. […] Such a demonstration needs to establish that this feature impacts negatively upon the individual’s normativity, not merely that it is excessive or deficient with respect to a statistical norm and/or influences a behavior felt to be antisocial. […] all states are normal that enable the individual to exist creatively and flexibly within her environment, and this includes those structures or processes that are statistically anomalous. (308)

[…] for the human being, the pathological value of even a biological feature is never just biological. (308)

The concept schizophrenia could never fall simply within the domain of a biological science. This does not mean that it is not a medical concept; it means […] we have had to expand the definition of the medical to signify an evaluative activity attentive to human cultural and political norms.

I say political because norms of life are unintelligible except as the relation of an organism to its environment. […] An individual who is only able to act in accordance with societal norms is only apparently healthy because he has renounced that capacity to institute other norms that is inscribed in full normativity as the openness to being transcended. (310)

As such, any therapeutic intervention into the pathological norms of psychiatric symptoms is a political act, because it is one that refers an individual’s norms of life to the norms of a society. (310)

Psychiatrists and their patients have to make choices about the relative health gais of different forms of social actions, and no account of the organic, genetic etiology of psychiatric illness can remove this political dimension. (310)

Psychiatric concepts are healthy, not when they strive to be definitive, but when they are open to their own usurpation by new norms. (310)

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