Writings on Medicine

Introduction: Georges Canguilhem’s Critique of Medical Reason

i n t r o d u c t i o n : Georges Canguilhem’s Critique of Medical Reason Stefanos Geroulanos and Todd Meyers I. At the time of his death in 1995, Georges Canguilhem was a highly respected epistemologist and historian of biology and medicine. He was known for having extended and transformed traditions set by Gaston Bachelard and Henri Bergson, and as an influential figure for generations of scholars, including Michel Foucault, François Dagognet, Louis Althusser, Pierre Bourdieu, Dominique Lecourt, Gilbert Simondon, and Gilles Deleuze. At different stages of his life, he was in conversation with important contemporaries , among them François Jacob, Jean Hyppolite, Maurice MerleauPonty , Jean Cavaillès, Kurt Goldstein, and René Leriche. He spearheaded both a radical undermining of scientific positivism and a retheorization of central categories of biology, medicine, and psychology in a period marked by major advances in these fields.1 Most of the work that placed him in such an exceptional position is to be found in five books published over the course of half a century: Essai sur 1 2 Introduction quelques problèmes concernant le normal et le pathologique (The Normal and the Pathological, 1943; second, modified edition, 1966),2 La formation du concept de réflexe aux XVIIe et XVIIIe siècles (The Formation of the Concept of Reflex in the Seventeenth and Eighteenth Centuries, 1955),3 La connaissance de la vie (Knowledge of Life, 1952; second, modified edition, 1965),4 Idéologie et rationalite ́ dans l’histoire des sciences de la vie (Ideology and Rationality in the History of the Life Sciences, 1977),5 and Études d’histoire et de philosophie des sciences du vivant et de la vie (Studies in the History and Philosophy of the Sciences of the Living and of Life, 1983).6 Strictly speaking, only the first two are books: the last three are collections of essays and talks, although Knowledge of Life and Ideology and Rationality each engages with a single problem and has rather clear aims. Canguilhem is best known for his first book, The Normal and the Pathological , which came at a crucial point in the history of medicine and which articulated a concern that had been vaguely felt across much of medical thought: that medicine, biology, and physiology rely on formal and statistical norms that hamper, rather than aid, not only diagnosis and treatment, but also understanding of the individual patient’s relation to society and to medical intervention. Canguilhem worked from a perspective directly influenced by the surgeon René Leriche and by the German neurologist and psychiatrist Kurt Goldstein, both of whom helped him to question the claim—which in France dated back to François-Joseph-Victor Broussais and Auguste Comte—that disease and the pathological condition more generally are nothing more than modifications of the normal condition. Canguilhem pointed out the normative and norm-producing effects that ‘‘the normal’’ had possessed ever since Comte: the norm was held simultaneously to be both identical to the normal and the only norm. Consequently , there could be no norms specific to disease—disease could be only an aberration. Thanks to these ideas, an elaborate language emerged aimed at helping the physician see signs as symptoms—thus bypassing the individual patient, for whom disease is a specific and qualitatively heterogeneous experience. Goldstein’s physiology allowed Canguilhem to suggest that pathology is much more complicated than that—in particular because Goldstein had demonstrated in the 1920s and 1930s that an organism attempts to compensate for damage done to certain functions and that the diseased body tends Canguilhem’s Critique of Medical Reason 3 to obey different rules than the normal body, but is not, for all that, normless , except in catastrophic situations.7 ‘‘Disease creates a shrunken milieu and is a narrowed mode of life, but it is also, for the individual patient, a new life, characterized by new physiological constants and new mechanisms.’’8 From Leriche, Canguilhem took up and recast the claim that ‘‘health is life lived in the silence of the organs,’’ while disease is what ‘‘irritates men in the normal course of their lives and work, and above all what makes them suffer.’’9 Canguilhem thus attended to the complexity of pathological experience in a way that was at odds with the positivist normative conception of health deriving from Comte. In so doing, Canguilhem gestured...