Biological Normativity

Biological normativity is the concept, developed by Georges Canguilhem in his 1943 doctoral thesis and elaborated in essays written between 1963 and 1966, that living organisms are not passive subjects of their environments but active centers of value-setting. An organism is normative in this sense when it can establish new physiological standards for itself in response to changed conditions — when it can, after illness or injury, find a new equilibrium rather than returning to a previous one, or when it tolerates a range of environmental variation by adjusting its own functioning. Health, on this account, is not a fixed state measured against statistical averages but a capacity: the capacity to be ill and recover, to confront novel situations, and to institute new norms. A sick organism is not without norms — disease is itself a normative mode of living — but its norms are narrower, more rigid, and less open to variation than those of health.

The Problem Biological Normativity Solves

The concept emerged from Canguilhem’s critique of a thesis that dominated nineteenth-century medicine: that pathological phenomena are identical to normal phenomena, differing only in quantitative degree — not a different kind of thing but more or less of the same thing.(Canguilhem, 1978) This thesis, associated with Auguste Comte and Claude Bernard, had practical appeal. If disease is simply too much or too little of a normal process, then medicine becomes a rational science of adjustment, and the physician’s authority rests on the same objective footing as the engineer’s.

Canguilhem showed that the thesis collapses on its own terms. To call a state “too much” or “too little” is already to reference a norm — a scale deemed valid and suitable. “To define the abnormal as too much or too little is to recognize the normative character of the so-called normal state. This normal or physiological state is no longer simply a disposition which can be revealed and explained as a fact, but a manifestation of an attachment to some value.”(Canguilhem, 1978) The positivist framework that sought to make pathology a purely descriptive science had smuggled an evaluative judgment into its foundational concept.(Canguilhem, 1978)

The alternative Canguilhem proposed was to accept that the distinction between normal and pathological is irreducibly evaluative, but to locate the source of that evaluation in the living organism rather than in external standards imposed by medicine or society. If biological norms exist, it is because “life, as not only subject to the environment but also as an institution of its own environment, thereby posits values not only in the environment but also in the organism itself.”(Canguilhem, 1978)

The Concept of the Normal: Polemical, Not Descriptive

Canguilhem insists that the concept of the normal, in medicine as elsewhere, cannot be reduced to an objective concept determinable by scientific methods.(Canguilhem, 1978)(Canguilhem, 1978) “Strictly speaking,” he writes, “there is no biological science of the normal. There is a science of biological situations and conditions called normal. That science is physiology.” The normal is not discovered by measuring distributions and locating averages; it is established by an act of evaluation that the organism performs, in the first instance, and that medicine then tries to articulate.

What establishes whether something is the normal distribution for a species? In one sense, the concept of normal in biology is defined by frequency: for a given species, the weight, height, and maturation of instincts for a given age and sex are those which characterize the most numerous groups.(Canguilhem, 1978) But this statistical definition proves insufficient when applied to individual cases. A statistically defined norm (say, the state of 68% of subjects in a homogeneous group) is unable to resolve concrete problems of pathology: an old man may exhibit functions within the 68th percentile for his age and still not be physiologically normal, because aging expresses itself precisely as the reduction of the margin of security in the exercise of functions.(Canguilhem, 1978)

Canguilhem surveys several attempts to multiply and refine the concept of normal to escape these difficulties. J. A. C. Ivy distinguished four meanings: coincidence between an organic fact and an ideal setting upper and lower limits; presence of characteristics whose measure is the central value of an age- and sex-matched group; an individual’s situation relative to the measured distribution curve; and the awareness of the absence of handicaps.(Canguilhem, 1978) John Ryle, professor of social medicine at Oxford, took a different approach: he argued that certain individual divergences from physiological norms are not pathological indicators at all — that it is normal for physiological variability to exist because variability is necessary for adaptation and hence survival.(Canguilhem, 1978) The difficulty of defining the species norm is, for Canguilhem, itself evidence of the problem. In population genetics, the appearance in 1954 of Lerner’s concept of genetic homeostasis showed that the selective effect of a gene is not constant — it depends on environmental conditions but also on a kind of pressure exerted on any one individual by the genetic totality represented by the population, making the norm a product of the whole ecological-genetic system rather than any single causal series.(Canguilhem, 1978)(Canguilhem, 1978)

The norm, Canguilhem argues, is not a static or peaceful concept. “A norm draws its meaning, function, and value from the fact of the existence, outside itself, of what does not meet the requirement it serves.”(Canguilhem, 1978) The norm is by definition polemical: “A norm, or rule, is what can be used to right, to square, to straighten. To set a norm (normer), to normalize, is to impose a requirement on an existence, a given whose variety, disparity, with regard to the requirement, present themselves as hostile.”(Canguilhem, 1978) It negatively qualifies what falls outside its extension.

This means the abnormal has a paradoxical temporal relationship to the normal. As ab-normal, the abnormal comes logically after the definition of the normal, being its logical negation. But “it is the historical anteriority of the future abnormal which gives rise to a normative intention. The normal is the effect obtained by the execution of the normative project, it is the norm exhibited in the fact. Consequently it is not paradoxical to say that the abnormal, while logically second, is existentially first.”(Canguilhem, 1978) There is no norm without the prior existence of something that fails to meet it.

Disease as Inferior Normativity

The conceptual move that distinguishes Canguilhem from both the quantitative-identity tradition and from simple normativism is his treatment of disease as a normative condition in its own right. The pathological state can be called normal “to the extent that it expresses a relationship to life’s normativity,” but it involves other norms than the normal physiological state.(Canguilhem, 1978)(Canguilhem, 1978) The sick organism does not lack norms — it is governed by norms that are narrower, more rigid, and more dependent on controlled conditions than those of health. “There is no life whatsoever without norms of life, and the morbid state is always a certain mode of living.”

This is confirmed by examining organic regulation. In the case of the organism, the fact of need — for food, energy, movement, rest — expresses the existence of a regulatory apparatus. An organic regulation or homeostasis assures the return to a constant when the organism diverges from it because of variations in its relation to the environment.(Canguilhem, 1978) The healthy organism has wide latitude in this regulatory range; the sick organism maintains a regulation, but on narrower terms, within which any deviation is dangerous.

The physiological state is accordingly the healthy state not because it is identical to statistical normality but because it allows transition to new norms.(Canguilhem, 1978) “Man is healthy insofar as he is normative relative to the fluctuations of his environment.” Physiological constants have “propulsive value” — they open possibilities; pathological constants have “repulsive and strictly conservative value” — they close them. The sick organism can function within the conditions its disease has established, but any perturbation beyond those conditions becomes a second disease superimposed on the first.

Normativity and the Individual

One of the more striking implications of biological normativity is that norms are fundamentally individual. The norm that defines health for a given organism is not deducible from the population distribution but must be read from that organism’s own history and functional organization. “In dealing with human norms we acknowledge that they are determined as an organism’s possibilities for action in a social situation rather than as an organism’s functions envisaged as a mechanism coupled with the physical environment.”(Canguilhem, 1978)

This individuality extends to the norms people set through their own practice. “Each of us fixes his norms by choosing his models of exercise. The norm of a long distance runner is not that of a sprinter. Each of us changes his norms according to his age and former norms.”(Canguilhem, 1978) Normativity is not a given but an achievement, one that changes as the organism develops and ages.

Canguilhem names this biological capacity explicitly: “normativity” is “the biological capacity to challenge the usual norms in case of critical situations,” and health is measured “by the gravity of the organic crises which are surmounted by the establishment of a new physiological order.”(Canguilhem, 1978) The person who recovers from severe illness and finds new functional equilibria has exercised biological normativity. The person who is sick only within the narrow conditions the disease permits has not lost all normativity but has lost the excess that makes health capacious rather than fragile.

“The menace of disease is one of the components of health … the healthy man does not become sick insofar as he is healthy. No healthy man becomes sick, for he is sick only insofar as his health abandons him and in this he is not healthy. The so-called healthy man thus is not healthy. His health is an equilibrium which he redeems on inceptive ruptures.”(Canguilhem, 1978)

Cure and Irreversibility

The concept of biological normativity carries a specific view of cure. Cure is not restoration of a previous state but “the reconquest of a state of stability of physiological norms.”(Canguilhem, 1978) What is reconquered is stability, not the prior content of the stable state. “No cure is a return to biological innocence. To be cured is to be given new norms of life, sometimes superior to the old ones. There is an irreversibility of biological normativity.”

This irreversibility is not pessimistic. The person who has been ill and recovered is not simply diminished; they have instituted new functional standards that may be more adapted to their current situation than the old ones were. The new norms may be narrower (as in many chronic diseases), but they may also represent genuine adaptive reorganization. Biological normativity is not a fixed quantum but an ongoing process of norm-setting that the organism undertakes throughout its life.

Organic Norms and Social Norms

Canguilhem draws a careful distinction between organic regulation and social regulation that bears on the concept of normativity. Social regulation tends toward organic regulation and mimics it, but “without ceasing for all that to be composed mechanically.”(Canguilhem, 1978) The externality of social organs is irreducible in a way that the parts of a living organism are not. The key practical difference is that the therapist of organic ills “in the case of the organism, knows in advance and without hesitation, what normal state to establish, while in the case of society, he does not.”(Canguilhem, 1978)

This distinction has significant implications for the use of biological norms in political contexts. Canguilhem remarks, pointedly, that “a human organism’s norm is its coincidence with the organism itself, while we wait for the day when it will coincide with the calculations of a eugenic geneticist.”(Canguilhem, 1978) Biological normativity belongs to the organism; it is not an external standard to be imposed from above. Medicine uses the results of sciences in the service of the norms of life(Canguilhem, 1978), but “it is first and foremost because men feel sick that a medicine exists. It is only secondarily that men know in what way they are sick because a medicine exists.”(Canguilhem, 1978) The qualification of a phenomenon as pathological depends on the relation to the individual patient through clinical practice, not on objective measurement alone.(Canguilhem, 1978)

Error and Molecular Pathology

In the essays written between 1963 and 1966, Canguilhem extended biological normativity to the molecular scale. The concept of “inborn errors of metabolism,” coined by Sir Archibald Garrod in 1909, denoted hereditary biochemical diseases that block reactions at an intermediary stage and cannot be derived quantitatively from the normal state.(Canguilhem, 1978) Against Bernard’s conception, the existence of conditions like alkaptonuria — whose symptom can in no way be derived from the normal state and whose process bears no quantitative relation to the normal process — demonstrated that some pathological conditions are not simply deviations from a norm but failures of a different order entirely.

“The introduction of the concept of error into pathology is a fact of great importance … in contemporary molecular pathology, hereditary biochemical errors are always considered as a microanomaly, a micromonstrosity.”(Canguilhem, 1978) When disease is conceived as error, it changes the relationship between disease and responsibility: “Disease is no longer related to individual responsibility; no more imprudence, no more excess to incriminate, not even collective responsibility as in the case of epidemics. As living beings, we are the effect of the very laws of the multiplication of life, as sick men we are the effect of universal mixing, love, and chance.”(Canguilhem, 1978)

Certain innate biochemical errors receive their pathological value from the relation between organism and environment, as certain lapses receive their symptomatic value from a relation to a situation.(Canguilhem, 1978) This prevents the reduction of the normal and pathological to a simple relation of adaptation. The organism is not thrown into an environment to which it must submit; it “structures his environment at the same time that he develops his capacities as an organism.”(Canguilhem, 1978)

Limitations and Criticisms

Canguilhem acknowledged that the concept of biological normativity carried a risk. Louis Bounoure reproached him for yielding to the “evolutionist obsession” and treated the idea of the living being’s normativity as a projection onto all of living nature of the human tendency toward transcendence.(Canguilhem, 1978) The concept was, Canguilhem also noted, formed when young — identified with the previous euphoric state before illness, which is itself one kind of norm-setting. His own later reflections, he acknowledged, had reduced his norms in conformity with his argument.

More directly, Canguilhem proposed more forcefully in the 1966 Foreword than he had in 1943 that there is no a priori ontological difference between a successful living form and an unsuccessful one: “What lack can be disclosed in a living form as long as the nature of its obligations as a living being has not been determined?”(Canguilhem, 1978) This question remains open, and it is one that biological normativity cannot answer from the inside. The concept shifts the authority for defining health from external statistical standards to the organism itself, but it does not fully resolve what obligations any given form of life is under — which depends on broader philosophical commitments that the concept of normativity alone does not settle.

Human Notes

No human annotations yet.

See Also

• georges-canguilhem
• normalization
• vitalism
• vis-medicatrix-naturae
• normal-and-pathological
• claude-bernard
• homeostasis
• philosophy-of-medicine

Sources

Editorial Notes

No gaps flagged at this time. Future work might address the reception of biological normativity in contemporary philosophy of medicine (Boorse’s biostatistical theory as counter-position; Nordenfelt and Lennox as respondents) — but sources for those secondary debates are not yet in the Library.