Science and the care of the soul in Georges Canguilhem's writings

Abstract

Objectives: L'Essai sur quelques problèmes concernant le normal et le pathologique, a medical thesis defended in 1943 by Georges Canguilhem (1905–1995), is certainly the best-known French text on the epistemology of medicine. Canguilhem, then a young philosopher, medical student, and member of the French Resistance, defends the self-determination of the living individual, capable of judging what is normal or pathological – categories subsequently adopted by medicine and physiology – as well as a conception of the medical practice tailored to the singular situation. His argumentation is largely based on the theories of psychiatrists, yet excludes psychopathology from its scope. It is this paradox, little studied until now, that I attempt to resolve in this article. Methods: I have conducted an extensive study of the texts on psychology and mental care in G. Canguilhem's archives, his recently published complete works, and current academic research. Results: I propose to return to the two problems presented at the beginning of the Essai: “that of the relationship between science and technology, and that of norms and the normal”. Canguilhem responds to the latter by proposing the concept of vital normativity, which follows on from earlier work on psychology, presented in high school courses in the 1930s and in a Traité de psychologie, never published, which already promoted a subject able to value, to commit, and thus to escape from the determinism of his environment and organism. Regarding the relationship between science and technology, which Canguilhem began to conceptualize at the very end of the 1930s, in his Essai, he proposes a path that reverses that of positivism, moving from clinical practice to science, in which the former is clarified by the latter; however, scientific psychology cannot play a role equivalent to physiology in psychological care. Indeed, Canguilhem considers psychology's claim to objectivity incompatible with the respect for subjectivity that his psychologie réflexive, on the contrary, defends. To conclude, I examine Canguilhem's few writings on psychotherapy, as well as those on psychopharmacology. Discussion: I discuss the clinical consequences of the inability of scientific psychology to play a role in psychotherapy similar to that of physiology in medicine. Conclusion: Canguilhem's conception of psychological care is essentially a defense of human dignity, based on a philosophical, not a scientific, theory of the individual.