Towards a Critique of Normalization: Canguilhem and Boorse

Abstract

In this chapter, we flesh out some aspects of what can be called the normalization view, which involves the attempt to provide a definition of normality that can then be used as a standard to determine which deviations are diseases. This view, finding its roots in the nineteenth century attempts to bring statistics into biology and medicine, has been repeatedly defended in the twentieth century by various naturalists. In order to bring out some of the problematic assumptions that this view harbors, we first develop several insights by Georges Canguilhem, a philosopher of biomedicine about how this view is often formulated. Second, we show how these problems are at work in one popular naturalistic theory: Christopher Boorse’s bio-statistical account. In particular, we focus on how Boorse’s views on normality cannot escape from seeing it as both an average and an ideal and how they fail to convincingly account for the role of the environment in helping to distinguish normal and abnormal variation. Third, we provide some ways to overcome these problems by using Canguilhem’s ‘relativistic’ ecological account, which claims that there is no normal organism in itself, but only in relation to its particular environment. We conclude by mentioning some controversial conclusions that such a relativistic account arrives at when thinking about social norms and disease judgments.