The recent issue of the English translation of Georges Canguilhem, Writings on Medicine, prompts me to return to the discussion on the blog from a few months ago regarding the ANT attacks on Canguilhem. I won't rehearse their apparently misinformed attacks here. Instead, reading these essays on medicine brought to mind once again the inability of the ANT/STS approach in general to adequately address the human knowing subject. And this is at the center of Canguilhem's concerns. It seems to me that the choice of medicine is conceptual, rather than topical, for it is in medicine that the difficult philosophical problems of “knowledge in life” have particular force. As he puts it in the essay “Health: Popular concept and philosophical question”, “for man, to live is also to know.” And though health is a “silence of the organs”, it is a silence of a being that knows, knows itself and shapes its own life through this knowledge--including with the aid of sciences such as modern medicine.

“The living human body is thus the singular being whose health expresses the quality of the forces that constitute it: it must live with the tasks imposed on it, and it must live exposed to an environment that it initially does not choose. The living human body is the totality of the powers of a being that has the capacity to evaluate and represent to itself these powers, their exercise, and their limits.

“This body is at once a given and a product” (“Health”, 48).

Six statements

1. Human 'disease' is not natural, but a consequence of human activity. In three senses: 1) environments are human made and disease is only an inadequate relationship to environment 2) living with disease is a part of the disease itself; 3) epistemological developments in medicine change not just ideas about disease but disease itself (for example, smallpox vaccination changed the actual existence of smallpox, not just our ideas about it).

2. At the same time, Canguilhem often returns to the idea of a 'naturalist' medicine: a lack of intervention allows the body to, for itself, reassert its health. The organism seeks homeostasis through 'regulation', in that it attempts to assert its internal ends of life against the environment (for example, warm blooded animals preserve internal body temperature against external changes in temperature).

3. Thus, modern scientific medicine (“Diseases”, 35), by increasingly separating the existence of the disease away from the patient's experience of harm (mal), and by refusing to countenance the body's own powers to heal, gets into muddles: "many patients are satisfied with less than what one may think them owed certain others refuse to recognize that what was their due has been done" ("Pedagogy", 59). The proponents of an antimedicine, or what Canguilhem calls a “savage medicine,” have a grain of truth to their discourse.

4. Yet, Canguilhem soon qualifies this 'naturalism'. For in vaccination, and immunology more broadly, he finds both the fact of the bodies “natural” resistance to disease, and also the artificiality of this nature. For the vaccine exemplifies the human intervention that calls forth the “natural” response; thus, the body is no natural entity but a consequence of norms and regimens of living.

Contemporary medicine cannot honor Hippocrates better than by ceasing to reclaim him for itself; it cannot celebrate the approximate accuracy of his conception of the organism except by refusing his practice of observation and wait-and-see approach [expectation]. It is not prudent to wait for nature to declare itself once we have verified that to know its resources, one must mobilize them by alerting them. To act is to activate, as much to reveal as to cure” (“Nature”, 33).

5. Health can never be based on criteria external to the organism, but neither is it a wholly internal homeostasis that, even in ideal form, could be autonomous from environment. “Health, as the expression of the produced body, the body as product, is lived assurance--in the double sense of insurance against risk and the audacity to run the risk” (“Health”, 49). Health could never be secured for good and all; the absence of error, the refusal to take risks, is itself a 'disease' by becoming the organism's inability to respond to changes in environment or the reduction of its domain of activity. In this sense, disease “has its reason” (“Diseases”, 34): among them, the revelation of mortality and human finitude.

6. So, to live healthfully is not to attempt to liberate the “natural” body from the shackles of an artificial, objectifying medicine. “Admittedly, the body is not an object--but for man, to live is also to know” (“Health”, 52). As in his essay “Knowledge in life”, we are here confronted with the specificity of the human, as the living being whose knowledge is a part of that life and whose life is shaped by that knowledge. So while the organism is defined by its internal norm-giving, the human body is always both a given and a product, an internal telos that is shaped by norms given through the activity of life and knowledge (such as explicit regimens of hygiene, but also including other, often implicit, norms of living: how to eat, how to sleep, and so on).  

Works by Canguilhem referenced, all from the book Writings on Medicine, translated and with an introduction by Stefanos Geroulanos and Todd Myers (Fordham: 2012):   

"The Idea of Nature in Medical Theory and Practice"

"Diseases"

"Health: Popular Concept and Philosophical Question"

"Is a Pedagogy of Healing Possible?"