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From Essences to Norms of Reaction |
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Written by Staff Writer
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Feb 27, 2007 at 05:33 PM |
At the start of the 19th century, the ontological theory of “disease essences” was the dominant way in which the medical profession understood illness. However, the birth of anatamo-pathology heralded completely new ways of thinking about disease and death, and of defining what health and sickness actually were. Georges Canguilhem suggests that these changes in medicine, almost from the start, caused a shift in focus away from the “sick man”, who had thus far been at the centre of the medical profession.
In order to understand how this occurred, Xavier Bichat’s ideas on polarity and normativity are key. He viewed life and death as opposite poles, life being defined as “the sum of all those organic forces that resist death”, which is acting on the body from birth. Just how alive a body was depended upon its ability to return to what he termed “the silence of the organs”, or a normal state. This “normal” state, though, is simply the state to which the “sick man” wished to return – so was it really the true normal state?
Claude Bernard, one of the relatively new breed of French physiologists to appear after the revolution, took on a wholly new approach in answer to this question. Bernard, like Bichat, rejected the ontological theory of disease outright, but he sought to find out what was the “norm” using statistics – an idea harmonious with the politics of the French Revolution. By treating disease and death as points on a quantitative continuum of physiological function, Bernard not only does away with death as a symbolic concept, but also replaces the “sick man” with a statistical abstraction.
Bernard’s way of looking at disease soon became the prevalent one, and medical focus was gradually drawn away from the patient. Canguilhem, though, argues that there is a fundamental problem with going about matters this way: purely quantitative thinking leaves out the notion that the body is active and responding in ways which are qualitatively different. Because of this, he favours Bichat’s thinking on normativity and polarity, but in physiological terms instead of anatomical.
A parallel can be drawn between the ideas of normativity + polarity, and the desire of the “sick man” to return to health. Thus, Bernard’s rejection of Bichat’s polarity and normativity implied that the “sick man” was not possessed of an accurate qualitative understanding of his affliction, and therefore, the clinic was of limited value to medicine. Far more useful, according to this way of thinking, was the laboratory, and the triumph of Bernard’s theory has been translated into the preference in modern medicine of the laboratory, rather than the clinic, as the best environment in which disease can be understood.
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