To supporters of the Revolution like Comte, Broussais's work was the first serious philosophical and political challenge to the Restoration.
This last piece suggests another possible source of Comte's phrenological knowledge, namely the physician Broussais.
comte praises broussais for raising physiology to a positive science (no spiritual categories... all positive/observed)
- furthers revolution started by cabanis, advanced by gall and spurzheim
comte's very strategic use of broussais against the conservativist cousin
extended the positive method (the gaze - it misses senses, but also is an important sense, and engages sensual aspects; but also its power is filled with mythology) of clinical physiology (he does not become influential in the clinical world though - but rather does only through the arguably misinterpretive uptake by comte) to "emotion" and "intellect"
"excess or absence of excitation of diverse tissues, above or below the degree that constituted the normal state" - pathological different in instensity of stimulants on organ
broussais' principle that madness was merely irritation in the brain caused by stomach (body...) trouble (food... environment too...)
comte realized that normal and pathological states were basically the same (save differing intensity)
mary pickering "broussais' philosophy made comte's thought more deterministic, normative and optimistic"
- comte's own difficulty w health and esquirol, he affirmed a naturalistic account (and materialist)
comte (after sickness) then felt that the study of disease could lead to insights into what constituted health (of course!)
pickering: "he felt his bout of madness had given him insights into his own health as well as that of society"
comte: social unity = health = normal = systematic return (not empirical - total miss of broussais in his original territory and reapplying it to a different sphere) - social illness = revolution
comte: "broussais' principle" (continuity of disease and health)
broussais criticized gall's neglect of non-brain organs on madness
cours de phrenologie (broussais - 1936);
but this takes the materialist position and begins to categorically abstract it (thus becoming ontological - not physiological - in a highly absurdist way)
comte 1826 - bout of madness, stopped lectures - 1829 started again after studying biology (reviewed broussais in 1828) (more lectures on organic sciences - increased from 10 to 12)
for comte the advent of phrenology marked the final phase (vincent guillen) of an "epoch-making process in the history of science" - "gall's immortal works" were a legitimate continuation of the Cartesian enterprise
canguilhem:
Dorothy Porter
Journal of the History of Biology, Vol. 24, No. 3 (Autumn, 1991), pp. 542-545
Canguilhem theorizes that the categories of the natural and the
unnatural were replaced by the normal and the pathological in
early nineteenth-century physiology with the establishment of
their continuity and homogeneity. This resulted, he suggests, from
the influence of the famous phrenologist and investigator of
inflammation F. J. V. Broussais upon the founder of sociology,
Auguste Comte. Broussais built upon the Brunonian theory of
health and disease as conditions of greater or less irritability of
the tissues, to establish the principle of identity between pathological
and normal states. Comte suggested that according to this
principle the difference between these organic states, either
physiologically or sociologically, consisted only in a variety of
degree. On this basis the great founder of experimental pathology,
Claude Bernard, was able to verify that physiology was the study
of the quantification of the extremes of biological normality. Thus,
Canguilhem explains, qualitative contrasts became eliminated in a
science in which the pathological was reduced to a quantitative
variation of normal functions. The science of pathology was thus
annulled and the concept of disease disappeared into the belief in
a maladjustment of normal functions that could be therapeutically
managed.
Canguilhem considers that thereby experimental physiology
obscured the fact that the normal and the pathological are qualitative
values and not quantitative measurements. Biological norms,
he asserts, imbue both the organism and its environment with
qualities, and their reduction to a quantitative scale makes the
ontological differentiation between normal and abnormal states
impossible. He is convinced that because it provides no satisfactory
identification of abnormal states, the science of physiology
cannot be simply a "science of normal functions," as defined by
Bernard and Comte. It can only become, according to Canguilhem,
a science of health, because health is constituted through dynamic
biological normativity.
Biological normativity depends, Canguilhem tells us, upon
dynamic propulsive norms. It is the ability constantly to adjust and
set new norms in reaction to the endless challenges of a historically.
evolutionarily inconstant environment. Health is thus
defined through historical, biological flexibility. But most importantly,
health exists, as Canguilhem's mentor Rene Leriche maintains,
in the silence of the organs and becomes audible only
through its disruption voiced in the pathos of the patient. Canguilhem
insists therefore that the science of pathology creates the
science of physiology, and both are inherently linked to clinical
practice. He emphasizes that this is because pathology is the
pathos, the suffering, the "pathetic echo" of the call of the patient.
It is the experience of "the menace of disease" that creates the
science of health.
Canguilhem repeatedly stresses Henry Sigerist's maxim about
medicine's dialectical reciprocity with the morality of an epoch.
He points out that the model of physiology and pathology as the
study of the variation in normal functions coincided and chimed
with early nineteenth-century theories of the congruity between
biological and social harmony. Auguste Comte's mission was to
use the understanding of the biologically organic to establish a
new method of political government as the management of the
laws of the normal conditions of organic social harmony. Laws
were to be discovered through the science of positivist sociology.
The sociologist was thus to become the new "managerial" physician
of society, who replaced the need for the political representative
of vested interest. The epoch in which Canguilhem set up his
historical politics of the epistemology of the life sciences was the
Nazi occupation of France. Now was the time, more than ever,
when the metaphor of the normal and the pathological in organic
life must reaffirm the conflict, and not the continuity, between
good and evil.
By the time of the second edition of the essay in 1963 Canguilhem
had discovered that what he believed to have been an
original thesis about the definition of health arising out of the
study of disease had already been thought up by Kant. He therefore
decided to add a new section to his essay, which concentrated
on the relationship between the meanings of "'norm" in
biological and social life. He was, as he said, venturing into society
by keeping the organism in mind.
There has been, Canguilhem suggests, an essential historical
relationship between the social and organic concepts of "the
norm" and normativity. The social meaning of the normal has, he
believes, largely been expressed in definitions of rationality
through generality. For example, technological normalization has
been constituted through standardization, as illustrated in the
creation of interchangeable-part manufacturing. Juridical normalization,
on the other hand, has led to systematic rationalization
finding its ultimate expression in rational planning, which, although
often attacked by liberals as the totalitarian mechanization
of social life, could be, in Canguilhem's view, the creation of an
organic society responsive to need.
But he urges that the problem with the simple translation of the
meaning of biological to social normativity is that in the rules of
organic life there is no delay between rule and regulation; the
rules of social life, by contrast, must be learned and obeyed. Thus
the importance of the historical epistemology of normativity is the
relationship of knowledge to mechanisms of regulation - that is,
the crucial relationship between normativity and power. Ultimately
this must be understood, Canguilhem is convinced, as a
historical epistemology of the negative power of the dialectic, or
as he expresses it, the science of error.
The real message of this text was intended for Canguilhem's
students. It told them to become historians of science with an
epistemological viewpoint, or, as Michel Foucault suggests in his
introduction, "historianisi of rationalities." Canguilhem invites
future historians to examine the rise of the regulatory "gaze" and
to dissect its expression, perhaps in the birth of the clinic or in the
construction of panoptical criminology and psychology; to document
the relations of physiology and sociology in the nineteenth
century, which mark the rise of the science of man as opposed to
nature; to write the history of probability - discover the taming
of chance; to investigate the importance of the liminality of the
'6other." The legacy of this text was and remains its invocation to
interrogate it.
But there is yet a further legacy of this seminal work, and that
is the petition to write a history of science that acknowledges the
significance of the metaphor of the normal and the pathological
and its wide pervasiveness in the subtext of the moral messages of
scientific and technological rationality.
Normal and pathological
Health is more than normality; in simple terms, it is normativity.
(Canguilhem 1994: 35 1)
Why is Canguilhem interested in the writings of Auguste Comte? The answer is
that Comte not only coined the term sociology and provided it with its first systematic
content, but, as Canguilhem pointed out, Comte also played an important
role in the definition of the science of biology. He also of course provided
the frame of positive philosophy and the history of the sciences. More specifically
he took from Broussais a conception of the relation between normal and
pathological phenomena which was to have wide ramifications in medical and
social thought in the nineteenth century.
Broussais' idea was that there are no specific causes of pathological facts, no
domain of bad causes with a comparable domain of good causes. Michel Foucault
charted the complex sequence of developments which led to this idea in The
Birth of the Clinic (Ch. 10)' noting specifically:
Bichat's preoccupation remained that of finding an organic base for general
diseases: hence his search for organic universalities. Broussais dissociates
doublets, a particular symptom - a local lesion, a general symptom - and an
over-all alteration, intersects their elements, and shows the over-all alteration
in the particular symptom, the geographical lesion in the general symptom.
From now on, the organic space of localisation is really independent of the
space of the nosological configuration. . .
. This represents a new organisation
of the medical gaze in relation to Bichat.
(Foucault 199 1 : 1867)
Foucault calls this revolution the birth of 'the new science' (ibid.: 188), which
for the first time aimed to define the cause of diseases (ibid.: 188) and for which
'there are no longer either essential diseases or essences of diseases' (ibid.: 189).
Foucault expressed this in a surprising way: 'The medicine of diseases has come
to an end; there now begins a medicine of pathological reactions . . . the historical
and concrete a priori of the modern medical gaze was finally constituted' (ibid.:
192).
- this is not new (this gaze) - though perhaps it is less sensual than previous methods - also perhaps more localized - rather it's more abstracted, a better example then might be broussais and bichat's ontological opponents (more clinically technical and categorical) and the lab genius germans, who's technical, cell-based (not just the tissues) approach is highly abstracted - and very close to modern methods (clinically, bichat/broussais might represent a functional paradigm, but again their components like Laennec not only ruled the day in France, but whose ontological method and his very invention of the stethoscope are central to this day)
Foucault notes (one-sidedly as Canguilhem pointed out (in Gutting 1994:
87)), the 'frenzied' viciousness of the attacks on Broussais (1991: 191), but not
the glowing review of Broussais' De L'Irritation et de lafolie (Paris, 1828) written
by Comte in 1828 (Comte acclaimed Broussais, by developing the ideas of
Brown, as the true 'founder of positive pathology' which he defined as the
'science which connects the perturbations of vital phenomena with the lesions
of organs or tissues', so 'almost all recognised diseases are only symptoms, and
that functional derangements cannot subsist without the lesion of organs or
rather of tissues' (Comte 1974: 649). Comte claims this as a profound attack on
the lingering metaphysics of medical practice which seemed trapped in trying to
'determine the precise seat of each of the maladies considered to have no special
seat' (ibid.: 649). Even if Broussais was wrong in his precise locations, 'it was
better for pathology, and even for therapeutics, to propose a seat at variance with
the true one than none' (ibid.: 650). Progress requires the control of imagination
by observation, says Comte, and the idea that disease is the 'excess or deficiency
of stimulation . . . either rising above or below the degree which constitutes
the normal condition' opens the way to the analysis of pathology as a study of
'intensity in the action of stimulants indispensable for maintaining health' (ibid.:
650).
Canguilhem's famous discussion in On the Normal and the Pathological
([1943]1989) clearly presents the problems considered in the very headings of
the book: 'Is the pathological state merely a quantitative modification of the
normal state?' 'Do sciences of the normal and the pathological exist?' These are
the two fundamental questions posed by Canguilhem, and the aim of the work
is to provide an attack on the very possibility of a scientifically based study of
pathology. These projects are held to import into the sciences an extra-scientific
dimension of normalization. Canguilhem adds that what is remarkable is that the
very society from which these ideas come is also the society in which 'normalization'
processes became a common feature.
And Foucault's later studies take
these normalizing processes as an object of investigation, inaugurating an interesting
counterpoint to the work of Canguilhem.
Canguilhem suggests that Comte promotes Broussais' principle into something
equivalent to Newton's law of gravity (1989: 48). He notes Comte as saying
'Broussais established that the phenomena of disease coincided essentially with
those of health from which they differed only in terms of intensity' (1989: 49),
a 'principle of nosology vested with a universal authority that embraces the
political order' (1989: 50). Comte takes the principle as a basis for the claim that
pathology could play the role of experimentation, albeit indirect, in domains
where experiment was inherently difficult. Pathology could aid the discovery of
laws based on observation and empirical verification. Canguilhem remarks that
Comte aimed to divide pathology into anatomical and function forms but Canguilhem
is immediately suspicious that Comte provides no examples, and little
methodological help in determining what might be the norm, except to appeal
to the principle of natural balance and 'harmony'. This position is taken by Canguilhem
to be an evident moral judgement. Things are actually more complicated,
Canguilhem suggests, since although there is an implicit qualitative
judgement bere the actual distinction rests on a purely quantitative criterion
(degree of deviation from a norm). Canguilhem reviews the antecedents of
Comte's argument to show that the elements of this position had been available
for some decades, and (somewhat against Foucault's analysis) could be found in
Bichat (1989: 61-3). A vitalism found in Bichat balances the purely logical position
of Broussais (Canguilhem 1989: 64) and from this point Comte works
towards a position which subordinates Broussais' principle to system. Canguilhem
sums Comte's position as one which holds that the 'cure for political crises
consists in bringing societies back to their essential and permanent structure,
and tolerating progress only within limits of variation of the natural order as
defined by social statics' (ibid.: 64). Sociology as a discipline was thus constituted
by taking up the project of trying to define abnormal social phenomena by
relating them to normal social states (Comte's law of the three states).
Canguilhem's discussion continues however via and against Claude Bernard
to Rene Leriche. Leriche's view that 'health is life in the silence of the organs,
that consequently the biologically normal is revealed through infractions of the
norm and that concrete or scientific awareness of life exists only through disease'
is accepted as the most adequate position at this point in Canguilhem's thought.
He adds a number of additional ideas: disease isolates (Sigerist), pathology is an
individual norm (Goldstein), life is a dynamic norm, a judgement of value (Ey),
and this latter idea Canguilhem accepts as the 'correct definition' (1989: 119).
The first part of his book ends with the symptom-centred observation that if
doctors talk about diseases it is because they have a 'relationship with the patient
and his value judgements' (ibid.: 122).
The second part of his thesis of 1943 discusses norm and normativity directly,
and leads to the idea that:
there is no fact which is normal or pathological in itself. An anomaly or mutation
is not in itself pathological. These two express other possible norms of
life. If these norms are inferior to specific norms in terms of stability, fecundity,
variability of life, they will be called pathological. If these norms in the
same environment should turn out to be equivalent, or in another environment
superior, they will be called normal. Their normality will come from
their normativity. The pathological is not the absence of a biological norm: it
is another norm which is, comparatively speaking, pushed aside by life.
(Canguilhem 1989: 144)
This is the heart of the problem, Canguilhem remarks here: the relation between
the functional norm of the living being and the norms concerning the conditions
under which these norms are normal (1989: 145) forms a crucial issue for any
experimental science. Canguilhem quickly moves through a consideration of the
norm and the average, the work of the quantitative tradition from Quetelet to
Halbwachs (ibid.: 156-62), to conclude, characteristically and somewhat
dogmatically, that 'physiology has better things to do than to search for an objective
definition of the normal, and that is to recognise the original character of
life' (ibid.: 178)
Gane, Mike(1998) 'Canguilhem and the problem of pathology', Economy and Society, 27: 2, 298 — 312