Following this analysis, it seems accurate to argue that Canguilhem’s eco-organismic relativity of biological norms contains an implicit ecological account of functions and this is clearly at work in his analysis of anomalies and abnormalities. I presented evidence and arguments in favor of this view. Moreover, I also argued that this view solves many of the problems that Boorse’s biostatistical account of disease is confronted with. There are, however, two problems that remain: one minor and one serious.
First, if this description of Canguilhem is accurate, it seems that he might be open to the criticism that by relativizing functions to individual organisms, this would allow nearly anything to be considered a function, which might undermine the ability to distinguish accidents from functions and also functions from dysfunctions. One way of responding would be to take up the insights from the first chapter such that Canguilhem’s approach begins with the individual organism, not with the group or species. As such, because normality is determined by the organism, this would only pose a problem if we were after necessary and sufficient conditions. As this is not the case, this is not a fatal problem. There is, however, a bigger problem facing his account: social norms.
51 ‘One does not scientifically dictate norms to life’ (Canguilhem 1989, p. 226).
Many species are social species, our species being one of them. This means that we rely on other human beings for teaching us what to eat and what not, for healing us when we are sick and for consoling us when we are feeling sad or lonely. An interesting consequence is that the human environment is – to a large extent – a social environment, both because it was constructed together with other individuals of our species, and because other people are part of the environment. Now, if health and disease are relative to the environment, as Canguilhem claims, then one can expect that health and disease in a social species like ours are, in part, relative to the social environment.
To some extent, this point was already underscored by the example of dyslexia: in environments where reading and writing are expected and important for the well-being and overall functioning of an individual, dyslexia can be a disease, whereas the condition is not pathological in illiterate societies. Yet, it seems that there are examples of ‘social relativity’ that challenge Canguilhem’s account, e.g. homosexuality. Individuals who prefer to have sex with individuals of their own sex have been treated differently by different cultures. In Western Europe prejudice against homosexuality and homosexuals was almost endemic for much of the last millennium. Even worse, during that period many homosexuals were incarcerated for their homosexuality and it was not uncommon to execute so-called ‘sodomites’ (Gerard & Hekma 1989). Luckily, Western Europe has witnessed a dramatic change in sexual values to such a degree that sexual discrimination has become illegal in many countries. In this case, the emphasis on the environmental relativity of disease seems to lead to the judgment that homosexuality is a disease in some social environments and is normal/healthy in other environments. By defining disease relative to an environment, is Canguilhem incapable of preventing the relativistic claims that disease is what is deemed as deviant according to some local standards and that health is merely ‘adjustment to society’ (Woolfolk 1999)?
Canguilhem’s environmental relativity seems to lead to the conclusion that homosexuality was a disease during the era that it was heavily stigmatized, and stopped being a disease after it was (widely) accepted. Yet, for several reasons this might be easier to accept than many would expect. For instance, it is clear that calling homosexuality a disease (or a sin) may convince some homosexual individuals that they are suffering from a disease, especially if they cannot adapt their desires and behaviors to the very strict sexual norms of their society.
Furthermore, the social nature of humans also implies that humans are very good at internalizing social norms. If the homosexual individual has internalized the anti-gay norms, he
is bound to feel extremely guilty for his desires, or he may feel extremely disgusted about himself every time he acts upon his desires. You do not have to be a Freudian to see that this intra-psychic conflict can lead to serious psychiatric problems. These first two points might serve as a lubricant for accepting the view that homosexuality is a disease in some societies (and not in others!). However, they are far from compelling since the real problem seems to be that, according to a relational account, one has to claim that homosexuality is a disease in some homophobic societies even when the homosexual individual does not see his sexual orientation as a disease and even if there is no intra-psychic conflict within the homosexual individual. In such a context, the judgment would be based on the threat of being ostracized, the continual policing of one’s behavior, or the general social pressures to conform that characterize that environment.
There are two reasons for why this could be an acceptable view. First, saying that homosexuality is a disease in some environments does not necessary reflect a moral condemnation of homosexuality. To be perfectly clear about this, one can condemn homophobia while still arguing that a homophobic environment could make homosexuality a diseased condition. Secondly, emphasizing the environmental relativity of normality and disease also entails that therapeutic interventions and prophylactic measures can focus on the interaction between individual and environment, but also solely on the individual or solely on the environment. The case of homosexuality seems to be an example where the best results are to be expected from changes in the social environment. This idea will be further explored in the last chapter of this dissertation.
There is another aspect to this, however, which was pointed out above in terms of how Canguilhem’s account differs from Walsh’s by not appealing to average individual fitness. If we begin from the individual in its environment, then the question is not merely one of environmental relativity such that we can bracket the homosexual’s perception and experience.
In other words, it is not merely relative to the society’s homophobic norms, but also relative to what these norms entail for a given individual. If we take Canguilhem’s claim seriously that
‘from one individual to the next the relativity of the normal is the rule’ (2008, p. 130), then the following argument seems possible. Similarly to how a dyslexic individual who does not value reading need not be considered to have a disease even in a literate society, a homosexual individual who does not seek to conform to his heteronormative society need not be considered pathological. If the individual does not share the society’s values and practices, why shouldn’t
we be justified in calling the individual ‘normal’? It is not the society, but the individual who is the judge of the line between the normal and the pathological.
This chapter raises the following questions. Is this account of health and disease even biologically tenable? Why should we appeal to individual ‘experience’ or behaviors when trying to understand these concepts? While this might seem obvious, much of what we currently understand about the norms of health and disease reflects population-level considerations coming from epidemiology. While Canguilhem focuses only on the level of the organism, viewed as a functionally integrated whole relative to its environment, how are we to understand these social and population-level dynamics? If we are to incorporate the role of social norms in disease judgments, then why not go beyond the individual organism? The next two chapters will take up these questions and their implications for Canguilhem’s philosophy.