Traditionally, debates between psychiatrists and anti-psychiatrists have centered around the appropriateness of positivist models of psychological disorder. According to positivism, the cause of unusual or distressing mental states is to be found in biological abnormalities. This paper suggests that anti-psychiatry often challenges positivism by opposing accounts of social causation to those of physical, biological disease without first questioning the adequacy of positivist accounts of physical illness itself. Using the work of philosopher of medicine, Georges Canguilhem, I wish to elaborate a (...) non-positivist account of physical disease, which can then be applied to debates in mental health to redefine the terms within which the role of biological abnormalities can be thought. Applying Canguilhem's definition of pathology, the paper argues for a conception of mental illness in which the scientific identification of biological abnormalities is useful, but not in itself sufficient. Finally, these arguments are related to recent work involving cognitive therapy approaches to voice hearing and schizophrenia. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Philosophy, Psychiatry, & Psychology 9.4 (2002) 317-319 [Access article in PDF] Canguilhem and Social Pathology Victoria Margree Keywords: Canguilhem, organism, society, pathology. MIKE GANE'S COMMENTARY on my paper "Normal and Abnormal" engages with the important question of the possibility of a concept of social pathology. However, I would like to begin my response by conceding a couple of his points around my definitions of epistemological positions. First, I agree (...) that the critique of my original piece was indeed directed most specifically toward biological reductionism, and that this should not perhaps be conflated with all positions that might be grouped under positivism. Indeed, I found Gane's description of scientific objectivity as conceived by sociological positivism ("[as] the result of epistemological procedures, not what might be called ontological reduction to a physical level of the object") tantalizingly reminiscent of Bachelard's own conception of objectivity in the physical sciences, a conception that Canguilhem must have been in sympathy with, and that Bachelard himself explicitly opposes to the epistemology of the "positivists" in his own arena (Bachelard 1984). Second, Professor Gane is quite correct to foreground the changes that take place in Canguilhem's thinking around the pathological once his attention turns to the new discoveries of the genetic sciences. For the purposes of the original piece, my focus was on the work conducted in the thesis on the Normal and the Pathological of 1943, and the version of normativity/health elaborated there shall continue to provide the main frame of reference for my reply.However, it is the attention to the problem of social pathology that forms the major ground of Gane's response, and it is toward this issue that I will direct my remaining comments. Without reaching any final conclusions, I would like to outline what I believe would be at least one major tendency in Canguilhem's thinking on the possibility of such a concept, and then to explore some of the productive aporias or difficulties in this.Canguilhem's early theorization of health as normativity would seem to explicitly prohibit its extension to an idea of social pathology. For Canguilhem health, as Greco (1998) explains, is a meaningful concept because it is indexed to the inherent teleology of the living organism. Because a society is not alive, does not possess the intrinsic teleology of the organic body, terms such as health or disease cannot be attributed to society in anything other than an explicitly metaphorical way.In my original paper, I argued that for Canguilhem environmental features can be characterized as possessing pathological value for organisms—indeed, health for Canguilhem is always a matter of relations and not a quality inherent in isolated features. I then suggested that because the human environment is an irreducibly social one, social norms, such as impose a fixed regularity [End Page 317] upon what sorts of mental phenomena count as normal, could possess pathological value for the individual. As the previous paragraph ought to suggest, this was perhaps already to strain against the limits of Canguilhemian thinking by veering close to an idea of social pathology. Institutionalized racism and intolerance of aberrant mental experiences may not be diseases for the social body in quite the same way that cancer may be for the organic body, but because these could be argued to be detrimental to the health and normativity of those who live within that society, I argued that they could be said to have a pathological value in relation to the individual.This is a formulation that I suspect Canguilhem could not accept. As Greco again explains, for Canguilhem society is not an environment. Social norms do not possess vital value for the human organism (Greco 1998, or Canguilhem 1991 in the "New Reflections"). Social norms in fact present constraints with respect to which the individual has a choice, whereas environmental norms are determining for the health of the individual.Now, it seems to me that there are at least a couple of problems with this. First, what about societies that use violence to back up their social injunctions? Is it not the case that... (shrink)