Epoché (IX), 24. 9. 2020
A synopsis of our reading of The Organism by Kurt Goldstein
X. “On Norm, Health, and Disease. On Anomaly, Heredity, and Breeding” (pp. 325-351)
Abridgment by: Sebastjan Vörös
[his outline and commentary of the whole book can be found here]
On the Determination of Normality
(x) Health and disease
Goldstein starts by critically analysing two different views on normality:
(a) Idealistic view: Person is normal in the degree to which he corresponds to a certain philosophically founded ideal. However, any such idealistic norm is ultimately useless, because it will always differ according to the respective philosophy of life. Further, it carries an extrinsic character, because its frame of reference is not oriented on any reality but, rather, would have to justify itself in reality (325).
(b) Statistical view: This concept tries to derive the notion of normality from the concrete facts, by establishing the “average” in a given set of phenomena. However, such a view cannot determine whether a given individual is to be regarded as normal or abnormal, i.e., it cannot do justice to the individual (325-6).
Goldstein then tries to broaden his discussion about normality by introducing two related concepts: health and disease. As a preliminary note he states that any disease is an abnormality but that not every abnormality is a disease (326).
However, what exactly is being sick? According to some authors (e.g., Albrecht, Jaspers) a general definition of such notions as normal, healthy, and sick is impossible, as they are determined by convention: disease, for instance, is a concept value that depends more on the prevailing views of the respective cultural sphere than on the judgement of the physician. Goldstein feels that this is spurious at least insofar as it is unclear how a fact-minded science could get along without the concept of disease, which – in his opinion – is a fact, although it may be difficult to formulate it precisely (326).
In trying to get to the bottom of the concept, he says that he will disregard approaches that try to determine disease extraneously (as something that befalls the patient), and will focus only on the approaches that regard disease as a change of the organism. In the strictest sense of the term, then, he will really be more concerned with the problem of being sick than that of disease (but will continue using “disease” for the sake of simplicity).
(x) Disease not determinable as to contents, nor as deviation from a superindividual norm
Many studies determine disease as a deviation from a norm that is to be determined as to its contents (= conditions of the organism during the state of health). However, this is problematic since, strictly speaking, with regards to contents, there is no far-reaching fundamental distinction between the healthy and the diseased organism. Similarly, adding superindividual (social?) “norms” to the mix doesn’t help, as the sought for distinction still remains as elusive as ever.
Does it follow, then, as Mainzer suggests, that there is “no difference regarding healthy and diseased life”? Goldstein does not think so. In his view, normal life is related to ordered behaviour. And if this is the case, then although there might be no difference between healthy and diseased life with regards to content, there still could be a difference with regard to form(327).
Goldstein puts aside the problem of definition for a while, and focuses on how the physician goes about distinguishing health and disease. He maintains that the physician begins not by focusing on the content. True, deviations from the usual behaviour with regard to the content (abnormal fatigue, nausea, etc.) may make the patient and the physician suspicious as to health, but for neither will these deviations be manifestations of disease in themselves, but, at best, signs that a disease may exist. The experience of being sick does not necessarily contain any definite kind of change as to contents. And the physician, when deciding whether he is dealing with a case of disease, is usually guided by criteria entirely different from the proof of a change as to contents.
(x) Definition of disease presupposes a conception of the individual nature
What, then, is the basis for passing the judgement: “He is sick”? It is, Goldstein clams, the observation of a “disordered” behaviour, of a catastrophic reaction. The objectively verifiable changes of particulars – in pulse, temperature, etc. – are, for a physician, usually only a confirmation of this initial observation. Similarly, in the patient himself disease is experienced primarily as uncertainty and anxiety (i.e., a basic change of his attitude toward the environment).
“Being sick”, then, is experienced by neither the physician nor the patient as a change regarding contents, but rather as a disturbance in the course of the life processes. Consequently, not every deviation from the norm as to the contents appears as disease. It actually becomes a disease when it carries with it impairment of, and danger for, the whole organism. That is to say, a condition may be designated as a disease when it endangers “existence”, when it is shock and danger for existence (328).
It follows that a definition of disease requires a conception of the individual nature as a starting point:
“Disease appears when an organism is changed in such a way that, though in its proper, ‘normal’ milieu, it suffers catastrophic reaction.”
This, Goldstein points out, manifests itself not only in specific disturbances of performance, corresponding to the locus of the defect, but in quite general disturbances because disordered behaviour in any field coincides with more or less disordered behaviour of the whole organism (329).
*(x) Disease as “defective responsiveness”
This definition of disease, notes Goldstein, is in accordance with the views of many other authors (e.g., Otto Lubarsch, Hugo Ribbert, Viktor Schilling, Ludwig Aschoff), but probably comes closes to the conception of A. Grothe (329). For similarities and differences see pp. 329-30.
(x) The restoration of health
Careful analysis reveals that, after recovery, the former way of coming to terms with the former milieu – i.e., the way of performing prior to disease – is never reached by the patient. But doesn’t this contradict Goldstein’s view on a far-reaching relative independence of performances on their substratum? Goldstein responds in the negative. Normal performances are limited to the strict integrity of the organism throughoutin terms of its normal structural organization; and in such a qualitatively and structurally complex formation, as can be found in the organism, there is no such thing as compensation. If lost performances return, this is either possible through (a) the restitution of damage or through (b) the execution of performances that are similar only in their effect. But then, we will always find a simultaneous loss of other performances or shrinkage of milieu. To regain health, while the defect remains, is then possible only under certain limitations (331).
Health is restored if such a relation between preserved and disturbed performances is achieved, which makes (in spite of residual defects) “responsiveness” – i.e., fitting of the organism in its appropriate environment – possible anew. Note again that not all alterations are a sign of a disease: if certain changes do not indicate danger, then they do not make for disease but are only deviations that remain irrelevant as long as they do not endanger the individual’s existence – i.e., as long as the individual is able to meet the psychological and physical demands of his personal milieu in spite of these changes (331).
This might be the case with (examples) people whose heart is too small or with abnormal vasomotility, etc. Individuals with such changes appear perfectly healthy because they are adapted to a very specific personal milieu. As soon as such a milieu is taken away from them – e.g., as soon as “normal” demands are made on then – they become sick (331-2).
But wouldn’t such a definition entail that a patient with (example) a malignant tumor may be designated as healthy as long as no disturbances of his responsiveness have become obvious? No. First off, the assumption that there are no disturbances in such a patient can be traced, at least partially, to an insufficiency in observation. Second, such an objection is unjustified because it is short-sighted: it focuses only on the organism in its present situation and disregards the fact that a given phenomenon can be evaluated properly only as a part of the total life of the individual (i.e., it overlooks the dimension of temporality) (332).
In sum, being well means being capable of ordered behaviour, which may prevail in spite of the impossibility of certain performances that were formerly possible. But the new state of health is not the same as the old one. Interestingly, from any superindividual norm, disease cannot be determined as to its contents, while from the individual norm this can be done very well. If the individual has lost essential contents, he becomes sick. To become well again always involves a certain loss in the essential nature of the organism, which coincides with the reappearance of order (= new individual norm) (332-3).
The importance of regaining order in the process of recuperation can be seen from the fact that the organism seeks primarily to preserve, or gain, such capacities that make this possible. The organism first of all appears set on gaining constants anew. Recovery may entail changes in various fields as compared to the former nature of the organism; but the behaviour shows that the character of the performances is again “constant”. These new constants, which are present in both bodily and mental field (pulse rate, blood pressure, etc.), guarantee the new order. Importantly, we must not attempt to interfere with these new constants because we would only create new disorders (e.g., it is not always good to try and combat fever, etc.). Certain deviations from the norm – those that belong to the type of milieu change (e.g., p. 56 above) – are not always signs of the disease, but are actually necessary for well-being and protect the organism (333).
(x) Summary of Goldestein’s concept of disease and health
(1) Well-being = an individual norm of ordered functioning, expressed in definite constants, responsiveness, and in decidedly preferred ways of behaviour (essential nature, individual adequacy, etc.).
(2) Disease = disordered functioning, i.e., defective responsiveness, of the individual organism as compared with the norm of this individual as a whole. The disorder is disease insofar as it endangers self-actualization.
(3) Disease =/= change in content, the latter = indicator of the existing functional derangement of the whole.
(4) Recovery = newly achieved state of ordered functioning, i.e., responsiveness, hinging on a specifically formed relation between preserved and impaired performances. This new relation operates in the direction of a new individual norm, of new constancy and adequacy (contents).
(5) Recovery with residual defect = some loss in essential nature. There is no real substitution (333-4).
(x) The two types of adaptation to a defect
According to Goldstein, the organism can adapt itself to an irreparable defect in two essentially different ways (see also the example of calcarine lesions above):
(a) Adaptation: it yields to or resigns itself to that somewhat defective, but still passable performance that can still be realized, and resigns itself to certain changes of the milieu that correspond to the defective performances;
(b) Readjustment: it modifies itself so as to keep in check the defect and its consequences (334).
Example: “tonus pull”: in patients with one-sided cerebellar lesions, one often finds “tonus pull” toward the diseased side. All stimuli applied to that side are met with abnormal intensity, with abnormal “turning to stimulus”, which leads to deviation in walking, to a predisposition to falling, to past pointing, etc., all toward the diseased side (334-5).
How do patients cope with this? Through a posture anomaly, through which not only are the specific performances improved, but also the general disorder of total behaviour – the catastrophic reactions – are diminished. This postural change can take on two different forms:
(a) Adaptation: They yield to the tonus pull. That is to say, their body, especially the head, tilts towards the side of the pull, in which position the patient feels relatively at ease, has less vertigo, less subjective disturbances of equilibrium, etc. Note that all these disturbances immediately recur if the patient is forced to resume the old, “normal” position of the body. This kind of coping involves more security, is more passive/involuntary, and is usually accompanied by a lesser improvement in the performance levels.
(b) Readjustment: If the oblique bodily position itself becomes a disturbance – i.e., if the impairment is so strong that the patient would immediately fall over if he were to tilt toward the side of the disturbance – then we find a posture anomaly toward the opposite side, i.e., the healthy side. This kind of coping involves less security, is more active/voluntary (however, it gradually becomes a matter of course, so that the patient is hardly conscious of the abnormal posture), yet the performance in the special field may be more improved (335-6).
Now, since the main point of any adjustment is to achieve ordered behaviour, we find that, as long as the performance in the special field is at all sufficient, the first (a, i.e., more secure) adaptation sets in; the second type (b, i.e., less secure) appears only when the first no longer serves its purpose (336).
The analysis of various types of adjustments discloses the basic law that dominates the life of the organism very clearly: it is of paramount importance for the organism to attain a condition that is adequate to its “nature”, in this case, to its modified nature. Thus, it can happen that adaptation to a defect does not operate so much – as is the case in (a) above – in the direction of regaining former performances but rather – as in (b) above – in the direction of achieving ordered behaviour (336).
(x) The tendency toward preservation as expression of decadence of life
In pathological conditions, the tendency to preserve the present state may become the means of survival. So, the so-called drive toward self-preservation, which biologists often characterize as an essential trait of the organism, is in fact a phenomenon of disease – of “decadence of life” (337).
The necessity of obtaining a new, suitable milieu depends on two factors, as does life in general: (a) on the “nature of the organism”, and (b) on the world. Here, Goldstein is particularly interested in (b): the changed (diseased) organism must find, in the “world”, a new “milieu”.
The previous examples (injury to the calcarine cortex, amputation of limbs, etc.) have shown us that the readjustment occasioned by a defect is always accompanied by a limitation of the performances or a shrinkage of the milieu. In animal research and medical practice, this often gets overlooked (researchers focus only on the restoration of a particularly important performance, and ignore the fact that the restored function is considerably waker and/or that the milieu of the anima or patient is artificially kept stable, etc.). Readjustment is possible only if, concomitantly, provision is made for the required restriction of milieu, in such a way that no stimuli, which might evoke catastrophic reactions, can affect the organism. Brain-injured patients gradually develop a new, more suitable milieu for themselves, but only if fellow men make it possible by providing an environment adequate to the new condition. To produce such a state is, says Goldstein, the goal of medical practice in general – insofar as medical therapy does not eradicate the damage, it consists only in rearranging the milieu: taking certain drugs regularly, keeping with a certain mode of living, avoiding indulgence in the somatic or psychological realm, etc. (337-8).
Goldstein underlines the individualistic character of his description of health: adequacy (= responsiveness) manifests itself in the greatest performance activity of the respective individual. However, one should not equate this with “egocentric”/“individualistic”. The notion of “individuality”, which is central for Goldstein’s viewpoint, is left open with regards to the specific – be it individualistic or collective – nature of human being. Thus, it is, he says, quite possible that the social attitude belongs essentially to man. If this proves to be true, then that attitude will belong to the individual norm of human beings, and health will be maintained only when this essential trait also finds realization. Goldstein admits that he himself adopts this point, but leaves open the possibility that the results of later investigations might paint a different picture of man (338).
In extreme cases, the restriction of the milieu might become so great that the restriction itself may become a cause of catastrophic reactions. This occurs if the limitation incapacities the organism for executing other “essential” performances (e.g., certain mental activities that seem indispensable for the patient). In such cases, Goldstein say, the patient is often spared a catastrophe by losing the awareness of change or even by losing consciousness altogether. However, one also finds certain border situations, in which severe bodily impairment already exists, but consciousness of the condition has not yet disappeared, thus giving rise to intense psychological conflict. In such situations, we find tendency toward self-destruction: suicide is an expression of the utmost serious catastrophic shock, caused by the realization of the impossibility of existence (339).
This has important therapeutic implications, for the physician will have to consider whether the shrinkage of the milieu involved in the treatment does not limit, for the individual, the possibilities of self-actualization beyond the point of what is bearable. Thus, it will sometimes be necessary to tolerate a certain “symptom” as more bearable than the curtailment of more essential performances; or, on the other hand, one will have to make the demands on the organism as high as possible because only then does real responsiveness occur – demands that are too low can prove to be an obstacle in bringing about the optimal order of performances (339).
Biological Knowledge and Action
In deciding what course of action to take in the former case, one must consider both the entire premorbid personality of the patient and his transformation by irreparable changes. It is here – i.e., in deciding how to act in concrete situations – that the incompleteness of biological knowledge comes to the fore in all its severity. And it is impossible to avoid this difficulty by reverting to the “as if” philosophy (Hans Vaihinger), whose claim is that human action in general and medical practice in particular are based on useful fictions (“symbols”). For Goldstein, this is unacceptable. In his view, our cognition, though limited to the extant state of knowledge and therefore subject to change, is no fiction. For medical practice, he says, the body of knowledge at any given time is actually the reality (339-49).
However, the relationship between action and knowledge is much more complex than ordinarily assumed:
“While, on the one hand, the situation impels us to act, on the other hand, action itself becomes a source of knowledge for us. After all, all certainty arises from verification that knowledge finds in action, or from its correction through action. Thus medical, and probably all biological, cognition is very closely tied up with actions; yet not in the sense of a pragmatism determined by extraneous norms, but as action dictated by reality, which in turn can be grasped only through knowledge. The relation between this type of action and knowledge is not meant to be an extraneous one between two independent factors, like the usual connection between theory and practical application in medical science. Rather, knowledge and action are interrelated in a dialectically terminate manner. Knowledge without action is no knowledge, and action without knowledge is no action. Both mutually originate in each other, in the test of their fruitfulness, as well as in their adequacy to reality, and their aptitude to maintain nature, rather than to disturb or to distort it. In the physician, to speak correctly, knowledge and action arise together in their suitability to help preserve, as far as possible, the living human being in its specific nature.” (340) [!!!]
This “cognition action”, Goldstein continues, demands free decision because of the in-principle incompleteness of biological knowledge. Here, the holistic approach discloses its unique contribution to medicine in the relationship between physician and patient:
“If regaining health means loss of essence, this implies greater dependence on the environment, stronger bonds to environmental events; a decline from multiform, living behaviour to a more limited, compulsive, mechanical behaviour; a disintegration from a personally patterned, uniquely directed, behavioural organization to reactions governed more by the law of causality. In short, it means limitation of freedom. This, however, implies that medical decision always requires an encroachment on the freedom of the other person.” (340-1)
Thus, the infamous problem of freedom enters into medical practice, only it is here even more aggravated by the fact that the free decision of the patient must also be taken into account. In general, the patient has the choice (a) whether he wants to accept a limitation of the milieu and the resulting limitation of freedom, or (b) whether he wants less suffering and more freedom. In other words, “[h]e must choose between a greater lack of freedom and greater suffering”. Thus, quite often, it is in disease that an individual discloses his true nature (341) [!].
Goldstein concludes that the only way that the physician can give counsel and provide guidance to the patient is if he is completely endorses the conviction that the physician-patient relationship is not a situation depending alone on the knowledge of the law of causality but that it is a coming to terms of the two persons, in which the physician tries to help the patient acquire a pattern that corresponds as much as possible to his nature. In this, he must always bear in mind that any interference affects the essential nature of another person and thereby his freedom (341).
It can be seen, then, that action leads not only to (a) a deeper understanding in general, but also to (b) a deeper understanding of the nature of the specific organism in question. Further, the impossibility of grasping the phenomenon of disease without introducing the factor of freedom discloses an important attribute of man, namely (c) recognition of his potentiality for freedom, his necessity to realize his nature by free decision. And what is true of action in the case of human beings – the responsibility for the specific nature of a patient – exists in a similar manner in dealings with any living being whatsoever (342).
Thus, the discussion on the nature of health and disease leads one to topics that are usually far removed from biology: the issues related to freedom and responsibility, i.e., issues that belong to the spiritual sphere (342).
On Anomaly and Species
Goldstein now takes on a (very tentative) analysis of the concept of “anomaly”. Anomaly, he says, always represents a deviation as to content from a norm so defined. It differs from disease in two ways: (a) it does not necessarily entail a shock to the individual’s being; and (b) it requires for its understanding, beside closer reference to the individual proper, reference to a larger social unit (342-3). Of course, disease also requires reference to social relations, but in anomaly this reference is more primary – it can be understood only in reference to a “superindividual” norm (343).
It is precisely on account of this reference to a larger social unit, that investigation of anomaly is particularly problematic. Namely, in order to transcend the faulty atomistic conceptions of “superindividual” entities, which dominate the field, one would have to – as was the case with the individual whole – arrive at the “prototype” of this more comprehensive “entity”. However, such an attempt is beset with difficulties still greater than the ones encountered when trying to account for the individual organism (343).
One might provisionally accept Uexküll’s definition of the species as that number of different individuals that, when crossed, can still produce offspring, capable of living and propagating. One notices that, in this definition, as in the definition of the individual norm, the potentiality “to be” is the basis for the determination of the prototype; however, the idea of “to be” is rather sketchy. In general, concepts pertaining to various superordinated wholes – “tribe”, “family”, “race”, etc. – , are yet to be defined. One of the main issues in such an endeavour is whether they are genuine forms of Being that facilitate the understanding of the individual Being (343).
Anomaly, Goldstein says, has to be considered in two respects: (a) from the perspective of the wider “entity” to which the anomalous individual belongs by “nature” (= humanity); (b) from the perspective of the more specific community in which he lives (= nation, race, etc.). Of course, (a) will be simpler than (b), although far from devoid of difficulties. Namely, one has to avoid prejudices that loom large in most attempts to study foregin (especially “primitive”) cultures, and strive to acquire as comprehensive an understanding of human nature as possible. Thus, it is imperative that, when studying an individual phenomenon, we do not isolate it artificially from its natural context, but refer to the total pattern to which it belongs: by doing so, we realize that many phenomena that seem “inhuman” from our narrow, culturally biased perspective turns out to be very human (344)!
Goldstein is concerned by the fact that, in his time, the holistic approach – alongside terms such as “essential nature” and “holistic reference” – has been gravely (mis)appropriated by many authors, whose work is not scientific, but clearly ideological. Such approaches, deeply imbued with political creed and bias, introduce unscientific notions (e.g., pure blood, etc.) to their narratives, which is not only dangerous, but further obfuscates the attempts at understanding (b) – e.g., “race”, “nation”, etc. – above:
“Such confusions regarding the judgement of [say] the nature of ‘race’, or even the decision as to whether such a thing as race exists at all, make a correct judgement of anomaly particularly difficult. This judgement would require scientific fundaments that we do not as yet possess.” (345)
Heredity and Breeding
Goldstein’s main point is that the atomistic interpretation of hereditary processes is completely analogous to the procedure of reflexology. Mendel’s experiments have definitely significantly improved our knowledge regarding heredity and partitative characteristics, but just as there is no way from the reflexes to an understanding of the organism as a whole, so also there is no direct way from partitive characteristics, which genetics singles out, to an understanding of the genesis of the individual (346-7).
Special peculiaritiesthat are found in the organism do not represent discrete characteristics, but gain their significance only if considered within their functional “belongingness” to the whole of an individual. Already in the results of the atomistic approaches in the field of genetics, total characteristics of the organism become manifest. For example, the mere fact that dominant and recessive factors exist suggests that some factors are more related to the essential nature than are others. The dominant factors are, for instance, traits that are related to what we have called the “constants”. However, these constitute the individual only in the respective concatenation as given through the greater or lesser effectiveness of recessive factors. The reason why this gets often overlooked in contemporary experiments is because they are conducted on animals and plants, where it is difficult to grasp such a thing as individuality, but also where our view is so biased by our interest in artificially selected elements (e.g., certain individual traits, etc.) that the experimenter therefore sees only those. Such a view, Goldstein maintains, is in accord with the more recent views of the more acclaimed geneticists (Wilhelm L. Johannsen, Herbert Spencer Jennings, Heinrich Poll) (347-8).
One of the main errors of the (atomist) geneticist, then, is to apply the laws deduced from breeding experiments in plants or lower animals to human beings. This error owes its origin particularly to the failure to recognize the atomistic character of the isolating method. For the most part, the experiments that genetics has carried out were not really experiments in heredity (in the sense of an experimental observation of the natural genesis), but rather experiments in the drill type (cf. 380 ff below). As such, they are useful only insofar breeding is not concerned with the knowledge of the essential nature of creatures but rather with cultivating specific traits useful to man (348).
Now, if the task of human genetics and eugenics were to breed human beings with definite traits, irrespective of man’s essential nature – in Goldstein’s view this is decidedly not the case -, such drill-type experiments (in, say, plants) would be applicable to human beings. But even then, Goldstein warns, it is very likely that the atomistic approach would yield little success, because it is highly dubious whether human beings could live in the border situation in which the pertinent experiments would place them. Since one of the essential traits of human beings is individuality and freedom, it is possible that, in the context of such experiments, the capacity limits of existence would be overstepped (349).
What about the approach that aspires to meliorate the human race by eliminating the unfit individuals? Such an approach would necessitate a thorough knowledge of the significance of individual peculiarities for human natures – and who, asks Goldstein, would venture any decision in this respect at the present state of research? (Example: manic depressives: who could doubt the capability if not superiority of many an individual with greater or lesser manic-depressive predispositions?)
In general, when faced with an anomaly, society has to find the milieu best suited for the anomalous. It has to do this in order (a) to protect itself from the dangers of anomaly and (b) to enable the anomalous individual to exist. Goldstein maintains that (a) and (b) are actually in perfect congruence: the society has to protect itself only insofar as the anomalous individual does not live in the proper milieu; if he lives in a proper milieu, he is not dangerous, because he is in an ordered state (350).
Discussion
The following topics were pointed out during the discussion:
I) We posited that human individuals do not create an adequate environment for themselves through direct interaction with the world. Adequate environments for people are created by the collectives – superindividual structures like the educational and healthcare institutions, etc. Instead of coming to terms with the world, we do so with artificial (one could even say laboratory) milieus. Human environments are complex due to their diversity, fragmentation and our constant production of new ones. Our individual norms are hence complex as well and are expressed in specific behaviours that result from person’s adaptation to a certain milieu.
With that in mind, what comprises the whole of human being? Must culture, the individual’s social milieu, be included? Goldstein is hesitant to do so, offering a comparison between social restraint and individual affective norms. Is a project that a person carried out in accordance with social constraint (that is, for the most part, restrictive) comparable in its fruitfulness to intentional implementation of one’s individual norms?
Collectives can be considered a form of freedom, too. This freedom, however, hinders the individual’s self-actualization to a certain degree. Plessner nevertheless emphasizes the importance of culture, maintaining that individual’s actions only become meaningful in its context. In collectives we try to actualize our nature by interacting with one another and thus we form culture. Culture is simultaneously the world we create based on nature and other from nature because it is our creation.
II) In light of renewed interest in transhumanism in China (e.g., using targeted genome modification (CRISPR-cas9) to lower child’s susceptibility to a certain disease; there are also more generally approving attitudes toward old-fashioned eugenics programs that aim to “enhance the nation”), we discussed its potential benefits as well as its perils. Yuval Noah Harari and Oliver Sachs, for instance, warn about a possible future situation where only the wealthy segments of society could afford such techniques. In line with the example Goldstein gives, we then questioned the society’s endeavour to eliminate various anomalies in mental health, such as manic depression. Such stance is problematic because it implicitly refers to an idea that a normal person corresponds to a certain philosophically founded ideal. While the prospect of eradicating some somatic diseases such as cancer is universally agreed upon, there is no such consensus when it comes to the mental realm. A century ago, eugenicists tried to prevent procreation by law in a broad category of people that were deemed mentally unstable. On the other hand, many renowned works of art might never be created if cure for depression was discovered, say, two hundred years ago.
One of Foucault’s inspirations was Canguilhem’s writing, and Canguilhem took some of Goldstein’s arguments for starting points in his work. We compared their views on what is anomalous. Goldstein suggests that the society “will have to find the milieu best suited for the anomalous […] to protect itself from the dangers of anomaly and at the same time to enable the anomalous individial to exist,” stressing that “the society has to protect itself only so long as the anomalous individual does not live in the proper milieu; if he lives in a proper milieu, he is not dangerous, because he is in an ordered state.” As a doctor, he wanted to keep the discussion about pathologies inside the biological context. Foucault’s approach is Jaspersian, arguing that labeling somebody as lunatic stems from our incomprehension of their nature. Canguilhem’s stance is roughly somewhere between the two. We raised following questions:
i) How will the contemporary trends in left discourse cope with with the anomalous? In order to help and provide the anomalous individuals with an adequate environment, they first need to be recognized in some way. How can the latter not be considered an act of a marginalization?
ii) What is a dangerous anomaly?
iii) What place would prisons take in Goldstein’s philosophy? Is their purpose to protect the society by sequestering the individuals who are considered a threat to it or to rehabilitate such individuals in order to facilitate their reentry into the society?
III) Goldstein states that there is no perfect compensation in rehabilitation from a severe injury or in management of a chronic illness. The old individual norm is no longer attainable, but the organism can learn to function in accordance with its new norm. In some situations, however, “a severe bodily impairment already exists, but consciousness of the condition has not yet disappeared. […I]ntense psychological conflict may arise. Then we find the tendency toward self-destruction as the ultimate possibility of adaptation, although fatal for the individual. And therewith, suicide occurs as an expression of the most serious catastrophic shock, caused by the realization of the impossibility of existence.” We speculated whether we could stretch this citation and claim that self-destruction is the ultimate adaptation in a cosmological sense as well: Energy is more or less evenly distributed throughout space. Living creatures, however, manage to temporarily defy the second law of thermodynamics – they accumulate energy in order to create an energy gradient that makes work possible. Self-destruction dissipates such organismic accumulations of energy, obliterating the living beings’ resistance to the entropy. An organism thus conforms to the second law of thermodynamics, it adapts to the entropy.
Setting aside our thought excursion, Goldstein’s note is in contrariety with Frankl’s philosophy of “finding meaning in life even when confronted with a hopeless situation.” But is Frankl’s appeal justifiable if the discrepancy between a person and the world is way too severe for them to adapt adequately? The path that Frankl describes is tremendously demanding for such an individual. Establishing a new norm (i.e., finding meaning beyond the present misery) may prove as too abstract. We construct an identity for ourselves based on our projects. When we are no longer able to enact them, we lose our nature.
But suffering is not absolute. A prominent source of it, aside from pain, lays in comparing self to others or to the past image of self. It is often a major factor in the impaired person’s ability to form a new norm by which to live. For example, the able-bodied usually find it problematic to imagine how tetraplegics can bear on with their existence. But it is possible to reconcile even with an impairment of such severity, given that an individual does not dwell their memories or compare themselves to the able-bodied.
IV) In some societies with shamanic traditions, schizophrenia is not considered to be anomalous or even pathological. Interestingly, the developmental course of the condition is influenced both by the individual’s psychological and somatic predispositions and by how the society contextualizes it. A schizophrenic is thrown into their experience. A schism exists in their self, they simultaneously live in the ordinary world and the world of various sensations, disjoint from the first. In some societies such a person manages to meaningfully integrate their visions, inner voices, etc. into their way of living – they may, for example, become a priest. Here, we cast a doubt regarding the incidence of schizophrenics-turned-shamans, as shamans are seen as reasonable and sober individuals; their medicinal and/or ceremonial work requires making thoughtful decisions (for instance, ritual use of psychadelics is carefully supervised by them). But we might have a skewed view due to the picture we get of schizophrenic functioning in our society: since they often have no opportunity to actualize themselves, their condition turns pathological. Their world starts to fall apart as they are unable to ascribe any meaning to it. The schism (or diaphor) in mind, soul or reason gapes widely.
Can our society find a way to help the schizophrenics with carving out an adequate environment for themselves? History provides us with examples of sheltered environments that enabled such individuals to thrive, e.g., the Delphic Oracle. A habitat alike is hardly to be found at present day. People with schizophrenia are heavily medicalized in aim to make them as functional as normal members of society are and/or are recurringly admitted to psychiatric facilities. From the viewpoint of evolutionary psychology, such approaches are heedless: we cannot just do away with certain human conditions – in the process of natural selection, they have become a part of human framework. So what is an alternative? One of our thoughts was, were the stigma of the schizophrenic condition not so encumbering, they could find the arts as a suitable habitat.
