Keywords

1 Introduction

In the late eighteenth century and throughout the nineteenth century, the classical epistemological status of vitalist powers as “extra-causal agents powering the living body” (Wolfe 2008, 461) began to be transformed through reinforcing epistemological skepticism as a driving force for reproducing vitalist arguments (Benton 1974, 18,20). Observing that physiological functions as “too intimately intertwined to be quantified according to purely mechanical laws of force and motion” (Wolfe and Terada 2008, 552), this launched the “systematic negation of strictly linear causality in explaining health and disease.” (ibid) The shifting ontological status of vitalist arguments determined the split in accepting the potential (and indisputable) cognizance of vital phenomena and claiming the necessity of such argumentation as a “covering law.” (Osborne 2016) Vitalism began operating as “an intermediate, pragmatic position located in between two metaphysically rigid extremes,” (Wolfe and Terada, 2008 543) namely, mechanism and animism.

The “irreducibility of the knowledge about vital forces to a nomothetic explanation” (Huneman 2008 619) became a shared assumption for the various movements within medical vitalism, which fixed its role for the next generation of thinkers who theorized health and pathology in the contexts of evolutionary biology and genetics. Moreover, the animal economy, a defining concept of medical vitalism (Wolfe and Terada 2008 548), introduced the active language of function and of usage, which was opposed to the static, atemporal character of purely anatomical approaches (ibid 549).

Along with focusing on the complexity of the connection between actions and efficient causality, medical vitalism started differentiating irritability and sensitivity, which not only assisted in avoiding reference to a soul in the debates about the causes of mental diseases (Huneman 2008 617), but also precipitated a transition from a rationally devised vision on the developing organism to the investigation of an irrationally developed entity (Benton 1974 22,35). In terms of agential thinking (Okasha 2018 18), this trend nurtured a powerful platform for attributing to vitalist forces both negative and positive value to an organism.

The established interconnection between a skeptical vitalist view of explaining disease and the ascendency of a “cautionary” view on vital forces as potentially dangerous may be viewed as the primary tool for the survival of vitalist arguments and their conceptual continuity (Shan 2020 138) in theorizing health and pathology in the twentieth century. This text brings into focus the strong historical connection between the arguments introduced by medical vitalism, and their applications, and the arguments developed by biologists and theologians in the 1960s and 1980s.

In the late 1960s, ascribing destructive value to vitalist forces operated as a central assumption in different views on health and pathology and their role in human evolution. Anne McLaren (1968), one of the most publicly recognized reproductive biologists in the late 1960s, underscored in her preliminary article for the special issue of Contact, a journal affiliated with the British and Irish Association for Practical Theology that :

Even after millions of years of evolution, frogs return to the water to spawn; seals return to dry land to breed. Although most people seem reasonably content with the way in which we reproduce our species at present, recent advances in biological understanding make it certain that we shall soon be able to exercise much greater control over the processes of reproduction. (McLaren 1968 13)

Georges Canguilhem (1988), a philosopher and physician, asserted: “In distinguishing biological variety from negative vital value, we have, on the whole, delegated the responsibility for perceiving the onset of disease to the living being itself.”Footnote 1 Ivan Illich (1974), a philosopher and priest, challenged such a view: “[We] adapt to the stress of the second industrial revolution and over-population …this kind of survival with fear adaptability is also a heavy handicap: the most common causes of disease are exacting adaptive demands.” (Illich 1974 83)

I explore and offer critical reflections on the widespread practice of attributing negative value to vital forces in debates on health and pathology, as a direct result of the extensive dissemination of genetics and molecular biology and its implications since the late 1960s. The migration of genetics into the practice of reproductive politics on national and global levels had played a central role in reinventing the well-known debates from the interwar heyday of eugenics in the twentieth century about the criteria for health and disease, normality and abnormality. These debates around the dichotomy between the individual and the social space put into question the future of humanism and consequently the future of religion (Deane-Drummond 2012, 29). The exchange between scientific and theological arguments regarding heredity became a leading forum for shaping the variety of views on eugenics and its measures, as in the early 1930s. Since the 1960s, along with the flourishing of human genetics and its recruitment to various policies, these debates began to involve the most prominent representatives of both camps and to be widely disseminated. While Wolfe and Terada have called for attention to the recurring features of vitalism as non-doctrinaire, and the coherence that occurred in the late eighteenth and nineteenth centuries (Wolfe and Terada 2008, 542), this text aims to provide a philosophically informed historical reconstruction of vitalist arguments since the 1960s, as a construction mobilized for solving multiple issues concerning genetics and its social and ethical implications. These debates between theologians and biologists reflect the most significant turns in the resurrection of vitalist arguments after the Second World War.

2 Methodology

This text focuses on the most heated debates published in popular science periodicals, which have the longest-lasting public “echo,” and which have shaped intergenerational continuity in the reproduction of vitalist arguments in discursive practices regarding health, disease and the contribution of genetics . It addresses three streams of debates at the international level that focused on vital forces as decisive risks for humanity and its collective health between the late 1960s and 1980s: (1) the denial of “quasi-animal” reproductive patterns of “backward” people and societies, which connected human genetics with the longue durée of developmental idealism, and reinforced the division between doctrinal (systematic) theology and various theological interpretations of genetic arguments and their implications; (2) the deconstruction of the binary opposition between the norms of health and pathology in the approach invented by Georges Canguilhem and his successors, Michel Foucault and Gilles Deleuze; and (3) the rejection of genetics as a part of modern medicine in the movement for deinstitutionalization spearheaded by Ivan Illich and his supporters. The historical reconstruction of these debates provides the methodological grounds for answering the question: “How did the argument stemming from ascribing negative value to vital forces operate and develop in different cultural and political contexts?” Such reconstruction is motivated by the mission to move from the general and almost non-historical concept of “knowledge circulation” to a philosophically informed historization of medical science.

I reconstruct the history of vitalist arguments through a Lakatosian division of the history of science into internalist (“repertoires of thought, action, and technique, that shape the organisation of scientific inquiry”) (Knorr-Cetina 1999) and externalist (social, cultural, economic or political conditions make scientific progress possible) narratives (Lakatos 1970). The scientific “career” of vitalist arguments is embedded in the struggle of medical science for its legitimacy, often sought by rearranging of the dichotomy between holism (or organicism), and mechanistic models of explanation.

This struggle cannot be attributed wholly to either the internalist or externalist history of medical science. In the 1960s, the rapid rise of human genetics confronted an increasing contest between Mendelian and Lamarckian explanatory schemes to integrate the role of the environment in development and evolution (Koonin and Wolf 2009). This struggle included a whole range of possible arguments, including a long-lived theoretical and empirical rivalry between major research programs in human genetics (the internalist history, in Lakatosian terms), as well as various efforts aimed at rearranging the boundaries between genetics and eugenics in favor of legitimizing genetics (the wholly externalist history). Introducing vitalist arguments into this contest diversifies the models that explain the interconnection between nature and nurture. I connect the arguments for ascribing negative value to vital forces (internalist history) to their operation in the debates between geneticists and theologians that addressed the societal role of genetics (externalist history). The reproduction of vitalist arguments in these debates fixes the multifunctionality of such arguments.

The Bhaskarian taxonomy of negation into “real” (which creates a distance between animals and humans in their patterns of reproduction), “transformative” (which reconstructs the pre-existing binary opposition of health and disease into a scale for measuring the degree of normality and pathology), and “radical” (which welds biology with a well-disseminated, exceptionally positive view on human adaptability as a driving force of institutionalizing medical assistance in favor of overcoming such dependency) types, which maps the internalist narrative of ascribing negative value to vitalist forces. Mapping the attacks on vital forces as various types of negation joins different debates in the historically interrelated repertoire of potentially rival approaches to health, pathology and the genetic contribution to health and disease.

This continuum connects the operation of vitalist arguments with their transformation in the nineteenth century and the challenges produced by rooting genetics in various practices of demographic policy since the 1960s. Since Bhaskar accepts real negation as the necessary ground for developing transformative and radical negation, the continuum of these approaches is seen as a reflection of the dialectics of a skeptical vitalism, which “takes an opportunity to develop to a systematic methodology aimed at testing the new facts and implications by multiple criteria.” (Benton 1974 18–20) Rather than being separate efforts in negating vital forces, their interconnection had become of the grounds for adaptation, for example, in the countries of Eastern Europe.

The imperative to revise the social and political contexts of genetics, or its externalist history, will be explained as a feature of the “control society,” a social order recognized as predominant, and which has replaced the previous “disciplining society” since the 1960s. Technoscientific development, including the achievements of biomedicine, a core driving force of the transfer to a control society, had shifted from the previous practices of forming individuals through placing them into institutional spaces of confinement by “modulating” certain “individuals,” to defining individuals as a part of “samples, data, markets or “banks’” (Patton 2018 205).

Playing a significant role in establishing the first biopolitical strategies of the eighteenth century, medical vitalism had populated the models that problematized the division between the “normal” and the “pathological” through various arguments targeted at the criteria and signifiers of health and disease (Rabinow and Rose 2006). The transfer from a disciplining society to a control society that called for rearranging the boundaries between genetics and eugenics began to be viewed as an agent of control society. The non-scientific production of knowledge provided an argument for or against a control society in which “tacit assumptions about the contents of science are forced to become explicit.” (Gieryn 1999 24) Paul Rabinow and Nikolas Rose (2006 211) underscore that “contemporary biopolitics operates according to logics of vitality, not mortality: while it has its circuits of exclusion, letting die is not making die.”

Thus, I trace the role of vitalist arguments in the boundary work engaged by biologists and physicians on the one side and theologians on the other. The goal is to learn “where they may not roam without transgressing the boundaries of legitimacy” (Gieryn 1999 16) of their position regarding the control society. I explore the operation of vitalist arguments in various forms of boundary workFootnote 2 through deconstructing multiple analogies between organism and society or, more generally, through connecting vitalism and naturalism as signifiers for specifying the contexts of adapting vitalist arguments within societies that experienced various degrees of geopolitical dependence.

3 The Longue Durée of Developmental Idealism: In Search of the Best Path Toward Human Perfection

Since the end of the eighteenth century, recognizing reproduction as a “conservative pattern for all [that is] vital” (McLaren 1968 13), produced a particular view of human beings. It did so through the lenses of controlling reproduction and the ability to engage in the self-control of reproduction as the next stage of evolution toward becoming more human: “If conception were to become a deliberate act in its own right, it would less often be undertaken irresponsibly. Perhaps conception might then be awarded the same moral status as birth and death receive at present.” (ibid 15).

During the interwar period, the dissemination of eugenic ideas and politics aiming to distance people from “backward” reproductive patterns attained the function as a sustainable supra-national ideology for establishing a global agenda of reproductive politics. These ideas and practices received their “second wind” in the 1960s within “genetic demography,” an interdisciplinary program for applying the achievements of human genetics to reproductive policies.Footnote 3 Along with the revision of the genetic causes of disease, health, and fertility, genetic demographers struggled with the inevitable stigmatization of their explanatory schemes (and of themselves) due to the close connection of those schemes with eugenics.

Managing the stigma of eugenics utilized various methods for reestablishing the boundaries between “good” and “bad” science, from the blatantly ahistorical opposition of “sober” eugenics and “perverted” Rassenhygiene among the geneticists who cooperated with German scholars, including the most prominent members of NSDP (Koch 2004 317), to attempts to reform eugenics as a useful tool for bringing together the social and biological realms of degeneration as processes important to understanding the vicissitudes of evolution (Ramsden 2006 7). This boundary work aimed at distinguishing genetics from eugenics as “the less reliable, less truthful, less relevant source of knowledge about natural reality.” (Gieryn 1999 16) This interpretation of eugenics did not mean to label it “ersatz,” but sought to extend its frontiers.

Such an expansion of scientific boundaries resonated with the evolution of the complicated history of eugenics as an agent of the disciplining society and its very palpable presence in the history of institutional violence against disabled people and minorities, to the more refined methods of control over reproductive behavior offered by genetic demography where, “Limiting population in the interests of national economic prosperity does not operate according to the biopolitical diagram of eugenics, and is not the same as purification of the race by elimination of degenerates.” (Rabinow and Rose 2006 210) The duality of this evolution was reflected in the two paradigms of genetic counseling: “genetic cleansing” and “informed choice” (Clarke 1997), which were disseminated with the aim to regulate reproductive behavior among less socially responsible societies that needed to remain under surveillance and more advanced social groups that required intermediate forms of social control that avoided the centralization of government (Dean-Drummond 2012 106).

The growing controversy over nature vs. nurture added to the role of vitalist arguments in revising the connection between genetics and eugenics and their implications. In his publications for the public, Joshua Lederberg called for reintroducing vitalist argument in the name of saving progress and avoiding its risks. Lederberg recognized in the mechanistic understanding of heredity (though the inevitable output of the progress of molecular biology) the threat of a monolithic and sophistic rationalization of fundamental human policy and the decay of medicine wisely dedicated to the welfare of individual patients (Lederberg 1966 519). The solution offered by Lederberg and his prominent colleagues was “euphenics”, an explanatory scheme that sought to rival both eugenics and Mendelian biology. Constructing disease as “any deficit relative to a desired norm” adherents of euphenics relied upon epigenetics to produce “the healthy genotype as the product of communicating between environment and humans.” (ibid 521)

The mission of euphenics would be to maximize the efforts aimed at treating individuals affected by genetic diseases through all possible means for ameliorating genotypic maladjustment. Bringing forward the role of adaptability in coping with genetic diseases brought this question to the fore: “How to identify the most adaptable genotypes now living and what is the price, to the detriment in special skills of this adaptability?” (ibid)

Euphenics relied on the “match of pragmatic expectations of the milieu of the individual and his descendants.” (ibid 524) Generally, euphenics was seen as a remedy for all the applications that totally failed within the framework of eugenics, such as genetic counseling. Even more, prioritizing euphenics should prevent the “grave danger that the minority view will lead to a confusion of the economic and social aims of rational population policy with genocide.” (ibid) Remarkably, the main concern regarding the risk of abusing genetic implications was “a disastrous impediment to the adoption of family planning by just those groups whose economic and educational progress most urgently demands it.” (ibid 530)

Despite the constant rivalry with eugenics, euphenics functioned as a kind of developmental idealism, a concept used as an umbrella notion for the complex of ideas, politics, and practices, including population genetics, which directly link the ideal of “modern industrial and urban society with high levels of education, wealth, and health” (Thornton et al. 2012) and proper demographic policy, “considered under four headings: decrease, increase, improvement and substitution.” (McLaren 1968 15) The negation of primal instinct as insufficiently human for progress and its risks achieved all the qualities of real, basic, negation in terms of the Bhaskarian approach. It attacked the absence of consciousness regarding primatal instinct and launched the process of distancing from uncontrolled reproduction (Bhaskar 1993). Negating primal instinct as vital but destructive became one of the main responses to the duality of attributing to humans the immanent qualities of social life, especially culturation and biological evolution. Duality in understanding humans as both animals and God’s children has shaped the Christian version of developmental idealism.

Developmental idealism, a secular Enlightenment paradigm arising from the European religious context (Nickolson 1990), has been accepted by the Roman Catholic Church, despite the rhetoric of the geneticists who often opposed scientific collective responsibility to the selfish individualism of Christian mercy regarding those individuals considered “useless.” Well-known Scottish geneticist Patricia Ann Jacobs (1968) simplified the complicated history of the relation between genetic and theological arguments in favor of achieving efficient control over human reproduction:

In discussions on suffering and the love of God, there is a traditional view that we need our weak brethren to develop our attitudes of compassion and thus become spiritually refined. To many scientists, such a view seems of monumental and repulsive selfishness… Many ethnic groups have exposed their defective babies after birth, but now genetic knowledge can predict and detect many such children in good time and take remedial action. (Jacobs 1968 20)

Along with the proliferation of eugenic movements since the end of the nineteenth century, those associated with Christian churches embraced a wide range of positions in relation to the debate over strict control over reproduction. While the attempts to resist eugenic movements from the side of Christian associations and clergy were fragmented and based upon ethical concerns,Footnote 4 the acceptance of eugenic ideas among theologians, priests, and, even more, elite clergy established an intersectionality between theological arguments and eugenic ideas that transformed Christian epistemology. Despite the historically controversial bifurcation of negative and positive eugenics between Protestants and Catholics (Gillette 2014), Christian epistemology tied together the various driving forces that determined the wide range of strategies to put together religious and genetic arguments in favor of humanity as an exceptional quality, to be protected from the barbarity of those who remained more animal than human.

Opposing humans and animals fit well with the racial hierarchies that often included the distance between a particular “race” and the ideal of humanity as an argument to justify negative eugenics: “The races are different and, measured against certain ideals, may be more or less capable of striving towards these ideals.“(Muckermann 1934 29) Agostini Gemelli and Hermann Muckermann, two Catholic priests and prominent eugenicists, embraced mutually polar positions regarding forced sterilization (Dietrich 1992),Footnote 5 but both consistently developed an argument in favor of limited dynamic and vital racial “intermixtures,” in contrast to widespread negative opinions concerning intermixture with “aliens,” which were perceived as dangerous to the interest of “domestic raciality” (Heimrassigkeit) or Italian “purity” (Turda and Gillette 2014).

This motive dovetailed with the prioritization of improving the health of the nation. Muckermann explained the necessity to introduce forced sterilization, defined by him as “un-fertilization” (Unfruchtbarmachung), by referencing the vital interests of the German people: “Ethical concerns are therefore out of the question, because consideration for the common good requires this addition to the existing measures to maintain the health and work endurance of the people.” (Muckermann 1934 124) The mission to prevent hereditary diseases (schweren Erbleiden zu verhüten) inclined Muckermann to weld together not only neo-Lamarckian and Mendelian explanatory schemes for pathologies, but also to also label hereditary factors as given by Mother Nature (ibid 135), all in favor of stressing the impossibility of preventing so-called malformation in ways other than forced sterilization.

Remarkably, he built this argument through the division of families into “unnatural large families” (unnatürliche Großfamilie), “unnatural dwarf-families” (unnatürliche Zwergfamilie) and “true-to-nature normal families” (naturtreue Normalfamilie) (ibid 136). Only the last category was acceptable, able to bring religion and eugenic arguments together in mutual accordance in favor of a sustainable practice of health (ibid 157).

Blurring the boundaries between genetic and religious arguments for promoting developmental idealism had become a long-term trend, along with the regular attempts of the Roman Catholic Church to reestablish Christian views on reproduction and the ways to intervene in it. Between 1930 and 1995, the Catholic Church issued three different Encyclicals aimed at limiting the dissemination of eugenics and genetics-based politics.Footnote 6 Nevertheless, the preparation of these documents was accompanied by debates among Catholic experts that blurred the unity of the Catholic position regarding the regulation of reproductive policy. For the Catholic Church, the argument developed by the Methodists and accepted by Catholics (Ramsey 1970), shifted slightly from the non-acceptance of eugenics and genetic improvement as a dangerous practice of “playing God,” to moderate acceptance of the idea which posits “ourselves as in some sense co-creators with God.” (Deane-Drummond 2012 30) Seeing humans as “created co-creators” (Hefner 1993 37) reinforced the view on genetic medicine as a possible ally in the struggle by the Church for healthy “normal” families, putting the Roman Catholic Church in the position of “theologian interrogation of genetic science or conversation partner.” (Deane-Drummond 2012 29). In his salutary exhortation to the participants of the Twentieth International Conference on “The Human Genome,” Cardinal Javier Lozano Barragán claimed:

[W]e will start from the consideration of the genome as the structural element that organizes the human body in its individual and hereditary dimensions; it involves the set of genes, but it goes further to embrace all the other elements that together with genes constitute the original energy to develop through all existence and which signify the key mystery of human life. (Barragán and Lozano 2005)

This fundamental dualism, “which also positioned the Roman Catholic Church unconditionally on the side of the good,” was reinforced in a UNESCO report on culture and development (1995), which claimed “religion appears to be a resurgent force in human affairs today.” (Sjørup 1999 389)

One of the most visible outputs of this trend has been reestablishing the mission of Catholic Church (Deane-Drummond 2012 46) to balance the priority of the truth of scientific knowledge with the ideal of humanity as dependent on God. Since the late 1960s, in scientific and Catholic versions of developmental idealism, the uncontrolled instinct toward reproduction began to be viewed as similar to the risks of nuclear war and other ecological hazards directly linked with population growth (Castel 1973; Ornstein and Lederberg 1967).

In 1968, the editor of Contact wrote in an introduction to a special issue aimed at shedding light on the contest between scientific progress and the threat of non-civilized reproductive patterns that, “If we fail to control population size we may expect not only increasing dangers of famine and damage to our natural environment but a far-reaching erosion of privacy and self-respect.” (Contact 1968 13) The eschatological theme stemming from this non-doctrinal theology was balanced by the new official Catholic rhetoric on the interpretation of the sexual act as “a performance of love and dignity, valued and irreplaceable part of harmonious parenting and family life,”Footnote 7 part of the systematic “transformation of natural law under the new idea of love” (Deane-Drummond 2012 32) begun in the 1970s. This started the processof “develop(ing) theologically informed ethics which would be accepted by people.” (ibid 35)Footnote 8

This framework continues to underpin developmental discourse on religion, in contrast to a situated knowledge about religion “which is not blurred by Eurocentric universalist epistemologies.” (Sjørup 1999 406) But what are the options for negating these epistemologies for those who implement them? George Canguilhem and his colleagues focus on the binary oppositions of health vs. disease and norms vs. pathology in order to transform the approaches to the human individual and space in favor of balancing the interests of society and individuals, and medicine as a mediator between them.

4 Normative Vitalism: Transformative Negation of Medically Proven Imperfection

In his critical reflections concerning the strict opposition between health and disease in Western medicine, Georges Canguilhem aims at deconstructing the accusations of medical professionals concerning the faults in theories and the institutional violence resulting from such faults: “Is this a question of biology or parasitism of biology?” (Canguilhem 2009 72)Footnote 9 This question stems from the personal experience of Canguilhem, who had participated in the French Resistance and who grasped the interrelation between European medical traditions and Nazi medicine. Canguilhem introduced the concept of “scientific ideology” in order to reconnect internalist and externalist histories of sciences, or more precisely the history of medicine, to clarify the interrogation between science and society. To him, scientific ideology operates as “aligned with an already instituted science whose prestige it recognizes and whose style it seeks to imitate” (Canguilhem 1988 44), but generates its own norms of “scientificity” (Elden 2019 132). Science remains connected to and infiltrated by one or another scientific ideology.

Through his historical inquiry, Canguilhem traces the interrogation between science and scientific ideology to elucidate the role of global societal changes in shaping the research agenda for biology. Canguilhem explains the acceptance of the Malthusian view on population politics by Darwin through the transformation from agrarian capitalism to industrial capitalism, as the main historical context for the scientific ideology of the “struggle for life,” with its imperative of free competition (Canguilhem 1988 100). Other remarkable examples of the interconnection between biology and scientific ideology include a class-based explanation of division into neo-Lamarckism and Mendelism that Canguilhem had brought into focus. He underscores that Lysenkoism was correct to suggest that it was possible to change the hereditary constitution of the organism, but he does not accept the political arbitrariness with which the authorities dealt with geneticists who were labeled as the enemies of the Soviet people. In a quite provocative way, Canguilhem defines Mendel “as the head of retrograde, capitalist, and idealist biology.” (Canguilhem 2009 149) Expressing such an extreme view on the division into neo-Lamarckism and Mendelism reflects not only Canguilhem’s political affiliation, but also his intention to support an explanatory scheme that remained in the shadows for political reasons.

It is plausible to argue that Canguilhem accepted the call to emancipate biology from wide range of scientific ideologies as a way towards the protection of autonomy: a “kind of boundary-work results from efforts of outside powers, not to dislodge science from its place of epistemic authority, but to exploit that authority in ways that compromise the material and symbolic resources of scientists inside.” (Gieryn 1999 17) The task to emancipate biology from scientific ideology is complicated, according to Canguilhem, because “biology has taken concepts from politics, and it may be that here politics is simply taking them back.”(Canguilhem 2009 98)

Gieryn compares the efforts of scientists to prevent science from becoming “a hand-maiden to political or market ambitions” with establishing “interpretative walls to protect their professional autonomy over the selection of problems for research or standards used to judge candidate claims to knowledge.” (Gieryn 1999 17) The bulk of Canguilhem’s reflections can be interpreted as a kind of wall-building aimed at emancipating biology from one of the pillars of developmental idealism, the overarching contradiction between health as the norm and disease as pathology. The role of science in the appearance and disappearance of scientific ideologies remains a primary framework for critical writings by Canguilhem, with vitalism as a driving ontological assumption that would redraw boundaries between what medical scientists do and “consequences far downstream – the possible undesired or disastrous effects of scientific knowledge.” (ibid) As an alternative to “the susceptibility of medicals to ‘error’, sickness and pathology,” (Osborne 2016) Canguilhem redefines the processual dimension of human life because life itself invents and invests in norms.

Canguilhem may be aligned with the long and extended tradition of French naturalism, namely, providing analogies between physiology and medicine on one side and sociology and social science, more broadly speaking, on the other. Even more, Giuseppe Bianco (2013) explains the transfer of Canguilhem from rigid, rational, and mechanistic Cartesianism to a particular kind of vitalism through his involvement in the contest between two rival traditions informed by vitalism, the philosophy of concept and the phenomenological subjective analysis of experience. But which of these traditions prevailed in Canguilhem’s thought? It is noteworthy that the answer varies depending into which philosophical and historical contexts Canguilhem is situated.

Bianco focuses on the role of Alain’s philosophy in Canguilhem’s devotion to vitalism to highlight his critical response to the tradition of French naturalism and specifically to the multiple analogies between the human body and the body of the state, since both practice a hierarchy of obedience to certain social laws, which, in turn, obey biological laws. Canguilhem’s position is described as only partially accepting of such parallelism, operating “as an instrument devoid of an intrinsic teleology but with a teleology given to it by man (Bianco 2013 265).” Pasquinelli (2015), who claims that German Lebensphilosophie and the catastrophe of Nazi Staatsbiologie is the only context for understanding the intransigent position of Canguilhem against norms, recognizes that “Canguilhem is keen to deny any dominant function by a superior power and he recognizes the logical primacy of the abnormal over the normal.” (ibid). Exploring the normative vitalism by Canguilhem as transformative negation of destructive vital sources can add nuance to this debate.

Canguilhem’s rejection of violent intervention in biological laws by the means of social norms stems from the intention to “not change the powers, but rather render them rational” (ibid 260), and perfectly aligns with the core of transformative negation, namely, negating the source of the existential incompatibility between the elements of the totality, but not the totality itself (Bhaskar 1993 58). Since transformative negation often considers previously established stratifications as giving rise to internal contradictions, it seeks to transform not the whole subject of negation but that particular element in which change is decisive for overcoming the contradiction (Creaven 2002 86).

Canguilhem seeks to transform the opposition between health as a “normal” status and disease as a manifestation of pathology into a more refined scale of health/disease statuses, which he considers a demandable tool for the progress of medical knowledge and its implications. Canguilhem embedded this task in the mission to revise the impact of physiology producing knowledge of the body as a machine, as one of the primary grounds for institutionalizing medicine (Bianco 2013 256).

In this way, he follows the doctrine by Francois Broussais, whose systematic critique of the nosological viewpoint of Canguilhem, together with Michel Foucault, recognized the grounds for the systematic deconstruction of an essentialist view on health and pathology (Williams 1994). Canguilhem first developed his argument in 1943 in his MD thesis, The normal and the pathological, in the late 1960s. He revised his text as a critical reflection on the growing influence of developmentalist agenda of medical science. Apparently, Canguilhem used all the dialectical tools available to him to resolve the internal contradictionFootnote 10 between accepting all that is vital and attributing negative value to some of its manifestations, such as well-known diseases from Broussais’ time (Williams 1994 169).

In line with the Broussainian holistic intention to view “human beings in the lack of absence of health” as a performance of variation, Canguilhem directly defines biological normativity “as a response on the absence of impossibility of [biological] indifference.” (Canguilhem 1991 105) The idea of normativity serves the dynamic concept of health significant to Canguilhem, who rejects perfect health in favor of understanding health as organic well-being.

Instead, through two extremes, norm and pathology, Canguilhem divides anomalies into varieties (minor deviation), structural defects (deformations of a more significant kind), “heterotaxy” (complex structural shifts that nonetheless do not impede function), and monstrosities (both complex in appearance and serious in impairment) (ibid 109). This scale not only prevents thinking about anomaly in terms of general ideas on harmful or, even more, mortal deformities, but also separates extreme cases of monstrosity and places them in opposition to anomalies. While deviations are seen within normativity, the monstrous “holds to a different logic, a chaos of exception without laws, an imaginary, murky and vertiginous world.” (Canguilhem 2009 184)

Ascribing monstrosity with rarity reverberates with Canguilhem’s expectations that medical scientists and practitioners describe phenomenon in objective terms, as well as the impossibility to pass judgment based on a purely objective criterion: “only varieties or differences can be defined with positive or negative vital values.” (Canguilhem 1991 200) Lorna Weir (1998) explores the strengths and weaknesses of this conceptualization for prenatal diagnosis and achieving more sensitivity toward the needs of mothers.

While, according to Weir, Canguilhem’s approach “serves as a corrective to ideological criticism of the life sciences which fails to have a concept of cultural differentiation,” it fails with regard to “the understanding of the interactions between scientific and non-scientific culture.” (Weir 1998 256) Weir observes that biomedical rationality absorbs and subdues cultural contexts, instead of individualizing medical judgement in favor of the autonomy of patients, through the claims of physicians and scientists shaped by the concurrent medical ideology.

Claude Debru explains that there exists an antinomy between normativity and autonomy and the inevitable development of disease through which normativity and the dynamic concept of health have ceased to matter (Debru 2011 7). Ivan Illich had offered a more fundamental explanation for the loss of autonomy by contemporary people: “[Modern] man is the animal who has lost his instinct and it desperately dependent upon such extra-genetic, outside-the-skin control mechanism without which human behaviour would be ungovernable.” (Illich 1974 88)

5 Vital Human Imperfection: Unending Vulnerability vs. Lethal Adaptation

Ivan Illich, one of the most radical critics of the institutions of modern society, starts attacking the submission of medical science to the task of controlling people immediately after developing his campaign for “deschooling” people whom he saw as “the victims of an effective process of total instruction and manipulation once they are deprived of even the tenuous pretense of critical independence.” (Illich 1970 11)

Illich recognizes medicine as another agent of “paralyzing life” - through impeding people “to search perfect health” (Illich 2017 287).Footnote 11 Historian Barbara Duden explains the intervention of Ivan Illich with the debates regarding human health and disease through a particular moment in history when one agency, namely medicine, achieved a monopoly over the social construction of bodily reality (Duden 2002 222). Illich caustically suggests that all Christians would complete their daily prayer by saying: “Lead us not to succumb to diagnosis, but deliver us from the evils of health.” (Illich 2017 290)

His call for demedicalization may be recognized as an expulsion, boundary work that opposes “orthodox science against heterodox, mainstream against fringe, established against revolutionary.”(Gieryn 1999 17) For Gieryn, expulsion does not aim to challenge or attenuate the epistemic authority of science itself, but rather to deny privileges to the space of science. Illich aims to deny the monopoly of medicine in ordinary life in favor of “autonomous confidence in biological vigour, the wisdom of traditional rules, and the compassion of neighbors.” (Illich 1974 92) The initial argument against medicine, an inevitable transformation of “the human being who needs healthcare in a subsystem of the biosphere, an immune system that should be controlled, regulated and optimized, as ‘a life,’” (ibid 107) moves far beyond the traditional opposition of mechanism vs. vitalism and rearranges the already mentioned positions regarding health, disease, and human perfection.

In contrast to mainstream Christian theology and aligned with the Kierkegaardian tradition of negative theology, Illich places the complicity of the human and animal nature of “man” as a product of civilization at the center of his argumentation. For Illich, the fundamental distinction between animal and human health is the positioning of pain, impairment, and death as a gift of human culture (Illich 1974 90). He explains the unique role of pain in the human experience by its function to give rise “to a cultural program whereby individuals could deal with reality in those situations in which reality was experienced as inimical to the unfolding of their lives.” (ibid 94) Besides the anxiety over the nature/culture boundary, personal attention and shared interpretation equip the individual to make pain tolerable, sickness understandable, and the life-long encounter with death meaningful. Illich focuses on the social and political functions of facing and experiencing pain to set limits on humanly constructed abuses when these became intolerable. However, “the modern cosmopolitan medical civilization denies the need for man’s acceptance of pain, sickness and death.” (ibid 90)

Illich explains the sustainable struggle of medicine against pain with the intention to gain power: “Pain only the part of human suffering over which the medical profession can claim competence or control.”(ibid 96) By ceasing to conceive pain as a “natural” or “metaphysical” evil in modern society, medicine had become, for Illich, a main driving force of separation from self-regulation through emotions: “grief, guilt, sin, anguish, fear, hunger, impairment, and discomfort.” (ibid) Replacing personal responsibility for pain by medical control triggers an atomization of the social order: “Compassion turns into an obsolete virtue. The person in pain is left with less and less social context to give meaning to the experience overwhelming him.” (ibid 96) The efforts of medicine to present pain, impairment, and death as abnormal make people dependent on seeking medical treatment.

This pessimistic view on modern medicine is exemplified by another of Illich’s key stances on becoming human, through discovering “a particular program ...to conduct themselves in their struggle with nature and neighbor.” (ibid 105) This entirely ironic paraphrase of the Darwinian “struggle for life” is reinforced by the no less ironic elucidation of the stance that “people are more the product of their environment than of their genetic endowment.” (ibid)

Indeed, the binary opposition of nature vs nurture, one of the main concerns for biology and genetics, is viewed by Illich as only meaningful for medicine itself but not for ordinary people. However, Illich abandons his irony regarding “the weapons and the rules and the style for the struggle…supplied by the culture in which [people] grew up” at the moment he starts to discuss the “main achievement of human evolution,” namely, adaptation: “Mankind has so far shown an extraordinary capacity for adaptation. Man has survived with very high levels of sub-lethal breakdowns.” (ibid 89)

While Illich agrees that “[M]an, unmodified by a particular place and companionship, simply does not exist,” (ibid 82) breaking with the underlying, unchanging normative type of the human as the formal object of scientific enquiry. He proves his stance by opposing the “natural man” generated by Enlightenment anthropology and the “consensual man” introduced by classical anthropology. This division leads Illich to an internal contradiction between his negation of “given genetic make-up, given history, given geography,” (ibid) the whole range of attributions impeded by progress, and the obvious acceptance of individual development through personal experience, described by Illich as a two-sided process. He concludes, “In determining their health, people create their physical being, just as, more generally, by determining their culture, they create themselves.” (ibid 93) He tries to solve this contradiction by the systematic opposition of culture as system of meanings vs. civilization as a system of techniques.

Culture, a necessary “cocoon” for people’s ability to cope, determines their competence to live with their own recollection of past injuries and their certainty of unending vulnerability. Illich returns to pain as a key signifier in differentiating culture and civilization: “Culture makes pain tolerable by integrating it into a meaningful system, cosmopolitan civilization detaches pain from any subjective or intersubjective context in order to annihilate it.” (ibid) Using the attitude to pain as a signifier for differentiating culture and civilization can be explained by Illich’s multiple affiliations with various theories regarding civilization, but probably one of the key connections is represented by his intention to reinvent the mission of socialist-Christian medicine to move beyond the individualist focus of human physiology to the level of the collective. (Williams 1994 218) Clearly, Illich opposes the authentic collective sympathy that turns pain “into a political issue which gives rise to a snowballing demand on the part of anaesthesia consumers for artificially induced insensibility, unawareness, and even unconsciousness.” (Illich 1974 94)

Illich does not indicate a specific date for the transition from culture to a “cosmopolitan civilization,” but introduces a criterion for determining whether medicine works in favor of culture or serves civilization: “Human survival rather than disease; the impact of stress on populations rather than the impact of specific agents on individuals; the relationship of the human niche in the cosmos to the species with which it has evolved rather than the relationship between the aims of people and their ability to achieve them.” (ibid, 82) Civilization transforms “the concrete person into a resource fostering and legitimizing the proliferation of agents and services of high-tech biomanagement.” (Duden 2002 227) Health within civilization “designates a cybernetic optimum. It is conceived as an equilibrium, between the socio-ecological macro-system and the population of its human-like subsystems. By submitting to the optimization process, the subject denies himself.” (Illich 2017 288) This negation of adaptation as a vital force that started operating on the verge of mechanization follows the logic of negating primal instinct as compatible in its destructive potential to “technogenic” catastrophes in developmental idealism.

The aim to deconstruct the technogenic science-attributed and self-inflicted body, an output of civilization, would require radical negation of adaptation as a vital force coopted by civilization for alienating people from their subjectivity. Radical negation involves the auto-subversive overcoming of a previous vision and consciousness, and, for Bhaskar, performs the dialectic life of consciousness.(Bhaskar 1993 57) The demand of this negation for Illich is of highest priority because of his radical critical position regarding the role of the Catholic Church which, to Illich, had become a part of the new cult of civilization, an idol of life, and “increases of the distinction between Him who in the Gospel said that He was ‘the life,’ and the abstract fragment which today in biomanagement is called a life.” (Illich 2017 288) Illich recognizes in the united efforts of the Church and medicine to transform each human being into “a life” “an implicit denial of the one who said to Martha, ‘I am the life.’” (Duden 2002 227)

Along with distancing himself from the official position of the Church, Illich consistently differentiates his line of arguments from the transformative mode of negation. He calls for accepting all diseases as a socially created reality and recognizes the inconsistency in the partial destruction of medical norms in the anti-psychiatry movement and the other implications of Canguilhem’s approach (Illich 1974 117). Illich rejects the option to transform the existing order of medical care through refining the notion of disease and health: “[T]his is a true crisis because it admits of two opposing solutions, both of which make present hospitals obsolete. The first solution is a further sickening medicalization of health care, expanding still further the control of the medical profession over healthy people. The second is a critical, scientifically sound, de-medicalization of the concept of disease.” (Illich 1974 116)

Criticizing medicine for the separation of the mental faculties from actions and decisions, another feature of the socialist-Christian medicine presented in Illich’s theorizing, and the call for medical knowledge that would be “engaged, relational, and pragmatic,” (Williams 1994 220) gains new motives. Illich chooses genetic counseling to illustrate his thesis concerning the ambiguous power of medicine which had achieved incredible control but remains unable to help:

In these meetings [with genetic counselors], you shift from information on fertilization and a summary of Mendel’s laws to the drawing up of genetic family trees, up to inventory of risks and a walk through the garden of “monstrosities.” Every time a woman asks if something could happen to her, the doctor replies: “Madam, we cannot exclude it with certainty.” But, for sure, such an answer leaves its mark. For this ceremony possess an inevitable symbolic effect: it forces the pregnant woman to take a “decision” by identifying herself and her unborn child with a probability configuration. I am not talking about the decision for or against the continuation of her pregnancy, but the obligation of the woman to identify [that] she is forced to take an oxymoronic decision, a choice that one pretends to be humane but which, on the contrary, reduces her to a mere, inhuman number. (Illich 2017 289)

Like Canguilhem, Illich calls for studying the history of medical ideologies, but limits the timeline of such historicizing to current ideologies in order to understand “the degree to which we are prisoners of the medical ideology in which we were brought up.” (Illich 1974 117) Defining this prison as “a suffocating void” Illich urges people to fill it with new meaning through historicizing health “as the reverse of salvation, as a societal liturgy serving an idol of life that extinguishes the subject.” (Illich 2017 288) This argument is deepened by Duden, who sees the history of the body as aimed at understanding “how each historical moment is incarnated in an epoch-specific body and how we can decipher the body of subjective experience as a unique ‘enfleshment’ of an age’s ethos.” (Duden 2002 223)

6 Conclusion

The reproduction of vitalist arguments within the debates between theologians and biologists since the 1960s has added new forms of coherence and underscores the eclectic forms acquired by vitalism between the eighteenth and nineteenth centuries. Historicizing vitalist arguments in the debate between biologists and theologians introduces new contexts for interpreting the progress of human genetics as a science and the source of influential expertise for population policy. The attribution of negative value to primal instinct as an obstacle to the progress of human civilization not only united different camps of geneticists but also forged bonds between them and many of those affiliated with Christianity as main agents of developmental idealism. The ongoing expansion of boundaries between scientific and theological vitalist arguments in favor of a strong opposition between health and disease predisposes a kind of public consensus regarding the necessity to practice surveillance over reproduction.

While this societal context has increased the public legitimacy of medicine, and especially genetics, it has generated multiple contradictions in the epistemological grounds of medicine and genetics in particular, which has led to their critical revision.

Two main movements, the so-called ‘normative vitalism’ mainly associated with French philosophers Georges Canguilhem, Michel Foucault, and Gilles Deleuze, and the movement for the deinstitutionalization of health care within negative theology presented by Ivan Illich, have launched two different epistemologies of medical knowledge to address the question of transforming or deconstructing the opposition between health and disease in favor of sustainable individual autonomy. Like developmental idealism, normative vitalism and the deinstitutionalization of medicine rely on the revision of vitalist arguments. Normative vitalism replaces the opposition between health and disease with a refined scale of anomalies and pathologies that would provide the grounds for thoughtful separation between objective description and subjective judgement regarding health. Deinstitutionalization attacks various practices of modern medicine aimed at submitting vital forces to the aims of adaptation.

Both approaches have introduced the historicization of medicine as a prerequisite for its emancipation from medical ideologies, including developmental idealism. If normative vitalism focuses on the emancipation of medicine from medical ideologies as an ongoing process of creating the internalist history of medicine and its progress, deinstitutionalization focuses on the various practices of alienating people from their corporeality and expropriating individual experience through medicine. Both strategies of historicization underscore the unique role of vitalist arguments in connecting internalist and externalist narratives of medicine in to order to prevent a misreading of the history of medicine.

Further development of the type of historical reconstruction undertaken in this chapter is relevant to exploring issues that address the task of remapping the composition of driving forces and actors in at least three ways: (1) the transfer from eugenics to genetics in different regions and the exploration of intercountry cooperation through the lenses of adapting various modes of ascribing negative value and the strategies of boundary work to vital forces; (2) the history of deconstructing Nazi medicine (more generally, the history of professions and institutions in structural violence) and embedding this historicization into the debates regarding race, the limits of bioethics, and the role of medical science in historical justice; and (3) the role of theological arguments and their agencies in developing medical science and the dissemination of its implications.