172 RüdigerKunow
InTheNormalandthePathological,Canguilhem doesnotexplicitly
invoke the concept of dialectics, even though, I would argue, his
argumentisessentiallydialectical.Andifonereadshisdetailedanalysis
and the examples he offers, it becomes possible to read the cluster of
biological norms and their pathological counterparts as cultural
figurations that seek to manage differences, differences in the shape,
look,structureofthehumanbodyanditsbiology.Asacriticalfootnote
onemayaddherethatCanguilhem'sargumentconcerningthepolemical
edge of norms allows us to discover within the HegelianSein/Sollen
dualismatensionwhichiscentraltoMarxismandpoliticaltraditionson
theLeft,namelythedualismbetweenfatalismandvoluntarism,between
acceptanceofthestatusquo(of norms)and activeinterventionwith the
aim of changing it—of which culture, as will be shown, is both the
articulation and principal scene. A final point: Canguilhem's
observations concerning the polemical thrust of the normative carries
muchweightfortheanalyticstoalsobepursuedinthischapterbecause
it makes the assumption plausible that, under certain circumstances,
normscanevenattainsomesortofnon-humaninterventionistagencyof
theirown.
Iwillillustratethisbyabriefreferencetoasetofnormswhichseem
tobescientificallyvalidated,eventorepresentscientificprogress,inthe
field of medicine. Here, since World War II, clinical trials in the U.S.
havebeenthemostimportantgeneratorsofnewnormsfor(whatcanbe
regardedas)ahealthybody.Onthebasis ofthesetrials,thenorms,e.g.
for blood pressure or the acceptable level of LDL cholesterol, have
(been) progressively amended, in one direction, and all with the same
effect, namely to expand the domain of the pathological so that more
andmoreAmericanscametoberegardedasat-riskpatients.^19 Whilethe
settingofsuchnormshasredefinedbothhealthandtreatmentandinthis
way contributed to the increase of life expectancy among U.S.-
Americans,ithasalsotransformedtheirrelationshiptotheirownbodies.
(^19) My narrative is based on Clarke, Adele E., Jennifer Ruth Fosket, Laura
Mamo, Jennifer R. Fishman, and Janet K. Shim, eds. Biomedicalization:
Technoscience, Health, and Illness in the U.S.Durham: Duke UP, 2010. Print.
andJosephDumit'sessay"PrescriptionMaximation"(2012)whichreliesondata
from the Institute of Healthcare Informatics and the Centers for Medicare and
MedicaidServices.