What I mean by a norm is, in short, a model for the perfect operation of the thing to which it pertains.4 I believe that this definition of the norm is the one with which Foucault and Canguilhem work, and which can be found in historical discourses about norms from the seventeenth century on. Other scholars disagree that this is Foucault’s understanding of the norm, but this ultimately does not matter for the purposes of this book. Regardless of its provenance, this is what I mean in this book when I refer to the norm and derived terms.
Normality as Normative
Canguilhem’s book, The Normal and the Pathological, written in the middle of the twentieth century, remains the landmark investigation into the concept of normality.5 Canguilhem was a French medical doctor, historian and philosopher of science. His study concerns the technical question of medical normality. This ostensibly specialist work is more generally illuminating than one might imagine, not least because medicine has operated as a motor for the diffusion of the concept of normality throughout our culture.
Modern medicine is based on a notion of medical normality, which is to say on defining health as accordance with a predefined norm. Canguilhem’s key question is that of the origin of this norm. Modern medicine clearly considers itself to be a scientific enterprise, based on empirical study and objective criteria. Its basic norms do not really measure up to this self-image, however.
Canguilhem notes that it is commonly believed in the medical profession that what is normal is simply what is average, such that the normal condition of health can be defined by observing what most people’s condition is. He concludes, however, that medical normality cannot possibly be defined or derived in this way. To be normal is defined in medicine as being optimally healthy, and this is clearly not the average condition of human beings. Rather, most people are to some extent, in some way or other, unhealthy, which is to say that they deviate from the norm. Unless exactly as many people deviate in two opposite directions – for example, exactly as many people have high blood pressure as have low blood pressure, to the same extent – then the average will not be the norm. And such an absolutely symmetrical deviation in both directions from the norm never occurs in reality.
In fact, the word ‘normal’ only came to be associated with averages when statisticians in the late nineteenth century applied this word – which was by that time already in use in other technical fields, and in medicine in particular – to an extant statistical idea that they had called by other names previously, dubbing this now the ‘normal distribution’.6 However, I will argue that this invention of a statistical notion of the normal thenceforth serves to give a patina of objectivity to the concept of normality in general.
Canguilhem concludes that the medical notion of normality, although presented as an objective and scientific judgement, is in fact normative, which is to say, a judgement of what things should be like. Such normative judgements cannot be empirical inferences from scientific study – as Ian Hacking points out, statistical judgements of normality cannot have any normative implications7 – but rather must be a priori principles. These principles are, in a word, norms, imaginary standards of perfection to which reality is held.
Although it might seem like a great scandal that medicine is based on prejudices, Canguilhem does not reject these norms. He is instead quite clear that modern medicine needs the yardstick of normality to operate. Discarding it would cost untold lives. He instead suggests reforming the standard of normality by abandoning the pretence that it is objective and acknowledging its subjectivity by making patients themselves the final arbiters of whether they actually are sick.
For my part, I am not advocating even this: unlike Canguilhem, I do not have a medical background, and am not directly concerned with medical norms. Rather, I am concerned with what has happened as the notion of normality has exploded out of medicine and become a social phenomenon over the last two centuries.
Normalization
The concept of normality implies an underlying concept of the norm, the norm being the measure of what counts as normal. This is somewhat obscured in English by the fact that the word ‘normal’ is much more prominent than ‘norm’, perhaps because it came into our language first, only to be followed by the word ‘norm’ later.8 It is the latter word that is older, however, in the tongues in which these terms originated, namely the Romance languages.
‘Norm’ comes from an old Latin word for a carpenter’s rule, norma. For a long time in European languages, cognates of norma were synonymous with the cognates of a different Latin word with a similar literal meaning, regula (from which we get the English word ‘rule’, in all its senses). At a certain point, the meanings of these two terms diverged sharply. Canguilhem finds that this new sense of the cognates of ‘norm’ first appears in relation to seventeenth-century French ‘normative grammar’.9
Michel Foucault, following in Canguilhem’s footsteps, detects the logic of normality earlier than in the application of words derived from norma to describe it, namely in medieval practices for dealing with outbreaks of plague. While the exact point of origin of this logic might not be precisely locatable and matters little to the claims I want to make about contemporary society, it is at least somewhat important that this is a concept that has been invented at some point or other, and the fact that the genealogy of this notion involves plagues cannot but be interesting to us, living as we are through the COVID-19 pandemic.
Foucault finds that, in the Middle Ages, there was initially only one systematic method for dealing with contagious disease, namely that used to deal with leprosy: to remove the visibly sick from society in order to prevent the spread of disease.10 This approach did not work with the Black Death pandemic that descended on Europe in the fourteenth century, however, because that new disease was so contagious that people spread it before they could be exiled. So a practice was adopted of continuously monitoring habitations once plague had appeared in a vicinity, looking for signs of infection and isolating any household in which it appeared. Though this was not exactly the twenty-first-century lockdown with contact tracing with which we are now so familiar, it nonetheless represents the same basic approach. This in effect requires norms – that is, specific ideas about exactly what a healthy person should be like in order to detect relatively small variations from these. This is still the basic approach we have taken today with COVID, where a cough or elevated temperature raises an alarm. Hence I do not see in our response to the contemporary pandemic a new normal strictly speaking, so much as an instantiation of an old one, albeit in an age of hand sanitizer and phone apps.
In contrast to age-old measures to control the spread of disease, normality has, in other areas, developed into something rather more sophisticated. A crucial development in this regard was certainly the explicit formulation of the concept of the norm as such. This occurred by the seventeenth century at the latest, with that notion and the derived one of normality expanding in influence rapidly throughout the nineteenth century. What is crucial to grasp about the novelty of this notion is its original reference to an ideal model for the operation of a particular thing. Previously, there were perhaps some templates for making certain things, and plenty of rules – but nothing was governed by a positive model of perfection towards which a thing was pushed without ever entirely reaching it. With the introduction of the norm, however, increasingly many things began to be normalized, brought into a relation with a governing norm to which they were now made to tend.
This pervasive normalization began relatively modestly. French normative grammar was invented