On the Normal and the Pathological

Birth of the Allostatic Model: From Cannon’s Biocracy to Critical Physiology

“…(Canguilhem, 1978(Canguilhem, [1966 For the allostatic model, the mechanisms of addiction exemplify how chronic demands bind physiological life forms to socio-historical contexts. For instance, the physiology of the workaholic is impossible in a hunter-gatherer society since it constitutes the adaptation by the individual to a type of individualist society that valorizes work, competition, and pushing oneself past one's limits.…”

“…The notion of addiction in the allostatic model is thus distanced from any axiological sense that would identify it with a disease (see on this topic Szasz, 1972). It takes the sense of an adaptation, a "normative" health (Canguilhem, 1978(Canguilhem, [1966 It is noteworthy that all these authors refer to allostasis as a seminal model that allows us to understand the "cost of physiological adaptation" (Schulkin, 2004).…”

“…But it also allows avoiding the irremediability, thus the depoliticization, tied with naturalist essentialism. Indeed, as Canguilhem put it, "What habit has made, habit unmakes and remakes" (Canguilhem, 1978(Canguilhem, [1966, p.169). In others words, if physiological norms are embodied physiological habits, the political usage of science becomes epistemologically justified.…”

“…For the school that recognizes ruptures (Sterling, Eyer, 1988;Rose, 1997;McEwen, Wingfield, 2010), the history of regulation has been marked by a rejection of the normo-centricity of Claude Bernard's model (1879). Insisting on the constancy of the milieu intérieur, the father of modern physiology took as his foundation a fixed and normative conception of the organism (Canguilhem, 1978(Canguilhem, [1966; Rose, 1997), which proved incapable of accounting for the adaptability of living organisms. Peter Sterling and Joseph Eyer (1988) worked in this interpretive line when they wanted to reground the homeostatic model by introducing the concept of allostasis, understood as "the stability of the organism through change" (Sterling, Eyer, 1988, p. 636).…”

Creating a patient-led NHS: some ethical and epistemological challenges

“…For example, while figure like Boorse, Daniels and Groopman describe health in the technical terms of scientific biomedicine, writers like Canguilhem, Nordenfelt and Seedhouse characterise health very differently as a socially constructed category related to the well-being, capacities and experiences of the patient. [12][13][14][15][16][17] Whereas the former perspective is based on secondary observation of the patient's condition according to the various disciplines of anatomy, physiology and pathology, the latter perspective has its roots in the direct phenomenological and social experience of the suffering patient who must learn to live with their illness. As I have explored in more detail elsewhere, the different relationships that doctors and patients have to the phenomenon of ill health provides reason to take seriously the suggestion that patients and medical professionals often do conceive of ill health in contrasting ways and, as a consequence, may hold different beliefs, values and agendas when it comes to decision making in the consultation and commissioning processes.…”