A historical review of the concepts of normal/pathological and health/disease

L. C. Álvaro González
Neurosciences and History 2024;12(1):1-19

Type of article: ORIGINAL

AUTHOR

L. C. Álvaro González
Neurology Department. Hospital de Basurto. Bilbao, Spain.
Department of Neuroscience. Universidad del País Vasco/Euskal Herriko Unibertsitatea, Leioa, Spain.

ABSTRACT

Introduction and objectives. The concepts of normal/pathological and health/disease have been the pillars of the history of medicine and of ideas, in a mutual interaction. These concepts are mutable and have been strongly influenced by cultural and arbitrary factors, both in the past and today. This article presents a historical review of key moments in this evolution, followed by an analysis of key sources and interpretation.

Methods. The concepts in question are analysed first from an etymological and semantic perspective, and subsequently following a strictly historical approach, addressing relevant works in the history of medicine and the history of thought; we shall also consider their role today, analysing reports from the recent literature. Excerpts related to these concepts are placed in their historical context, and their medical and social implications are analysed.

Results. Normal is derived from the Latin norma, carpenter’s square; therefore, normal would be that which fits or belongs, always in accordance with a predetermined rule or criterion. Thus, the concept of normality has evolved over time to fit the ideology of each era. Pathology or disease was defined by a lack of balance or by external invasion. It was the absence of normality, characterised by the existence of various morbid species. Only in the modern age was the patient’s pathos or pain accepted as a criterion for disease; now, the concept also encompassed subjective experience, with patients beginning to decide the meaning of disease. Scientific medicine in the time of Comte, Claude Bernard, and Leriche understood health/disease as a continuum that could be explained in both directions. Canguilhem emphasised health as a biological luxury, in a struggle to maintain internal constants in an adverse environment, ideas clearly influenced by the theory of evolution. His disciple Foucault was able to unravel how health came to be possessed by power from the 18th century, as a result of direct productive interests adjusted to the expanding liberal model.

Discussion. After the excesses of the concept of normality from 1857 (Morel and degeneration theory) until 1945 (eugenics), the World Health Organization (1948) created a new concept of health, still valid today, based on a loosely defined status of multidimensional well-being. Marinker characterised new public perspectives of disease based on linguistic nuances (1975); almost at the same time, Lalonde included healthcare systems and lifestyles among the determinants of health (1974). Currently, biomarkers and predictive medicine, exploiting big data and artificial intelligence techniques, have been used to stratify levels of differential risk into bands delimited by clinical criteria. These new models of health/disease are subject to outstanding issues around equity, liability, and privacy. There is a need for collective debate and reflection to avoid repeating the mistakes of the past.

KEYWORDS

Normality and pathology, health and disease, degeneration theory and eugenics, Claude Bernard, Canguilhem, Foucault, biomarkers, predictive medicine

Neurosciences and History 2024;12(1):1-19