Biomedical Engineering Reference
In-Depth Information
individual. Other types of information put a demand on the patient and
his or her relatives to make decisions about for instance having children,
or whether to reveal knowledge about a genetic risk to their children. As
a consequence, medical professionals often have to be able to take part in
these types of discussions, and try to help patients and their relatives to
explore possibilities and to reach a decision. This is not something new in
medicine, but has probably become a more general problem, affecting many
more medical professionals in various specialities - and their patients.
The construction of normality
As we have argued, medical technology and the results these technologies
produce, can take on different meanings in the world of medicine and the
life world. One important and intriguing question has to do with the role
medical technology plays in relation to the process of defi ning normality and
abnormality and the (changing) boundaries in between.
The modern usage of the word 'normal', Ian Hacking (1990) argues, evolved
in the nineteenth century in a medical context, more precisely in pathology.
'The normal was one of a pair. Its opposite was the pathological and for a
short time its domain was chiefl y medical' (Hacking 1990: 160). Something
was normal when it was not associated with a pathological organ, and the
normal was thus secondary, the opposite of the pathological. Hacking (ibid.)
describes how this then was 'turned around' (by Comte) and the pathological
became secondary, characterized in terms of deviation from the normal, or
from 'the normal state'. Importantly, pathology was not understood as a
different kind from the normal; 'nature makes no jumps' but passes from the
normal to the pathological continuously, and the normal is the centre from
which deviation departs. 'There is no pathological disturbance in itself, the
abnormal can only be evaluated in terms of relationship' (Canguilhem 1991:
188).
One of the long-standing debates concerning the concept of normality has
to do with the relationship between the normal and abnormal or pathological,
more specifi cally
where
normal variation ends and abnormality begins. It has
been argued that more attention should be given to variations of the normal.
One interesting example is the way women's health and bodily processes
have been treated as deviations from a norm based on the male body. The
feminist biologist Linda Birke (1999) has pointed out that deviations from
the normal could be understood as 'differences' rather that pathological, and
that normality/abnormality then could be conceptualized as variations of the
normal/deviations from the normal.
The concern with identifi cation of pathology in the ill person which was
at the heart of 'Hospital Medicine', was replaced by a concern with normal
populations in twentieth-century 'Surveillance Medicine' (Armstrong 1995).
A precondition of surveillance was the problematization of the normal.
Within this medical paradigm, the distinct categories of healthy and ill are
