A Scientific Viewpoint on Normalcy

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A SCIENTIFIC VIEWPOINT ON NORMALCY EDMOND A. MURPHY, M.D., ScD* The art ofmedicine has undergone a long and extensive development; the science, a brief and recent one; the philosophy, virtually none. It is hardly to be wondered at if, during the growth of the second of these disciplines much of the traditional content of medicine is found to have little business in any scientific field. Medicine is concerned with practical matters; and if from time to time arbitrary definitions prove necessary, little harm is done provided that they do not become endowed with absolute value. Many practitioners from other professions have contact with their medical colleagues precisely because they require absolute statements for use in a syllogistic fashion; and the medical expert has perhaps erred by trying to meet this demand. Probably only a lawyer is happy to treat "insanity" or "responsibility" as other than convenient but vague notions. There is never any difficulty in constructing classifications which meet the minimum requirements of logic—that the categories be exhaustive and disjoint. The difficulty lies in ensuring that the classification is useful —that it follows natural divisions of importance. We could divide all people into two classes: those who have caviar for dinner every night and those who don't. This classification is unambiguous, but is it useful? We might suppose that the two categories correspond to the wealthy and the poor, though even the poor man may be an epicure or the wealthy man a Philistine. But do we really believe that there is a discontinuity rather than a gradual transition between the groups? Ifthe change is gradual, our system ofclassification (which is a discrete one) fails to represent this fact. To anyone considering the subject for the first time, it is a matter of * Carroll House, Catholic Center at theJohns Hopkins Medical Institutions, Baltimore, Maryland. Supported by a grant oftheJoseph P. Kennedy, Jr., Memorial Foundation to the Cardinal Gibbons Center for the Study ofHuman Reproduction. 333 some astonishment that so much is written about the normal, so little about normalcy. The former relates to the practical guide lines which the medical practitioner may use, the latter to the kind of"abstractions" with which the theologian, the philosopher, the educator, the politician, or the lawyer would like to deal. In the popular mind, unfortunately, the word "normal" has insidious overtones. What is not "normal" is "abnormal" and therefore (such is the connotation of the word) to be condemned. Thus it is difficult to control the consequences of identifying a group of subjects as abnormal. There has been a fine disregard for the need ofa realistic definition of "normalcy." Everyone knows what the word means and everyone looks to someone else tojustify his use ofthe term. To philosophers, the normal is defined by observation; among scientists, it is widely believed that the statisticians have proved that the normal is "the mean plus or minus two standard deviations." The term "normalcy" in the usual sense is applied mostly to the more complicated organisms, and therefore, nowhere more widely used than in relation to man. The most popular (ifnot the proper) study ofmankind being man, the medical practitioner is commonly called upon to adjudicate in individual cases, and at a more academic level to provide a definition. All too often the ill-considered pronouncements ofa "medical expert" are borrowed for use in such areas as education and politics and his most casual comments can provide substrate for generations of speculative philosophy. The medical specialist most likely to come to grips with the problem is the academic pathologist. It is strange that the physiologist and the anatomist whose declared area ofexpertise is the normal never seem to consider the problem at all—whether through inadvertence or through a feeling that the question is trivial is not clear. Six leading texts on anatomy and six on physiology have been consulted: it would be invidious to particularize further. None of them has a discussion on the normal; though each contains a long index, none has so much as an entry on the subject. It is only when the student comes to study disease that it becomes necessary to define when the limits of the normal...

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