The medical humanities in the USA and France: Towards a comparative history

Abstract

This article presents a comparative historical analysis of the development of the medical humanities in the United States and France. In the US, the field evolved through three major phases: an initial focus on human values and bioethics in the 1960s; a second phase from the 1980s emphasising culture, narrative, and transdisciplinary approaches influenced by the social anthropology of medicine and the biopsychosocial model; and a third phase, emerging in the 1990s, centred on structural forces in relation to health, exemplified by Paul Farmer's use of the concept of structural violence. In contrast, the French medical humanities, institutionalised from 2010, emerged from the integration of the humanities and social sciences (SHS) into medical education. Rooted in a tradition of critical engagement, French scholars draw heavily on the philosophy of Georges Canguilhem, particularly his vitalist conception of life as a normative struggle against limitation. The article explores how Canguilhem's influence, largely underappreciated in Anglophone contexts, offers a powerful framework for rethinking health, illness, and care. It also examines the differing receptions of Michel Foucault in both traditions, proposing a re-reading of Foucault through Canguilhem's writings. The authors argue that the French emphasis on care, normativity, and the lived experience of illness – especially through the emerging field of ‘la philosophie du soin’ – offers a valuable counterweight to the more institutionally critical orientation of Anglophone medical humanities. The article concludes by proposing a renewed dialogue between these traditions, grounded in a shared commitment to understanding medicine as a human, social, and philosophical practice.

Introduction

In this article, we offer the beginnings of a comparative history of the medical humanities in the US and France. We argue that in the US, the field has passed through three distinct major phases. The first began in the early 1960s and was centrally preoccupied with the values underpinning health and the human in the contemporary United States. In this initial phase, the field essentially functioned as an incubator of interdisciplines. Bioethics served as a model interdiscipline, while others included literature and medicine and phenomenological ethics. The second phase began around 1980 and was characterised by a transdisciplinary effort to understand health and illness in relation to culture, using narrative methods. Culture had seldom featured as a category in its own right before then. Two developments in allied fields were crucial for this second phase: the refounding, along Geertzian lines, of medical anthropology; and the elaboration of the biopsychosocial model of health and illness. In this phase, the field absorbed an immense amount of critical theory from disciplines it had not previously considered. The third phase – the phase when the field changed its name from ‘medical’ to ‘health humanities’ – began in the mid-1990s and has been characterised by a preoccupation with structural forces in relation to health. The field today is largely rooted in these three visions. The version of the field that has taken root in France since 2010 is evolving in dialogue with the second and third. A central feature of the French scene is 20^th-century vitalism, a philosophy focused on the presentation of life as the ‘spontaneous effort of defense and struggle against all that is of negative value’ (Canguilhem, 1978: 131). We attempt to advance this dialogue by considering how far the three phases of the medical humanities are compatible with Canguilhem's vitalism, and by comparing the place of Foucault's work in Anglophone and Francophone contexts. French medical humanities scholars often present Foucault as an epigon of Canguilhem, in contrast to the sui generis status he enjoys in the English-speaking world.

In the beginning was the chaplaincy: The Society for Health and Human Values

Perhaps the best way to understand the medical humanities is to consider their institutional origins. The medical humanities are largely a product of the American university system. In 1962, a small group of clinicians, medical administrators, humanists, and theologians began meeting under the auspices of the United Ministries in Higher Education, an association of university chaplains uniting several Christian denominations (Banks and Vastyan, 1973: 251). Membership of what became known as the Committee for Health and Human Values was by invitation only and was limited first to 8 and then to 14. The CHHV soon sponsored a more secular version of itself, the Society for Health and Human Values (SHHV), which became in effect the world's first professional organisation of medical humanities scholars. It is worth pausing on the phrase ‘human values’ for that was the core notion underpinning the field in its first phase. The SHHV promoted what it called ‘values programmes’ which emphasised the development of bioethics as the medical humanities’ most important work-in-progress (see e.g. Bickel, 1987; McElhinney, 1976).

Many of the original participants at the meetings of the CHHV were instrumental in persuading universities to invest in the field throughout the 1960s. One of the most visionary figures was E. A. Vastyan (1928–2010), an Episcopalian chaplain and theologian who was the founding executive director of the William Temple Foundation for Humanistic Studies at the University of Texas Medical Branch in Galveston from 1962 to 1967. In 1967, Vastyan moved to the newly-opened Milton S. Hershey Medical Center of Pennsylvania State University at the invitation of its founding Dean and Director of the College of Medicine, Dr George T. Harrell (1908–1999). There, he set up the first full-scale Humanities Department in a medical school. In 1970, Edmund D. Pellegrino (1920–2013) – a devout Catholic physician and arguably the most important academic politician the field has ever known, who joined the CHHV in 1968 – persuaded the State University of New York at Stony Brook to open a Division of Social Sciences and Humanities in Medicine, with the phenomenological philosopher Richard Zaner (b. 1933) as its founding director (1971). Zaner recruited 20 faculty members. Pellegrino was centrally involved in the establishment of the field at Yale, Georgetown, and the Catholic university where he served as president. Two members of the SHHV, H. Tristram Engelhardt (1941–2018) and Chester Burns (1937–2006), were able to expand Galveston's William Temple Foundation for Humanistic Studies to start the Institute for the Medical Humanities of the University of Texas Medical Branch at Galveston in 1973 (Hudson Jones and Carson, 2003: 1006). Engelhardt was a medically qualified philosopher of medicine and a Catholic who later on converted to the Eastern Orthodox Church. Burns was a physician and a historian of medicine. Ronald W. McNeur (1920–2005), a New Zealander by birth and a Presbyterian university pastor at the University of California at San Francisco, was a crucial figure in developing the medical humanities in US medical schools by becoming the director of the SHHV. Finally, mention should be made of Samuel A. Banks (1928–2000), who was for a long time a Methodist chaplain and the head of a student counselling service at the Gainesville campus of Florida University. Banks worked closely with most of the leading figures in that first cohort.

The Hershey School, Stony Brook, and Galveston all received philanthropic donations to support their work in the medical humanities. From the early 1970s, they also benefitted from considerable funding from the federal government's National Endowment for the Humanities (NEH). This funding bears out Merve Emre's claim that the emergence of the medical humanities is closely linked to a crisis affecting the humanities and the social sciences that began in the 1970s (Emre, 2019).

The second major institutional supporter of the emerging field was the Hastings Center, founded in 1969 as the Institute of Society, Ethics, and the Life Sciences. The Hastings Center was a bioethics think-tank seeking to become a major reference point for organisations like the National Institutes of Health in respect of ethical and legal questions. At the time it came into being, there was very little infrastructural capacity in US universities in bioethics. One of its first research programmes was entitled simply ‘the humanities’. This strand was led by Eric J. Cassell (1928–2021), one of its board members, and a perceptive and profound writer on medical practice.

According to an NEH report, by 1975 there were around 20 programmes in the medical humanities in US medical schools. The internal sequencing of how these programmes were built up is instructive. Vastyan's experiment supplied the blueprint for others. Vastyan himself was a theologian by training, and his first hires were a philosopher and a historian. Once he obtained NEH funds in 1971, he engaged scholars from theology, political science, and literature. Vastyan thought the medical humanities had a lot to contribute to the critique of America's war in Vietnam, and this may explain his wish to hire a political scientist. The literature scholar he hired was Joanne Trautmann, who went on to edit (with Harold Nicolson) Virginia Woolf's letters. A similar pattern obtained at Galveston but with vastly more private philanthropic funding (and a more explicit Christian orientation). The Institute for the Medical Humanities began with a philosopher (Engelhardt) and a historian (Burns), and a teaching programme based on medical ethics. After NEH funding was obtained, they were joined by colleagues from law, literature (Anne Hudson Jones), and religious studies as well as further hires in history and philosophy.

The thinker with the most programmatic conception of the field was Pellegrino. Pellegrino saw the humanities in general as a guide to the ideals by which humans had sought to live, and to the difficulties they encountered in trying to live by them. Such ideals shaped the cultures in which humans live and necessarily have shaped any philosophical reflection taking place there. As Engelhardt and Fabrice Jotterand put it in their essay ‘Pellegrino's Project’: ‘The humanities disclose the implicit assumptions regarding human flourishing that supply the taken-for-granted content of the ethics at the root of bioethics’ (Pellegrino, 2008: 3). The medical humanities were preeminently concerned with such implicit assumptions, and their special mission was to bring these to light. But Pellegrino also thought that the medical humanities were ultimately in the service of the philosophy of medicine, which for him meant the study of the morality intrinsic to medical practice in all its dimensions. There could be no bioethics without the medical humanities, and neither could be brought to their full potential without the philosophy of medicine. Pellegrino believed that the technological advances of biomedicine were likely to encourage a morally reductive view of humans. What was needed, he said, was a new paidea, a new critical ideal of culture that placed medicine in its proper context: as a mirror onto the values prevailing in contemporary American society which might be changed through the systematic study of those values. Richard Zaner has said that it was this clarion call more than anything else that brought him into the field (Embree and Barber, 2017: 278).

Pellegrino's humanism was rooted in the medieval Catholic reinterpretation of Aristotle, but he was also very drawn to phenomenology. He described his own approach to the philosophy of medicine as phenomenological. It may have been this that drew him to Richard Zaner around 1970. Zaner had studied with Alfred Schutz, Aron Gurwitsch, Hans Jonas, Dorion Cairns, and Maurice Natanson. Schutz was the founder of social phenomenology and was highly regarded by Husserl. With Engelhardt, Zaner translated Schutz's complete philosophic works. They also translated the book Schutz wrote with Thomas Luckmann, The Structures of the Lifeworld (1974). Hans Jonas did his PhD under Heidegger and had taught Merleau-Ponty. It was partly thanks to Jonas that Zaner published the first English-language accounts of Merleau-Ponty's late works. Gurwitsch had worked with Kurt Goldstein at the time the latter treated ‘Schneider’, the patient at the centre of Merleau-Ponty's Phenomenology of Perception (2012). There was thus only one degree of separation dividing Zaner from Husserl, Heidegger, and Merleau-Ponty. It has been said of Zaner that ‘by the late 1960s, [he] was internationally recognized as one of, if not the, preeminent American phenomenologist working in traditional, academic philosophy’ (Oral History of Health Ethics Project (OHHE), 2016). His move into the medical humanities was therefore a very significant development for the field. It stalled after two years when he left Stony Brook for Southern Methodist University in Texas to resume his career as a phenomenologist. But he returned in 1981 to take up a chair at Vanderbilt University, a step which enabled him to immerse himself in hospital life and develop his own version of ‘narrative clinical ethics’ (Zaner, 1973, 2004).

Given the role of university chaplains in establishing the medical humanities, one might have expected a conflict to occur between those committed to a religious point of view and more secular-minded scholars. Among the SHHV group, a fissure did open up but it was between those – like Pellegrino, Engelhardt, Carson, and Zaner – who were fundamentally committed to the development of bioethics rooted in some version of the philosophy of medicine and those – like Banks, Cassell, Trautmann, and Vastyan – who wanted to continue with the study of the implicit assumptions surrounding health and illness. For the former group, the medical humanities would continue to nourish the interdisciplinary side of bioethics, but they would be an instrument in the service of bioethics and the philosophy of medicine. Engelhardt became the editor-in-chief of a new journal, the Journal of Medicine and Philosophy, in 1976, and by the early 1980s could be said to have left the field. The second group had a different centre of interest: depth psychology. The hidden human values underpinning health and illness could be brought to light using Freud, Jung, and the existentialists. Cassell, a secular Jew, was strongly committed to Eriksonian psychoanalysis and, as his first book showed, he was a subtle psychoanalytic thinker in his own right (Cassell, 1978). The title of Banks’s PhD dissertation was ‘Limitation and Self-Worth in Psychotherapy and Salvation’ (1971). In it, he compared Paul Tillich's account of self-worth in moments of crisis with that of Ernest Becker, Otto Rank's great exponent. Erik Erikson's and Carl Rogers’s ideas also feature prominently in the thesis.

Outside bioethics, the most important venture in the medical humanities was literature and medicine. Mindful of the work of George Sebastian Rousseau, Marjorie Hope Nicolson, and Lilian Furst, Joanne Trautmann began to build up the field. In 1975, under the auspices of the SHHV, Trautmann convened a symposium at Penn State entitled ‘Healing Arts in Dialogue: Medicine and Literature’. The proceedings were eventually published in 1981, with a preface by Pellegrino. What is striking about this volume is how open Trautmann and her colleagues were to any and every use of literature. In 1982, a new journal was launched, called Literature and Medicine, under the joint editorship of Trautmann and five others, Kathryn Allen Rabuzzi, D. Heyward Brock, William Claire, Peter W. Graham, and Anne Hudson Jones. Literature and Medicine was an annual publication for the first 10 years of its existence, and it is worth noting that literary scholars were usually a minority in its pages. Many of the articles it carried were by or about physician writers, the representation of clinicians or illness in literature and film, medical specialties (psychiatry, neurology), and from 1985, the forms of medical writing. Anyone who looks at the first 10 years of that journal will find a striking division between those contributors who were interested in literature as a vehicle for bioethics and those who wanted to extend the reach of literary studies at a time of great ferment within that discipline. Both were content to treat fiction as a source of vernacular social science data because both were committed to the idea of literature as a window onto the world. Literature and Medicine built bridges to scholars who were not part of the original SHHV group, such as Robert Coles (b. 1933), Harvard's first professor of the medical humanities (for a discussion of his work, see Vickers, 2025).

Transformation by the social sciences in the 1980s and beyond

It is sobering to observe how few social scientists were involved in the SHHV version of the field and how little dialogue there was between the new departments of the medical humanities and fields such as microsociology and the sociology of medicine, which shared the aim of revealing the hidden values underpinning medicine. The original SHHV group weren’t conspicuously interested in the contemporary social sciences. They knew about and drew on psychoanalytic ideas, they engaged with phenomenology, and they were aware of thinkers like Gregory Bateson in anthropology. But in the main, they showed no aptitude for addressing social science fields in their evolving states. The only serious exception was Richard Zaner, who wrote extensively about the social sciences up until about 1980, largely as a way of bringing Schutz's work on social phenomenology to wider notice (Zaner did his PhD at the New School on Gabriel Marcel, Sartre, and Merleau-Ponty, all three of whom were socially- and politically-oriented philosophers.)

The significance of this blind spot may be gauged from the fact that the next phase of the medical humanities was transformed by two social sciences that were barely represented in the first iteration of the field: anthropology and second-wave cognitive psychology. The second wave of the medical humanities was nourished by two powerful developments: the first was the effective refounding, along Geertzian lines, of medical anthropology as a discipline; the second was the rise of the biopsychosocial model of health and illness. As the second wave is discussed extensively by Vickers in a separate essay in this volume, we will confine ourselves here to a small number of observations concerning it. Those who refounded medical anthropology – Joan Kleinman, Arthur W. Kleinman, Byron Good, Mary-Jo DelVecchio Good, Leon Eisenberg, and others – were not in the business of creating an interdiscipline. They were engaging in a much more transdisciplinary enterprise organised around the category of culture – a term that was largely absent from the SHHV vision. This category, anthropological at base, would, it was hoped, generate new theoretical models of illness in society, break down disciplinary barriers, and optimally give rise to new institutional forms in universities. Narrative analysis would enable different disciplines to contribute to this project. The writers at the origin of these developments recognised the medical humanities as a natural vector for their ideas and addressed themselves directly to them (see e.g. Kleinman, 1988). They saw themselves as annexing onto the medical humanities a vast territory that the field simply could not ignore. The same was true of the psychologists Elliot Mishler and Jerome Bruner, two writers who were themselves steeped in anthropological thought. These developments also took place under the signs of ‘story’ and ‘narrative’ but were completely different in emphasis. Members of the original SHHV group tried to engage with this work but it was not easy for them to use their own hard-won insights to critique the work of the social scientists, so different were the fundamental aims and assumptions that distinguished the latter projects. However, they were almost all committed to the biopsychosocial model which became the main bridge between them. A figure like Rita Charon is the product of both these traditions.

In this second phase, which ran from the early 1980s until the early 2000s, the medical humanities opened themselves up to disciplines and thinkers with which they had previously only been on corresponding terms: anthropology, disability theory, ethnography, social psychology, the work of Habermas and Levinas, Donna J. Haraway's early work on cyborgs and feminism, the postcolonial theory of Homi K. Bhabha, cognitive psychology, the work of Foucault and Lacan (and this list is far from exhaustive). It was also the most fecund in terms of the intellectual resources it developed, which found expression in a slew of major monographs: Eliot Mishler's Discourse of Medicine: Dialectics of Medical Interviews (1984), Arthur Kleinman's The Illness Narratives (1988) and Writing at the Margin (1994), Kathryn Montgomery's Doctors Stories: The Narrative Structure of Medical Knowledge (1991), Ann Hunsaker Hawkins’s Reconstructing Illness: Studies in Pathology (1993), Byron Good's Medicine, Rationality, and Experience: An Anthropological Perspective (1993), Arthur Frank's The Wounded Storyteller (1995), G. Thomas Couser’s Recovering Bodies: Illness, Disability, and Life Writing (1997), Jens Brockmeier's Literales Bewusstsein. Schriftlichkeit und das Verhältnis von Sprache und Kultur [The Literate Mind: Literacy and the Relationship between Language and Culture] (1997), Suzanne Poirier and Lioness Ayres’s Stories of Family Caregiving: Reconsiderations of Theory, Literature, and Life (2002), and Rita Charon's Narrative Medicine: Honoring the Stories of Illness (2006). This is before we get to two important anthologies of papers on narrative medicine (edited by Brian Hurwitz, Trish Greenhalgh, and Veena Das) or the hundreds of articles that have appeared in Literature and Medicine.

The third phase

The rise of the health humanities constitutes the third phase in the field's development. The replacement of ‘medical’ by ‘health’ was a recognition that health was and always had been the core subject of the field. It is also a way of acknowledging the involvement of clinicians of all kinds in its development (psychotherapists, occupational therapists, nurses) as well as others in the sick person's lifeworld. The third phase began to take shape in the mid-1990s when the Harvard anthropologists became interested in Pierre Bourdieu's and Luc Boltanski's work on social suffering (see e.g. Kleinman, 1994). But it was Paul Farmer's work on structural violence that set the seal on the transformation. Farmer was a medically qualified anthropologist who was much influenced by Catholic liberation theology. He succeeded Kleinman (who had been his doctoral supervisor) as chair of Harvard's Department of Global Health and Social Medicine. In a landmark essay from 1996, Farmer introduced the concept of structural violence to describe the situation of the Haitian population at the end of the millennium. According to Farmer, Haiti had ‘long constituted a sort of living laboratory for the study of affliction, no matter how it is defined … life choices are structured by racism, sexism, political violence, and grinding poverty’ (Farmer, 1996: 262–3; original emphasis). Modern Haiti could not be understood anthropologically unless account was taken of the successive waves of imperial immiseration it had suffered over the previous five centuries. In the 1996 paper, Farmer deployed the narrative methods recently developed by the Kleinmans and the Goods. But he went beyond his mentors in asserting that suffering must be understood in a global historical context. Analysis must be ‘geographically broad’ and ‘historically deep’ (ibid.: 274; original emphasis). Farmer also called for the study of ‘social “axes”’ in order to bring greater precision to the ‘political economy of brutality’ (ibid.: 274). These included gender, race, and poverty. But he believed that the most important consideration to keep in mind was structural violence, observing that ‘[one] of the unfortunate sequelae of identity politics has been the obscuring of structural violence, which metes out injuries of vastly different severity’ (ibid.: 279). The chief victims of structural violence were the world's poor.

The term ‘structural violence’ had first been described by the Norwegian sociologist Johan Galtung (1930–2024) in a paper proposing a novel typology of violence (Galtung, 1969). It was widely taken up by liberation theologians and it is through them that Farmer appears to have become acquainted with it. Here is Galtung's original definition:

Structural violence is silent, it does not show – it is essentially static, it is the tranquil waters. In a static society, personal violence will be registered, whereas structural violence may be seen as about as natural as the air around us. Conversely: in a highly dynamic society, personal violence may be seen as wrong and harmful but still somehow congruent with the order of things, whereas structural violence becomes apparent because it stands out like an enormous rock in a creek, impeding the free flow, creating all kinds of eddies and turbulences. Thus, perhaps it is not so strange that the thinking about personal violence (in the Judaeo-Christian-Roman tradition) took on much of its present form in what we today would regard as essentially static social orders, whereas thinking about structural violence (in the Marxist tradition) was formulated in highly dynamic northwest-European societies. (Galtung, 1969: 173; original emphasis)

In the context of the medical humanities, it should be noted that Farmer was using Galtung's work in much the same way that epidemiological researchers in social medicine were pointing to societal structural health impairment. It is surely no coincidence that Farmer draws on Michael Marmot's work in this first paper (Marmot afterwards chaired the World Health Organization Commission on Global Health Inequalities).

Farmer's emphasis on structural violence inaugurated a move away from intensive, micro-focused, relatively synchronic anthropological analysis towards extensive, macro-focused historical investigation. It was of a piece with the turn in epidemiology and public health towards the study of the social determinants of health, worldwide. Note, however, that there is no intrinsic contradiction between intensive and extensive analysis. The latter augments the former; it need not be at odds with it.

Farmer's work on structural violence was rapidly assimilated by the medical humanities (see e.g. Bhuvaneswar and Shafer, 2004; Hammar, 1997, 1999; Karnik, 2000; Metzl and Kirkland, 2010). It dovetailed nicely with the emphasis in literary studies after 2000 – especially in English – on race, class, gender, and sexuality, although English studies seldom takes poverty as seriously as Farmer did.

All three of the phases we describe above are represented in The Health Humanities Reader (Jones et al., 2014) and in The Edinburgh Companion to the Critical Medical Humanities (Whitehead et al., 2016). We do not claim to have done justice to the sheer variety of projects the field has sponsored or to the creativeness and inventiveness that have characterised its best work; our account has endeavoured to explain the major turning points in the field's history in the US. We now want to address the different chronology of the field in France.

The medical humanities in France

Unsurprisingly, there are resemblances between the emergence of the field in the US and its establishment in France from around 2010. Beginning in the 1990s, medical schools in France began to integrate teaching from the sciences humaines et sociales or humanities and social sciences (SHS), to give them their collective name. SHS is not simply an umbrella term, for it entails a set of assumptions about the linkages between the humanities and the social sciences that wouldn’t ordinarily be taken for granted in the Anglo-American university (Feuerhahn and Orain, 2019). Chief among these is the notion that the humanities and the social sciences are concerned with understanding the place of the individual in society in a historical context. The sciences humaines began life as an equivalent to the German Geisteswissenschaften. The earliest recorded usage occurred in the translation of Wilhelm Dilthey's Einleitung in die Geisteswissenschaften (Introduction to the Human Sciences) (1989). In 1958, the French state decreed formally that the sciences humaines belonged with the discipline of Lettres (Journal officiel 27 July 1958). ¹ Roland Barthes’s early works, like Michel Foucault's or Lucien Goldmann's, supply the clue as to why. In those authors’ works, literature was often treated as an authoritative form of social and historical evidence. In 1970, the larger category of SHS was brought into existence by the state, as a combination of these subjects alongside all the subjects that might count as social sciences in the Anglo-American university (Ministère de l’Enseignement supérieur et de la Recherche, 2010). Since 2010, the French government has used the following categorisation of the SHS disciplines in determining the funding of teaching and research:

SHS1: markets and organisations (economics, finance, management);

SHS2: norms, institutions, and social behaviours (law, political science, sociology, anthropology, ethnology, demography, information and communication sciences);

SHS3: space, environment, and societies (environmental studies, physical geography, social geography, urban and regional geography, land economy);

SHS4: human mind, language, education (cognitive sciences, linguistic sciences, psychology, educational sciences, the sciences of physical and sporting activities);

SHS5: languages, texts, arts, and culture (languages, literature, arts, philosophy, religion, history of ideas);

SHS6: the ancient and contemporary worlds (prehistory, archaeology, history, history of art).

Theoretically, the teachers who were brought in to medical schools to teach SHS disciplines could have come from any of these disciplines. However, their situation was almost always precarious. In the early 1990s, SHS were made compulsory in the first year of medical school, taking up a significant amount of teaching time. In 2010, France followed Germany, Switzerland, and other European countries in making medical education map onto other kinds of doctoral training. What this meant in practice was that medical students had to do a bachelor's degree and a master's degree before they could qualify as doctors. Throughout the 2010s, SHS subjects were compulsory during the bachelor's degree, and optional thereafter (Visier, 2011). Thanks to an act of parliament in 2020 (Arrêté du 2 Septembre 2020), they became compulsory in the second half of medical training too. In 2016, the College of Teachers of SHS in Medical Schools, founded in 2007, renamed itself the Collège des humanités médicales, thus using the Anglo-Saxon terminology. Today, there are around 20 master's programmes in the medical humanities taken particularly by medical students.

This brings us to our first significant difference between the medical humanities in France and the US. In the US, the medical humanities came about largely through the efforts of a group of enthusiasts who were able to mobilise significant philanthropic, state, and federal resources to make them a reality. In France, the medical humanities arose almost as a way of naming a guild, the guild of teachers of SHS disciplines in medical schools. The precise distribution of disciplines varied from place to place, as it did in the US; philosophy, history, philosophy of science (thanks to the influence of philosopher Dominique Lecourt, a former pupil of Georges Canguilhem who had the ear of Jean-Pierre Chevènement, Minister of Research and then of Education in the 1980s), medical anthropology, and sociology were predominant – but they had to wage a long battle to gain recognition for their potential contribution to public health, psychiatry, or ethics, all the preserve of doctors.

The cadre of medical humanities teachers in France was already well aware of the naive and restrictive nature of the task of ‘humanising’ medicine. They were never in the business of adding mere ‘perspectives’ to medicine and medical practice. The role of medical humanities is not seen by them as addressing a putative ‘dehumanisation’ of biomedical practices, but rather as an attempt to understand how ‘medicine’, in its extreme diversity, is constructed and practiced, socially, historically, ethically, politically, legally, and organisationally. For this reason, it can be said that the teaching of SHS in France was in some ways not far from the contemporary health humanities in the US or the ‘critical medical humanities’ in the UK, which call for an examination of the way in which health problems are constructed, represented, and governed beyond the clinical scene (Viney, Callard, and Woods, 2015). For French medical humanities scholars, the inclusion of the humanities in medical education carries with it the critical project of refounding medicine itself.

Nevertheless, the adoption of the name les humanités médicales has resulted in an alignment of interests between France and the English-speaking world. In 2020, a field-defining volume appeared bringing together some of the leading currents of medical humanities scholarship in France today (Lefève, Thoreau, and Zimmer, 2020). Four areas of scholarship are developed in particular detail: the first, inspired by Descola, Latour, Stengers, and Haraway, criticises the perpetuation of the opposition nature–culture, the supposed neutrality and universality of biomedical sciences, and the division of tasks between the biomedical sciences and the humanities which cannot be reduced to the ‘contextualisation’ of knowledge and practices in health and medicine; the second, inspired by Canguilhem and Foucault, describes clinical evolution through health politics and institutions, especially in hospitals; the third, inspired by Canguilhem's central notion of ‘milieu’ and by Fassin, underlines the role of toxic environments in reproducing illness and the production of public health ignorance on this subject. The fourth demonstrated the value of introducing illness narratives into medical training, whether historical, literary, cinematic, drawn from visual culture (Lefève, 2020), or provided by patient partners (Lechopier, 2020). It was influenced by works on learning empathy (Shapiro, 2008), sensitivity and sensibility (Bleakley, 2015), and attention, in the sense of perceiving what matters morally, particularly enriched in France by the ethics of care, as well as the philosophies of Wittgenstein, Murdoch, Diamond, Cavell (Laugier, 2014), or Schutz (Zaccaï-Reyners, 2023). It intersected with the growing interest in France in narrative medicine and in the narrative-based medical humanities more generally (Avérous and Galichon, 2021; Vasset, 2017). Because the medical humanities in France are still tied to clinical teaching – as is the case almost everywhere – the clinic holds a central place there. However, the critical medical humanities (Whitehead et al., 2016) are a source of lively debate in France especially because of their critique of the ‘three Es’ (Experience, Empathy, Ethics). At issue is the place of socio-historical approaches to health on one hand, and the subjective experience of illness and the moral question of care on the other.

One emerging difference between France and the US lies in the growing number of French researchers engaging in ‘field philosophy’ in health and medicine, in the style of Annemarie Mol and Jeannette Pols. Field philosophy research projects have in common that they base their research not only on bibliographic sources, but also on work that they carry out themselves on site or with people concerned with their research object (Benetreau et al., 2023; Dekeuwer, 2019; Despret, 2018). Aligned with social sciences and participatory research methods, field philosophy contributes to an ethnography of illness and the lived experience of care, and documents ‘the irreducible diversity of ways of living and being’ (Gaille, 2019: 53) – for example, with cancer or with a chronic disease. Field philosophy does not aim to respond to a medical demand or solve a practical question, but rather to reformulate it while deploying an intimate knowledge of the field and respecting the viewpoints of all actors. It is particularly about recognising the importance of the experience and expertise of individuals with illnesses and their caregivers in order to rethink practices according to the needs of patients and to promote more assertive forms of cooperation. Here, the French situation has drawn inspiration from excellent field-philosophical projects in the UK such as ‘Hearing the Voice’ and ‘Life of Breath’. But this approach finds one of its major inspirations in the philosophy of Georges Canguilhem and his study of the patient’s perspective.

If there is a dominant current running through the French medical humanities, it derives from the particular version of vitalism that emerged from the work of Canguilhem. Canguilhem's work is still not widely read in the English-speaking world; it is striking how seldom he is quoted in Anglophone medical humanities journals. He is known in the Anglophone university principally as the teacher of Gilles Deleuze and as the doctoral supervisor of Michel Foucault. A large part of Foucault's legacy is bound up with his lifelong engagement with Canguilhem's thought. In France, Canguilhem's influence has been amplified by the publication of his complete works by Vrin, from 2011.

For present purposes, we will focus on just two aspects of Canguilhem's legacy. First, we will identify the salient features of Canguilhem's view of medicine. Second, we will consider how his ideas have been developed in France by contemporary thinkers associated with la philosophie du soin, which literally means ‘the philosophy of care’, but we will refrain from using the English term here so as not to conflate it with the ethics of care movement or with the way some philosophers of medicine have considered care as an isolable topic in a wider field (see ffrench and Lefève, 2025).

Canguilhem's overriding allegiance is to modern vitalism. Vitalism in the sense in which Canguilhem used the term should not be confused with the 18^th-century doctrine that life must depend on immaterial causes. In France and Germany, vitalism survived the demise of its 18^th-century antecedent in the form of a subtler claim, namely that life is somewhat autonomous from and independent of physico-chemical processes. Under the influence of Claude Bernard, Henri Bergson, and Kurt Goldstein, Canguilhem emphasised the constitutive relationship of organisms with their environments. In the process of creating this relationship, organisms establish norms. Note that in making this claim, Canguilhem does not dispute the ontological status of living entities as material substances. But life, for Canguilhem, is best defined as a normative activity in a perpetual struggle against anything that limits it (Canguilhem, 1978: 126). As Arantza Etxeberria and Charles T. Wolfe explain, it is ‘the inherent plasticity and variability of life … evident in its interactive or relational capacity’ that makes it irreducible to physico-chemical laws for Canguilhem (Etxeberria and Wolfe, 2023: 132). The living being (le vivant) is a subject of vital values (Canguilhem, 2008). The term ‘subject’ in Canguilhem refers neither to the psychic subject nor to the transcendental subject, but only to the living being insofar as it always gives meaning to what happens to it and asserts its values in its relationship to the milieu (Badiou, 1993).

In his most celebrated book, The Normal and the Pathological (1978), Canguilhem was fond of observing that illness is best seen as a transition from one normativity to another. Health, or the normal, corresponds to the normative capacity of the living being to establish relationships with its milieu that allow it to overcome any of its alterations (or infidélités) and ultimately to continue structuring it. A healthy person, for Canguilhem, defines his or her own normativity. ‘The sick man’, Canguilhem writes, ‘is not abnormal because of the absence of a norm but because of his incapacity to be normative’ (Canguilhem, 1978: 186). A person with an illness must institute new norms of life, norms that are compatible not only with the biological limitations imposed by the illness but with group life. As Lennard J. Davis has noted, in many respects, this is a point of view that anticipates modern disability studies’ emphasis on the resistance of the healthy and the able-bodied to sick or disabled norms (Davis, 2017: 17).

This view of illness ramifies into health and medicine. Health becomes merely one form of normativity among several. Medicine is nothing but the human extension of the normative activity of living beings’ struggle against death and disease through science and technology. Medicine, moreover, is irreducible to biomedical science because it deals with individuals leading their lives in a social context shaped by social norms and values. It combats death and disease and at the same time it supports the individuality of the patient as a norm-creating agent. Health and illness are first and foremost vital and normative experiences lived by human subjects before they become objects of knowledge. Canguilhem defines it as ‘an art at the crossroads of several sciences’ while being reducible to none (Canguilhem, 1978: 34). Throughout his work, Canguilhem reviewed the history of medicine since the 18^th century and found that as it became more conflated with a science, medicine tended to turn patients into objects of knowledge and, by that means, robbed them of their status as normative, meaning-driven subjects. In so doing, it turned away from its original mission, which was to respond to the call for help from a subject with their own norms and needs (Lefève, 2024).

Canguilhem revalues clinical practice and therapeutics as the essential activities of the physician. Biomedical sciences must remain instruments in service to clinical practice – the art of observing and understanding the individual norms of the patient – and therapeutics – the art of restoring or, when restoration is not possible, establishing new norms of life that must first and foremost be appreciated by the patient themselves.

Canguilhem followed Kurt Goldstein in emphasising the fact that medicine depends not only on a knowledge of pathophysiology, but also on:

a coming to terms of two persons, in which the one wants to help the other gain a pattern that corresponds, as much as possible, to his nature. This emphasis on the personal relationship between doctor and patient marks off, impressively, the contrast between the modern medical point of view and the mere natural-science mentality of the physicians at the turn of the century. (Goldstein, 1995: 341, quoted in Canguilhem, 2012: 63)

Canguilhem's conception of the sick person's normative activity has been especially influential among scholars of chronic illness (Barrier, 2010; Camus, Gaille, and Lancelot, 2022; Lefève and Ricadat, 2022). The chronically ill person has to struggle with two forms of normalisation: that imposed by the illness, and that imposed by society. The psychological and physical effort may be overwhelming and lead to an aggravation of the illness. This way of looking at chronic illness was echoed in the English-speaking world by Anselm Strauss, Juliet Corbin, and others associated with the ‘grounded methods’ approach in sociology (see e.g. Baszanger, 1998; Strauss and Corbin, 1988). Canguilhem distinguishes human normativity from generality, whether based on a so-called scientific and statistical conception of health or on a deterministic conception of the living environment, biological or social. His revaluation of clinical practice and therapy opposes the epistemological error that confuses medicine with a science, and the moral fault that regards medicine as a technique for adapting the individual to society.

The philosophic interest of medicine for Canguilhem arises from the fact that it offers a way of understanding the unity of the problems related to care. And if there is a single focus bringing together French researchers in the medical humanities today, it is the nature of care, conceived as broadly as possible from as many disciplinary standpoints as possible (without limiting it to the feminist ethics of care, for example). Care is, after all, a very entangled subject (Fitzgerald and Callard, 2016). It is perhaps not surprising then that medical humanities scholars who take their inspiration from Canguilhem make the nature of care their central object. Frédéric Worms is perhaps the most distinguished exponent of this new wave. Worms follows Canguilhem in seeing life as struggle against death, and medicine as one tool among many enabling the extension of vital normativity. But, for Worms, medicine must be integrated into a more general theory of care, which is a superordinate term for the struggle against death. Here, Worms finds himself in agreement with Arthur W. Kleinman and others who see medicine as just one mode of care (Kleinman, 2019; Vickers and Bolton, 2024). For both Worms and Canguilhem, one cannot conceive of life without the individuation of the living. There is no life except through living individuals (Worms, 2015). But, for Worms, following Winnicott, the primitive relationship between humans must include care (Worms, 2006). Subjects do not preexist their relationships any more than relationships preexist the subjects who are their terms: ‘it could well be the relationship without which there would be no subjectivity’ (Worms, 2010: 249–50). Worms's vitalism is critical insofar as it is relational. It does not separate the vital from the relational since the relational (between parents and child, between caregivers and cared-for, and between individuals in society) is a condition of the vital (and the vital has obviously implications on the relational). Care also has an opposite in Worms's system: violation. Violation consists in the intentional and active negation of care as it is recognised as a relationship (Worms, 2010).

Worms delineates two moral orientations for every care relationship, vital and social: the first aims at the relief and protection of life, but biological life also depends on relationships between individuals; and the second aims at justice, but inequalities among humans also depend on the conditions afforded to biological life. In medicine, these two orientations crystallise in two polarities: treatment and accompaniment.

Medical care has two distinct but inseparable purposes: supporting life against illness and death, and accompanying individuals in their endeavours to be norm-creating agents. These two moral orientations of medical care carry opposing risks. The strengthening-of-life function may result in a failure to overcome the inherent asymmetry in the medical relationship by subjecting the patient to useless treatments. The moral risk associated with accompaniment is that it can infantilise the patient and ‘parentalise’ (Worms's term) the caregiver. Worms draws on Winnicott and notes that all caring relationships must emancipate the care recipient. As Winnicott might have put it, holding must culminate in ‘letting go’ (Vickers, 2020; Winnicott, 1960).

The philosophie du soin trend in the medical humanities is politically engaged. As Worms puts it: ‘Social norms are different from strictly vital norms, but we still find in them the vital polarity of creation and destruction, extended this time to the entirety of a society as well as to the various power relations that traverse and constitute it’ (Worms, 2015: 26). The same applies to global justice, which is the action of humanity on itself and on its ‘environment’, its overall milieu comprising other living beings, the planet, and, if you will, ‘life’ itself. For we cannot care for the natural ‘world’ without caring for justice among humans, on the entire planet, nor can we care for humans without caring for other living beings and the planet itself. It is not about reducing humans to ‘life’ but about instituting norms of justice that allow for the preservation and creation of relationships among all living beings.

The philosophie du soin that developed simultaneously with the introduction of feminist ethics of care in France partly intersects with them, particularly as developed by Tronto and Butler when they inscribe medicine within the interdependent networks of relationships and institutions supporting the physical and moral life, both individual and collective, of human subjects. However, the pioneers of care ethics in France (Molinier, Laugier, and Paperman, 2009) were keen to break the link between care and medicine, and refused to translate the English term ‘care’ into the French term ‘soin’ for fear that medicine would be seen as the privileged model of care and would hinder gender or social aspects of care. On the contrary, for the contributors to the philosophie du soin, by emphasising the irreducibility of care to medicine, the ethics of care contributed to rediscovering medicine as care. Worms, Gaille (2023), and Pierron (2021) thus bridge the gap between care and medicine by situating medicine within a set of actions that exceed it and that support life.

Canguilhem and the US medical humanities

Canguilhem's work has had little impact on the English-speaking medical humanities world. It has had more success in adjacent disciplines, notably, the history and philosophy of science, science and technology studies (Mol, 2008), and medical sociology (Fraser, Kember, and Lury, 2006). The only English-language thinker to place the medical humanities squarely against the background of vitalism is Monica Greco, who has published two significant articles on the subject (2008, 2013). Greco did not have a historical account of the medical humanities to work with, and following Kirklin and Richardson, saw the field as ‘[encompassing] any interaction between the arts and health’ (Greco, 2013: 227).

In recent years, attempts have been made to link Merleau-Ponty's phenomenology to Canguilhem's vitalism (see e.g. Vörös, 2023). But none of the original phenomenological contributors to the US medical humanities pursued this connection. (Somewhat confusingly, Engelhardt and Pellegrino wrote about vitalism in the 18^th-century sense.)

It is, however, in the second phase that the stakes of vitalism become much more conspicuous. In Writing at the Margin (1994), Arthur Kleinman surveyed Canguilhem's writings and noted their relevance for the new medical anthropology he was trying to put in place. Kleinman explicitly approved of Canguilhem's vitalism, noting that it was consilient with Chinese views of medicine (Kleinman, 1994: 36). The extreme anti-vitalism of biomedicine needed to be opposed. In Kleinman's recent memoir, The Soul of Care (2019), he notes that it has become clear to him that his primary subject throughout all his books was the nature of care, a point of affinity with the thrust of la philosophie du soin.

It seems to us, however, that the biopsychosocial commitment of the second wave of the medical humanities to which Kleinman made such a powerful contribution was fundamentally vitalist. The biopsychosocial model posits the power of the lifeworld to determine biology. It considers humans as open biological systems being modified by their environments and modifying the latter in turn. It was as concerned as Canguilhem was ‘with indeterminate surplus of vital possibilities available to an organism’ (Greco, 2008: 28) at any given time. The Harvard anthropologists’ account of ‘culture’ in relation to health highlighted the dynamism of those possibilities alongside their biopsychosocial significance.

In recent years, as the medical humanities in the English-speaking world have increasingly come under the dominance of English studies, this emphasis has fallen away. The French version of the field offers a powerful means of reasserting it and building on it yet further. In concluding, we would like to offer a hypothesis which has the potential to re-orient the field in this direction.

Canguilhem and Foucault

Excepting the engagements described above, until quite recently in English-speaking contexts, Canguilhem was predominantly known in association with Foucault, whose authoritative role in the medical humanities is well-established. One might say that a deeper engagement with Canguilhem's work has been occluded or, at worst, prevented by his status in the shadow of his former pupil. We want to invert the perspective, and view Foucault's work through Canguilhem's vitalism. We might observe straight away that Foucault's preoccupations with the origin of norms and with the arbitrary nature of what gets designated as ‘pathological’ come directly from Canguilhem.

If Canguilhem's influence has remained largely hidden in the English-speaking world, it is because there Foucault is most celebrated as a theorist of power. It is also instructive to note that the early reception of Foucault in the US and the UK was shaped by anti-psychiatry. Translations of the abridged version of Foucault's History of Madness (published as Madness and Civilization: A History of Insanity in the Age of Reason in 1967) and then The Birth of the Clinic: An Archaeology of Medical Perception (1973) were published in the UK by Tavistock Publications, then directed by R. D. Laing, and by Pantheon in the US. The first had a preface by David Cooper. A 1961 Times Literary Supplement review of Histoire de la folie, then titled Folie et déraison, remarked on Foucault's ‘animus against doctors’ (Anonymous, 1961: 654). In the wider field of the SHS, Laing's endorsement and Cooper's introduction linked Foucault's work on madness and medicine to the critique of institutions and to a broad front of Western Marxist-influenced social criticism referencing figures such as Herbert Marcuse and Lucien Goldmann. Emerging through and aslant this tendency, it was then through association with Althusser and the Marxist theory of ideology in UK-based journals, such as the New Left Review and Radical Philosophy, that Foucault's archaeological work – in The Order of Things (1970) and The Archaeology of Knowledge (1969) – was most substantially discussed.

Thanks in no small measure to Judith Butler's several engagements with Foucault, notably in The Psychic Life of Power (see Butler, 1997: 83–101), his engagement with power-knowledge continues to hold pride of place in the English-speaking world.

In the genealogy of the medical humanities, Foucault is generally placed on the side of the critique of institutions and medical power-knowledge. For instance, the Edinburgh Companion to the Critical Medical Humanities acknowledges the work of Foucault and his legacy as an ‘important intellectual landmark’, foregrounding: ‘Foucault’s influential archaeologies of thought, which mobilised critique in an oppositional sense “as a means to resist” presumptuous reason and its specific effects of power’ (Whitehead et al., 2016: 5).

Multiple references throughout the Companion emphasise the importance of Foucault's ‘archaeological’ (i.e. pre-1970) account of the construction of the medical patient through the clinical gaze, as well as through the discursive and institutional arrangements of medical power-knowledge. Anna Elsner and Steven Wilson, in their recent survey of ‘French Studies and the Medical Humanities’ also acknowledge that:

The publication of Foucault's Naissance de la clinique and the elaboration of what he called ‘le regard medical’, exposing the power relationship between doctor and patient, marked an additional major reference point in the elaboration of the medical humanities, in France and beyond. (Elsner and Wilson, 2024: 304)

This emphasis on Foucault's critique of the institution of medicine, the framework underpinning the clinical encounter, and the imbrication of medical and especially psychiatric practices with the imposition of techniques of discipline and power finds expression in volumes such as History of Madness (2006[1961]), The Birth of the Clinic (1973), and Discipline and Punish (1977), and in the Collège de France lecture courses Psychiatric Power (2006) and Abnormal (2003). Foucault thus provides the humanities and the social sciences with a powerful set of critical tools with which to critique the institution of medicine. The medical humanities, especially but not solely in their third phase, have filled out a profile image of Foucault in which these accents are dominant (see e.g. Diedrich, 2007).

With the replacement of archaeology by genealogy, and especially once work on the History of Sexuality had got underway, a new preoccupation can be seen to take root, one that for many French commentators represents something like a ‘return to Canguilhem’ (Foucault, 1979). It begins in 1975 when Foucault changes the focus of his analysis to what it is that power acts upon. Up until, say, Discipline and Punish (1977), power in the modern era was presented as a means of controlling deviance, whether in the form of madness (1961, 1973–1974), illness (1963), sexual delinquency, or criminality (1975). Deviance meant deviance from norms. Once he began work on the History of Sexuality volumes, the focus switched to a newly-theorised form of power which he famously called biopower, a power ‘that endeavours to administer, optimize, and multiply [life], subjecting it to precise controls and comprehensive regulations’ (1976[1978]: 137). Biopower, it soon became apparent, went to work not on deviance from norms but on vitality itself.

Hence, Foucault would seek to ‘pass to the other side’ (Foucault, 2019[1977]: 71), to grasp and articulate the struggle of life ‘understood as the basic needs, man's concrete essence, the realisation of his potential, the plenitude of the possible’ (Foucault, 1979: 145). As Frédéric Worms has suggested in this volume, this proposition of a ‘vitalist’ Foucault is broached, against the grain, by Gilles Deleuze, who writes:

Life becomes resistance to power when power takes life as its object.… When power becomes bio-power resistance becomes the power of life, a vital power that cannot be confined within species, environment or the paths of a particular diagram. Is not the force that comes from outside a certain idea of Life, a certain vitalism, in which Foucault's thought culminates? Is not life this capacity to resist force? From The Birth of the Clinic on, Foucault admired Bichat for having invented a new vitalism by defining life as the set of those functions which resist death. And for Foucault as much as for Nietzsche, it is in man himself that we must look for the set of forces and functions which resist the death of man. Spinoza said that there was no telling what the human body might achieve, once freed from human discipline. To which Foucault replies that there is no telling what man might achieve ‘as a living being’, as the set of forces that resist. (Deleuze, 1988: 92–3)

Although Deleuze's reference here is to Bichat, whose insights concerning the ‘essential structure of medical thought and perception’ structured around ‘that to which life is opposed and to which it is exposed; that in relation to which it is living opposition’ (Foucault, 1973: 144–5), it is hard not to see the shadow of Canguilhem. The ‘fold’ (Deleuze, 1988: 97), whereby bio-power is confronted by the ‘power of life’, as a resistance and a struggle, engages the shift of perspective we want to propose here, which involves the hypothetical proposition of relation between Foucault and Canguilhem different from that which one might assume from the relatively scarce references to Canguilhem in the former's work – Foucault is often somewhat reticent about his influences. This would involve the postulation that across his work, alongside the critical dimension, Foucault had always been pursuing and developing a Canguilhemian understanding of the struggle of the living being with the negative, the shifting dynamics of normativity. Foucault's critical investigations of the dispositifs – the frameworks and operative structures – of power-knowledge can then be seen as part of that endeavour.

While a translation of Canguilhem's The Normal and the Pathological, with an introduction by Foucault, was published in 1978, it passed more or less unnoticed, and Canguilhem remained invisible to an English-speaking readership until the re-publication of the 1978 translation by Zone Books in 1991. This text would be slightly revised for the last essay Foucault signed off before his death in 1984, ‘Life, Experience and Science’, in a journal issue devoted to Canguilhem. The essay concluded with these words:

Although phenomenology brought the body, sexuality, death, and the perceived world into the field of analysis, the cogito remained central to it; neither the rationality of science nor the specificity of the life sciences could compromise its founding role. In opposition to this philosophy of meaning, the subject, and lived experience, Canguilhem has proposed a philosophy of error, of the concept of the living [du concept du vivant], as a different way of approaching the notion of life. (Foucault, 1994b[1985]: 477)

We suggest that in The Birth of Biopolitics and in The History of Sexuality, Foucault found himself substantially in this territory. Canguilhem's notion of vitality has a shadow presence all through the oeuvre (Foucault, 2008). It is quite explicit in an early essay entitled ‘Psychology from 1850 to 1950’. Contemporary psychology, Foucault writes,

is in its origin an analysis of the abnormal, the pathological, the conflictual, a reflection on the contradictions of man with himself. And if it has been transformed into a psychology of the normal, of adaptation, of the ordered, this is secondary, as if through an effort to dominate these contradictions. (Foucault, 1994a[1957]: 150)

It is perhaps also visible in the History of Madness. Although Foucault later deplored the fact that that work assumes the existence of madness as a transhistorical fact, it could be rehabilitated if what is described as madness is seen instead as a manifestation of the disempowered subject's vitality. The work can be said to remain true to Canguilhem when it portrays madness as a revolt against the constraints of reason and the progressive delegitimisation of a minority normativity (Canguilhem, 1980, 2008).

Further into the middle of Foucault's œuvre, we might consider ‘The Lives of Infamous Men’ (1977), a preface to an aborted book in which Foucault writes with explicit fascination about the ‘singular lives, transformed into strange poems’, captured in 18^th-century lettres de cachet contained in the archives of the Bastille. The fragments he considers were letters about ‘infamous men’, from wives or neighbours, requesting their incarceration. Reflecting on his approach and his interest, Foucault imagines a rebuke about his incapacity to ‘pass to the other side … always the same choice, on the side of power, of what it says or causes to be said. Why not go listen to these lives where they speak in their own voice?’ (Foucault, 2019[1977]: 71–2). But he then counters his own objection with the proposition that it is only through the encounter with power that these lives are illuminated, in a ‘brief flash’ (ibid.: 72):

Is it not one of the fundamental traits of our society, after all, that destiny takes the form of a relation with power, of a struggle with or against it? Indeed, the most intense point of a life, the point where its energy is concentrated, is where it comes up against power, struggles with it, attempts to use its forces and to evade its traps. (ibid.: 72)

We might see this as a kind of hinge or pivot, the unsettling moment at which the profiles switch, where we glimpse an image of Foucault doubled by Canguilhem. The intensity of a life is in its struggle against what opposes its vitality, its freedom. We can recall here Whitehead and Woods's proposition, cited above, and reflect that, with Canguilhem back in the picture, it is no longer just critique that resists ‘presumptuous reason and its specific effects of power’, it's also the body and the person in the body.

By way of a conclusion

The French medical humanities can teach their Anglophone counterpart how to use Foucault in ways that make room for the constructive side of medicine to a degree that has few parallels in the English-speaking world. The preoccupations of the first two iterations of the field – hidden values and culture – can come back into this vision much more readily than if Foucault is seen as first and foremost a critic of power. Exploring and developing this French way of seeing Foucault – to which Deleuze and Worms have drawn attention – is an obvious way for the French and the American traditions in the medical humanities to influence one another. From an English speaker's point of view, Foucault's debt to Canguilhem makes his oeuvre appear less discontinuous.

In this light, rather than seeing the humanities solely as an armoury of tools for the critical analysis and revelation of the biopolitical and disciplinary management of life through medical science and practice, the medical dimension becomes, as it is in Canguilhem, the field from which the humanities can draw lessons concerning the relation of the living being to its milieu. True entanglement might be seen in light of the unity of Canguilhem's philosophy of life and medicine. Canguilhem's philosophy articulates a philosophy of life, described as a normative activity in struggle against that which limits it; an epistemology of medicine, defined as an art utilising the sciences (without being reduced to them); an ethics of the clinic, grounded in the physician's attention to the patient (and not solely to their illness); and a political project that demands scientific and institutional means not to adapt the patient to social norms, but to support their individual normativity and preserve their place in society.