Norm

NORM is a scale of evaluation; moreover, it is not only a direct quantitative measure, but also that which "specifies" and assigns to a certain qualitative class. Norm is not a transcendent, immutable value and does not exist in an isolated form; it is viewed as a correlation of something with something else. Norm must always be taken dynamically in concrete conditions, in connection with all surrounding factors to which it relates. Norm in biology and medicine must meet social and class demands. In modern bourgeois science, the concept of Norm is often identified with an absolute concept of what "ought to be," and thus it is ascribed an absolute and, moreover, purely qualitative meaning, or else Norm is understood as a mathematical average—and in that case, it becomes a purely quantitative concept. Norm as a category of "ought to be," as a term of teleological evaluation, is most often understood in logic, ethics, and aesthetics: here, that which corresponds to the ideal postulates of ethics, aesthetics, etc., is considered normal and positive. But in the natural sciences and in medicine, Norm is also often treated in the same sense—as a postulate of human perfection. Morel, for example, considered Norm to be "the original, perfect type of man created by the Creator," and considered any deviation from it to be a degree of degeneration. For Hildebrandt, Norm is "the unification of the highest values of the species; a creative type, full of creative instincts, with a fullness of feelings and an eudaemonistic (as opposed to hedonistic) worldview; this is the hero, the creator, the benefactor of humanity." The same teleological principle also lay in the definition of concepts by early medicine: health = norm = good, and disease (a negative phenomenon not corresponding to the postulate) = evil. The same teleological meaning is also held by the definition of the normal structure of an organ as one "which, according to scientific experience, leads to its most perfect work, corresponding to the laws of physiology" (Ribbert); for example, if the absolute physiological Norm in the field of eye refraction is considered the physiological optimum, i.e., vision where a bundle of parallel rays from an infinitely distant object, to which the eye is set, intersects exactly on the retina (emmetropia), or if the Norm is taken, for example, as having not a single rotten tooth. Such an abstract norm-ideal lies, strictly speaking, outside the plane of studying actual life relations. If we take the Norm of Morel or Hildebrandt as a yardstick, we would have to come to the absurd conclusion that all or almost all people are abnormal; Ribbert's definition leads to almost the same result, since among modern adults there is almost no one without rotten teeth, and among the urban population, the majority are nearsighted. On the other hand, in technical sciences, when establishing the concept of Norm, there is an effort to create a quantitative yardstick that would make possible the quantitative comparison of certain individual objects; here, the Norm is quantitative, a scale—a standard meter, gram, standard solution, etc. At the same time, in defining such a Norm-measure, there has long been a tendency to find a more or less stable basis for it and thus eliminate its arbitrariness. Usually, more or less stable relationships that are common in nature are chosen as normal measuring devices: a meter = 1/40,000,000 of the Earth's meridian, a gram = the weight of 1 cm³ of water at 4°, a standard solution = a solution corresponding to the specific weight of the soluble substance, etc. In the definition of disease as a "vital process which significantly deviates from that existing in the majority of similar individuals" (Cohnheim, Podvysotsky, Krehl, etc.), there is also an aspiration toward a purely quantitative Norm; here, the Norm is taken not as a postulate-ideal, but as a certain quantitative scale: the morphological structure (macroscopic and microscopic), physiological function, and evolutionary development "existing in the majority of similar individuals" are considered abnormal and pathological here primarily because they are encountered rarely, in few. From this point of view, five-fingeredness turns out to be the Norm because we encounter it as a rule; if the majority were six-fingered, then six-fingeredness would be the norm. This kind of approach to the concept of norm naturally cultivated the application of mathematics to the problem of standardization. The crudely empirical "by-eye" definition of what "is encountered most often" did not satisfy researchers, and therefore, as methods for the precise quantitative determination of what is encountered in the majority of individuals, methods of variation statistics (see) with their precisely mathematically expressed average values were put forward. Initially, the arithmetic mean was usually taken as the average, but the insufficient representativeness of this average is quickly discovered in very many cases where individual features are distributed unevenly in the general series, and at the present time, the so-called mode (Mo) is most often used, i.e., the value that is encountered most often in a given series (der dichteste Wert). Furthermore, it became clear that the more individual values are scattered in a collective, the less reliable any average is, and as a second stage of the statistical study of a collective, there appeared the indication not only of the average but also of the characteristic of the dispersion of values throughout the entire series. The average should serve only as a reference point for determining the space that groups around it and which is a broad yardstick of the Norm. The most common measure of this dispersion of the breadth of fluctuation of features is the so-called "sigma" (σ)—the standard deviation. By means of σ, the question of the limits of the normal was resolved. This mathematical Norm gives a precise expression of the regularity of a certain modus in a group of phenomena, makes it possible to assign an individual to one place or another in the entire collective, and to judge with one degree of probability or another how usual he is for the collective or not. The further the features of an individual move away from the features lying in the space around the average, the greater the degree of his deviation from the norm. However, the insufficient suitability of such a purely quantitative mathematical Norm-measure soon made itself felt. Being torn from a biological basis, not being under the constant control of a socially important practical goal for which the calculation is taking place, and built as if on the most precise objective data, the mathematical average as a norm nevertheless just as easily becomes a function of an immaterial order, an ideological construct having no practical meaning, just like the norm-ideal. A great merit of Johannsen in the field of biology is the clarification that it is necessary, when applying mathematical-statistical methods, to clearly imagine what we are measuring, and whether the objects we are measuring are comparable in relation to the value-quality we have chosen. One can fall into a great error if, when compiling a "collective" of biological individuals for mathematical processing, one does not take into account the homogeneity of their biological qualities, if one does not reckon with the biological influences that create quantitative differences. Johannsen, through an analysis of the laws of inheritance developed by English biometricians (see Biometry) using mathematical methods (Galton's laws), clearly showed the biological incorrectness of these laws, because biometricians combined individuals into a general collective without sufficient analysis of whether they are biologically (in the case of studying heredity—genetically) equivalent. The average value, as Johannsen showed, is a true representative not only of quantitative values but also a biological representative in the study of heredity only within completely identical genotypes—a "pure line." Therefore, in order to calmly trust the conclusions obtained by statistical means, it is necessary, on the basis of a preliminary qualitative analysis, to combine into one group only types that are qualitatively uniform for the phenomenon being studied. Then it is necessary to clearly imagine the goal for which we are performing the mathematical-statistical measurement, the nature of those social needs-evaluations that have developed in the process of class struggle and which "specify" mathematical quantities. Furthermore, the collective subject to study and standardization must necessarily be considered historically from the point of view of the tendency of its development. Here it should be noted that bourgeois scientists, tendentiously ignoring the need for qualitative yardsticks when defining a norm—yardsticks that "specify" quantitative ones—and the need to take into account the concrete social environment and the historical development of what is being measured, often sought to cover up class interests with the fictitious "objectivity" of the average-norm. A whole series of races and peoples were declared "inferior" and degenerating, completely without regard for the socio-economic conditions in which they live. Everything peculiar, everything going beyond the limits required by class interests, was declared "abnormal" with reference to the "objectivity" of the mathematical average. As early as 1848, Groddeck wrote, for example, morbus democraticus, and at the present time, in bourgeois literature, especially psychiatric literature, quite a few works have appeared on the "pathology" of revolutionary leaders.

Hence, the metaphysical nature of mathematical formulas for defining the norm is clear, such as the one given by J. Bauer and Rautmann, who assert that all those cases which lie within the boundaries of ±1σ (i.e., 68.3% of the entire population) most likely possess the adaptability to life in given conditions most characteristic of the collective, because it is as if the very fact that they are encountered most often in the population testifies to their greatest adaptability to life; all cases which lie within the boundaries of ±1σ to ±2σ (i.e., 27.2% of the entire population), although more or less adapted to life, may include significant deviations; those cases which lie beyond the boundary of ±2σ (a total of 4.5% of the population) are unusual for the given collective and given conditions and are most likely not adapted to life. It is easy to understand the complete uselessness of these figures for deriving the Norm in the event that the majority of the "population" reflected by them, due to one historical reason or another, stands on the eve of its transformation into a minority, and the complete groundlessness of an abstract-mathematical analysis that does not rely on a deep (and in relation to people, first and foremost, a socio-economic) study of the "collective" being normalized. In this connection, the question of the boundaries of the normal also receives its illumination. It is correct not to absolutely contrast the normal and the abnormal, but to consider both phenomena as certain opposites finding their unity in concrete life moments. What is normal in some conditions may become abnormal in others. There is no difference between the normal and the abnormal that would lie by its nature only in the realm of biology and mathematical quantities. For example, in the simplest cases, if we have in mind fitness for military service, we will consider as the norm the height and chest circumference which, on the one hand, are most frequently encountered in the population (respectively, close to the mathematical mean, since it is necessary to select a maximum of people for military service), and on the other hand, sufficiently meet the needs of the activity required for this. For the position of, say, a clerk, the Norms will be different. The "nodal points" separating the qualitative features of one group from the qualitative features of another must be determined in connection with all socio-economic requirements. If we take any collective for which the mathematical mean turns out to be features clearly unacceptable for practical life, we will in no case consider this mean as the Norm. For example, under no circumstances will syphilis be the Norm, even if the majority of the population suffered from it, etc. Only a dialectical combination of qualitative definitions, given by all life needs in all their constant variability, with a mathematically precise quantitative definition creates the criterion of the norm as a "qualitative definition of quantity." The awareness of the need to combine the understanding of the Norm, health, and disease (see Disease) with real life conditions arose spontaneously among many physicians who provided corresponding definitions of disease. Thus, A. A. Ostroumov defined disease as "a disturbance of human life by the conditions of his existence in the environment." S. P. Botkin defined it as "the reaction of the organism to the harmful influences of the external environment acting upon it," and other pathologists as "life in abnormal conditions." In more recent times, although proceeding from other considerations, Grote also protests against the mathematical average Norm; he says that as long as there exists a relationship (responsiveness - Responsivitat) between the work of individual organs and the entire organism and the demands placed upon them by the environment, the organism is normal. The Norm, according to Grote, is determined by this responsiveness, and not by average values. However, Grote protests against the mathematical Norm not at all because it is static and does not take into account the continuous variability of the environment; he quite incorrectly sets as his main task the "liberation," as he says, of the "concept of medical Norm as an individually conditioned concept from the connection with the Norm as a concept oriented toward the collective (the mathematical mean in the collective)." Grote protests against the mathematical average Norm mainly because its value is obtained based on relationships in a group, a collective, whereas "every individual person," according to Grote, "is the scale of his own normality." Borchardt, Mainzer, and others quite reasonably pointed out that Grote's responsiveness is not an "immanent" property of the organism, is not in any way stable in one and the same individual under different conditions, and therefore cannot serve as a measure of anything whatsoever. A very weak heart, for example, can be responsive if no significant demands are placed upon it: in bed, a heart with an organic defect that is sharply decompensated outside of bed can be responsive, and conversely, under high demands (for example, at an altitude of 4000 m), even the strongest vascular system will turn out to be unresponsive. Thus, by taking responsiveness as the norm, Grote incorrectly ignores not only the question of whether the character of an individual's activity corresponds to the tasks of a given social class and whether this activity itself, along with the indicators of the Norm characteristic of it, is subject to change, but also the question of the variability of environmental conditions throughout an individual life. Grote's position is a position of an opportunistic attitude toward the existing types and forms of professional and all other activities created in capitalist society, a crudely metaphysical position, because it tears man away from the concrete-historical social environment, considers him individualistically, and turns him into a dead abstraction having nothing in common with Marx's conception of man as the "ensemble of social relations." It should also be added that the mathematical mean, even when correctly understood as an auxiliary tool contributing to greater quantitative precision of the established norm, cannot in all cases be accurately quantitatively calculated, and for this reason alone cannot have universal significance. First of all, there are many traits whose variability cannot be expressed in the form of a continuous variation series; these are traits with so-called alternative variability, which are either present or entirely absent (without an intermediate quantitative decrease) or there is either one type of trait or something completely unlike it. In these cases, according to the principle of constructing sigmas of a variation series, it is proposed to consider as abnormal that type of trait which occurs less frequently than in 4.5% of all cases, and to consider the remaining types as normal variations. Of course, such a proposal has some relative significance, but it is precisely here that it is especially clearly seen that the method of mathematical means when defining the Norm has only auxiliary significance and that it must be combined with clearly understood qualitative criteria provided by life as a whole. Furthermore, the statistical mean as a Norm does not satisfy the physician because it does not reflect the features of the entire organism as a whole, but only gives the averages of its individual features. "We will be able to define the norm more accurately," says J. Bauer, "if we know the variability of all traits of the population." But in reality, even if it were possible to establish the variability of all traits, this would still be insufficient for characterizing a personality, because for this one needs to know not only the variability but also the interdependence of each trait with all others. For a long time, attempts have been made, for certain practical tasks, to replace the characterization of the entire personality with its infinitely complex relationships with a formula of interdependence of only a few traits most important from the point of view of practical requirements for a given task. Thus, various "indices" (see Indices of physical development), canons, standards, and their averages were created. The ancient Egyptians, for example, considered the 19-fold size of the middle finger to be the norm for height; the canons of the artists Polyclitus, Michelangelo, and Dürer are known (the practical goal here is beauty). Anthropometric, sanitary-hygienic, and psychotechnical indices, as well as standards for certain professions (the canon of the young soldier of Geigel, the canon of the woman in labor), etc., have the same meaning. In the Method of correlations (see Correlation), we have a more precise mathematical method for calculating relationships and the average values of these relationships. But all these relationships are only partial and intended only for a specific social task as indicators of only certain aspects of the personality, and not of the personality as a whole. A way out of this situation, in the opinion of Brugsch and Schultz (Brugsch, Th. Schultz), is the concept of type. The type is a representative of qualitative features as well; it does not fragment the organism into separate parts. While remaining individual, it is at the same time composed of elements inherent to the entire group of people united by its traits, and not to an individual person.

The type itself is not a measure of the norm, but should only serve as a basis for a more correct selection of a collective, taking into account not only quantitative but also qualitative (Brugsch and Schultz speak in this regard exclusively about biological features) features of the personality as a whole. Johannsen attempts to isolate types on the basis of genetic analysis, insisting at the same time on a strong correlation between somatic and functional features of the representative of each such type. We have attempts of this kind, for example, in Kretschmer's body types and in their somatic profiles. The matter here is thus about the creation of holistic constitutional measures of the norm linked to the genotype. Thanks to this norm (the type and its reactions), it is possible, in the opinion of the constitutionalists, to characterize each individual personality not only by morphological signs, but also by the type of reactions expected from them. Johannsen's considerations are of interest only in that they combine the accounting of qualitative biological features with quantitative accounting; they are more dynamic than the statistical average. However, they, like Grote's considerations, reduce man to the level of an isolated living animal individual and therefore easily lead to biological teleology, an example of which is the position of Schultz, who identifies the 'strivings of the organism' with the type, speaks of 'Typovergenz,' and goes so far as to assert that 'organic development' is an independent integration, at the basis of which lies a predetermined principle of purposeful order; or the view of Roux, who says that it is precisely the genotype that is always the norm, which becomes atypical and abnormal from the influence of the external environment. On the other hand, identifying the concept of the norm with the concept of 'constitution' leads, for example, Henle to the assertion that 'a synonym for the norm is a good constitution,' without any explanation of how and by what this good quality is determined. From all these definitions, we see that a correct understanding of the norm in medicine can be obtained only with a dialectical combination of quantitative and qualitative study, taking into account the social essence of man and the requirements of social practice. In the conditions of the USSR, this practice is the practice of socialist construction, and the 'essence of man' — the worker and the collective farmer — are fighters for socialism. Such a state of affairs dictates the necessity of a fundamental revision of all, including medical, norms established by bourgeois science — a revision based on Marxist-Leninist theory.