2. Health as normality

So now we know that there’s no such thing as average and that designing for outliers creates better systems. But if that’s the case, why does the myth of averageness and normality persist? In order to answer that, we need to talk about the conditions that gave rise to the concept of normality in the first place. And it all starts with how we view health. For a long time, health was seen as a form of harmony, either within the body or between the body and its environment.

In Ancient Greece, it was about having a balance of your four humours - blood, phlegm, yellow bile, and black bile. Ayurveda in India, Ancient Chinese Medicine, Ancient Egyptian medicine, Incan oral medicine traditions, and many other ancient societies also had their own conceptions of health as a balance, equilibrium, or harmony. This view persisted under feudalism, which arose from the fall of the Roman Empire, whose growth relied on slavery. Slave revolts led to landlords giving former slaves their own land to live on and till with their families. These newly freed agricultural workers swore fealty to local lords for protection and were able to work their own land, had access to common lands, and had duties to the lord in exchange for protection. Under feudalism, production levels were relatively low, most people worked from their homes or on their own land, and there weren’t set deadlines or quotas. Instead, people worked together as a family to produce what they needed to sustain themselves and lived slower paced lives with more flexible, self-determined hours. Chronic illnesses and disabilities were more accommodated as disabled people could still find ways to contribute to the household. People worked in relation to the seasons and health was thought of as harmony between various factors, including harmony of communities.

Then the Black Death wiped out up to a third of the population and with the new worker shortage, workers rebelled to demand better conditions. Meanwhile, some landowners began making profits from selling their products and accumulating and reinvesting their new wealth. Increased specialization of labor also led to greater production and population growth, and managing a larger population and larger production levels required stricter forms of measurement and quantification from the state.

This led to the formalization of surnames and standard measurements for measuring harvests and profits, which also coincided with classifications relating to ability, leading to a distinction such as the “deserving” and “undeserving” poor who weren’t eligible for help from the state.

The emerging property relations in Europe were also driven by European colonization of Africa and the Americas, during which adapted the early racist ideas Europeans held about the Irish and Slavs to justify their genocide and enslavement of Indigenous and Black people. This led to a new slave trade much more brutal than the Roman Empire’s slavery and out of all this, a global capitalist system began to grow.

The advent of capitalism coincided with the start of health being seen as normality rather than harmony. This context led up to the Industrial Revolution and the normalization of Cartesian dualist thinking - the idea that the mind and body are completely separate entities and that the body is a machine that can be fixed with proper intervention. Cartesian dualism is absolutely awful, I have a whole video about it.

During the Industrial Revolution, the development of new technologies led to labor becoming even more specialized, leading to even higher productivity and profits. Merchant capitalism transformed into industrial capitalism and the bourgeoisie, who owned the means of production by definition, were able to invest their profits and accumulate more capital, making them even more wealthy, powerful, and influential than the kings and lords of feudal times. Aside from the aristocrats left over from feudal times, everyone else was now a free worker selling their labor to the capitalists, an enslaved laborer forced to work against their will, or unemployed and part of a new surplus population.

Women’s work, which was mainly unpaid domestic labor, was also no longer seen as real work. Industrial capitalism led to poor living conditions, overcrowding, pollution, new epidemics and diseases, and so on, all of which was already terrible for the human body, and all of which reframed the view of the body from a dynamic organism that could be in out of balance depending on a number of factors, including the environment, to a machine that was either working or broken depending on whether it could fulfill its productive potential. As machines became standardized, the ideal worker was standardized too.

Workers had to be able to travel to the factory and work with the pace and production norms of the industrial workplace, and anyone with an impairment that prevented them from doing so came to be seen as broken, thus cementing able-bodiedness as the norm and creating a surplus unemployed population who either couldn’t work or had to compete with other workers for employment. Uh congrats, if you’re unemployed, you’re part of the surplus. Which capitalism requires Enslaved workers in the American South were the first to be scientifically studied and manipulated to increase productivity and maximize output and thus profit.

This management and study of workers was then expanded to all workers after the slave trade and slavery were outlawed, although the 13th amendment makes slavery legal as punishment for a crime so it wasn’t really outlawed in the US. Under capitalism, workers were now pitted against each other and forced to compete for employment, and once they were employed, their performance was compared to everyone else’s.

So if you hate having to do those annoying performance review things at work, blame Descartes and the industrial revolution. And the French Revolution too!