Foucault, in my own words!
While we might assume modern medicine progressed naturally out of the Enlightenment, Foucault disagrees: “The clinic—constantly praised for its empiricism, the modesty of its attention, and the care with which it silently lets things surface to the observing gaze without disturbing them with discourse—owes its real importance to the fact that it is a reorganization in depth, not only of medical discourse, but of the very possibility of a discourse about disease” (xix).
In The Birth of the Clinic: An Archeaology of Medical Perception, Foucault describes what led to the development of modern medical perception (which includes medicine’s professionalization, the “birth” of the institution of the clinic, and “the medical gaze”). By historiciizing medical discourse from late 18C scientific, political and philosophical texts (see Ch 1, 2 & 3), Foucault locates the aftermath of the French Revolution as the site of major epistemological change. During this time of cultural upheaval, medical knowledge shifted away from its privileging of theory, nosology (the classification of disease), superstition, and treatment of the aristocracy only, towards emphasizing the importance of experiential learning and practice, and treatment of the general public.
Put simply, the French Revolution demanded basic human rights for all people. All institutions were questioned, including medicine: how could the hospital better serve the people? Before the French Revolution, European doctors held more of a priestly role in two ways: 1) they incorporated metaphysical and superstitious ideas into their medical practice, and 2) they mainly served the aristocracy. But by the onset of the 19C, physicians began taking more interest in public health. Through post-Revolutionary reforms, medicine sought more experiential learning and practice, with the clinic forming as the locus of medical treatment for the masses.
Overall, Foucault criticizes the myth that the modern medical practice as we know it grew organically out of the Enlightenment. Instead, Foucault argues that the modern clinic arose from a re-organization of knowledge amidst the political, economic, and philosophical disruptions caused by the French Revolution, which then changed cultural understandings of treating and caring for the sick (Ch 4 & 5). Through French political legislation, hospitals and universities began restructuring in the 1790s. Now an institutionalized space, funded by the government, Foucault argues, “The clinic figures, then, as a structure that is essential to the scientific coherence and also to the social utility and political purity of the new medical organization. It represents the truth of that organization in guaranteed liberty” (70).
But what exactly made the modern physician a champion of truth and liberty? (beginning of doctor-as-hero myth?) Foucault coins the term, the “clinical gaze” to signify a new medical practice based in empiricism in which symptoms are observable (ch 6 & 7). The disease is a text that makes itself legible on and throughout the body and its tissue: “in clinical medicine, to be seen and to be spoken immediately communicate in the manifest truth of the disease of which it is precisely the whole being. There is disease only in the element of the visible and therefore state-able” (95). Foucault describes the clinical gaze as providing “unmediated access. Theory is either absent or silent to allow the truth of the disease to express itself at the bedside” (107). Thus, the clinical gaze freed medical knowledge from the artificial confines of the rigidity of nosololgy.
(But the clinical gaze also doubly acknowledges the patient as subject and subjugated by medicine’s empirical analysis.) Is this not a thing until Discipline and Punish (1977)?
Aside: Right now I’m most interested in the clinical gaze and how I can trace it throughout literature, particularly how it might influence representations of the body-mind relationship. Typically, and what I made of the term before reading Foucault, the clinical gaze describes the distance, or gap, between healer and patient. The healer, usually physician or doctor, uses the clinical Eye to observe, diagnose, and treat the patient’s illness. Thus, the gaze literally objectifies the patient, eliminating their complex human identity. This might explain, for example, the legacy of women’s pain not being taken seriously, as well as why “invisible” illnesses and conditions have historically been de-legitimatized, diminished, or even dismissed by the clinical gaze because such conditions do not produce observable, visible pathology. Thus, the clinical gaze has had devastating effects on people with disabilities, and together with medicine’s empirical infatuation with normalcy (see L. Davis), we can see how the medical model of disability was born in the 19C. It wasn’t until the late 20C that social conditions were seen as impacting and even determining and defining health, ability, disease, and disability.
Anyway, The Birth of the Clinic seems a bit more like straight-forward history than Foucault’s other work. I wonder what I need to read instead.
draft: Ch 8 & 9: Foucault argues pathological anatomy + the medicine of the clinic produce new way of thinking about disease and death: “It is not that man falls ill that he dies; it is that man may die that he is susceptible to disease” (155).
ch 10: describes how the clinical gaze affected medical knowledge through a study of fevers, looking specifically at the differences in practice between Bichat and Broussais.
In sum, The Birth of the Clinic is interested in investigating the archeological rupture between taxonomic/nosological classical medicine (which classifies and considers diseases as containing an essence according to the model of natural history) and modern clinical medicine (based on pathological anatomy, capable of making the essence of the disease disappear, replacing it with the sick body as its object). In other words, death and disease, and the corpse, make the healthy body visible. Most of what we know about the healthy body comes from the study of dead, diseased bodies. In this way, modern knowledge shifted from the ideal and esoteric to the finite, the human.
Some interesting reads:
- Pryce, Dr. Anthony. “Contemporary Sociologies – Foucault, Power and Surveillance.” City University London. Web. 27 Oct. 2011
- Shapiro, Johanna. “(Re)Examining the Clinical Gaze Through the Prism of Literature.” Families, Systems, & Health 20 (2002): 161-70. Print.
- David B. Morris, “An Invisible History of Pain: Early 19th-Century Britain and America,” J. Clin. Pain. 14, no. 3 (1998): 191-196.
- Tony Walter, “Body Worlds: Clinical Detachment and Anatomical Awe,” Sociology of Health & Illness 26, no. 4 (2004): 464-488.
- Chris Philo, “The Birth of the Clinic: An Unknown Work of Medical Geography,” Area 32, no. 1 (2000): 11-19.
- Kirsti Malterud, “The (Gendered) Construction of Diagnosis Interpretation of Medical Signs in Women Patients,” Theoretical Medicine & Bioethics 20, no. 3 (1999): 275-286.
- John C. Long, “Foucault’s Clinic,” Journal of Medical Humanities 13, no. 3 (1992): 119-138.
- Joanna Latimer et al., “Rebirthing the Clinic: The Interaction of Clinical Judgment and Genetic Technology in the Production of Medical Science,” Science, Technology & Human Values 31, no. 5 (2006): 599-630.