The Birth of the Clinic: An Archaeology of Medical Perception

Product Information

spasms of lower abdomen, where it may cause dyspepsia, visceral congestion, interruption of the menstrual or hemorrhoidal flow, towards the chest, which breathlessness, palpitations, the feeling of a lump in the throat, coughing, and finally reach the head, causing epileptic convulsions, syncope, or sleepiness.” (p. 10) In the genealogy of medicine—knowledge about the human body—the term Le regard médical (The medical gaze) identifies the doctor’s practice of objectifying the body of the patient, as separate and apart from his or her personal identity. In the treatment of illness, the intellectual and material structures of la clinique, the teaching hospital, made possible the inspection, examination, and analysis of the human body, yet the clinic was part of the socio-economic interests of power. Therefore, when the patient’s body entered the field of medicine, it also entered the field of power where the patient can be manipulated by the professional authority of the medical gaze. [2]

Yet it concerns one of those periods that mark an ineradicable chronological threshold: the period in which illness, counter-nature, death, in short, the whole dark underside of disease came to light, at the same time illuminating and eliminating itself like night, in the deep, visible, solid, enclosed, but accessible space of the human body. What was fundamentally invisible is suddenly offered to the brightness of the gaze, in a movement of appearance so simple, so immediate that it seems to be the natural consequence of a more highly developed experience. It is as if for the first time for thousands of years, doctors, free at last of theories and chimeras, agreed to approach the object of their experience with the purity of an unprejudiced gaze. But the analysis must be turned around: it is the forms of visibility that have changed; the new medical spirit to which Bichat is no doubt the first to bear witness in an absolutely coherent way cannot be ascribed to an act of psychological and epistemological purification; it is nothing more than a syntactical reorganization of disease in which the limits of the visible and invisible follow a new pattern; the abyss beneath illness, which was the illness itself, has emerged into the light of language” (p.195). There is disease only in the element of the visible and therefore statable” (p. 95). Foucault qualifies, however, that “the purity of the gaze is bound up in a certain silence.” This silence is the need for a gaze unaffected by various theories, preconceptions, and other influences prejudicing interpretations of observations. He locates the space where a pure gaze is corrupted as “anterior to that of the visible” (p. 108). Wat een prachtig boek, zoveel wijsheid! Het vergt echt een boel inspanning om het te begrijpen maar het is het meer dan waard. Foucault gebruikt het halve boek om de tegenstelling te schetsen tussen hoe de geneeskunde was en hoe de geneeskunde nu is. Dat is nog best een lastig onderscheid, maar dat het zo moeilijk te begrijpen is, toont ook hoe normaal de huidige manier van denken is. Stap voor stap ontleedt en reconstrueert Foucault de klinische blik, de vanzelfsprekendheid waarmee je als arts je patiënt tegemoet treedt. Dat is ontzettend waardevol, want de blinde vlekken worden zo ook duidelijk. En kritische reflectie op het hoe en waarom kan ook nooit kwaad. Dit boek is een absolute aanrader voor iedereen die zich wel eens afvraagt waarom we de dingen in de kliniek op een bepaalde manier doen. Pathological anatomy, the science generating knowledge about the visible alterations on organs and tissues diseases cause, marked an important advance for the clinic upon “the day it was admitted that lesions explained symptoms” (p. 127). From then on, and accelerated by investigations using exhumed corpses, pathological anatomy became “an objective, real, and at last unquestionable foundation for the description of diseases” (p. 129). This was a very challenging book to read. Foucault's narrative is very meandering and tortuous, sometimes I had the feeling that the phrases made no sense at all, but they looked well altogether through the type of used words.Foucault jumps in during the mid-eighteenth-century period of “classificatory medicine,” when “…disease is given an organization, hierarchized into families, genera, and species,” (p. 4) akin to botanical classifications, offering doctors “a gardener’s gaze” (p. 119). Diseases were accorded their own existence independent of the individual body, and so knowledge of particular bodies only interfered with discerning true diseases. Botanical classification; 227 figures of plant anatomical segments with descriptive text. Colour process print. Wellcome Collection. Public Domain Mark But we are concerned here not simply with medicine and the way in which, in a few years, the particular knowledge of the individual patient was structured. For clinical experience to become possible as a form of knowledge, a reorganization of the hospital field, a new definition of the status of the patient in society, and the establishment of a certain relationship between public assistance and medical experience, between help and knowledge, became necessary; the patient has to be enveloped in a collective, homogeneous space. It was also necessary to open up language to a whole new domain: that of a perpetual and objectively based correlation of the visible and the expressible. An absolutely new use of scientific discourse was then defined: a use involving fidelity and unconditional subservience to the coloured content of experience—to say what one sees; but also a use involving the foundation and constitution of experience—showing by saying what one sees.” (p.196) the becoming of the clinical medicine, the whole narrative around "the gaze" made me realize again how important this step was in the development of modern medicine.

Naissance de la clinique" est sans doute la moins lue et la moins commentée de toutes les monographies foucaldiennes. Publiée pour la première fois en 1963, cette "archéologie du regard médical" n'a jamais suscité le même intérêt que des ouvrages désormais classiques comme "Les Mots et les choses" (1966) ou "Surveiller et punir" (1975). Thus, the medical—classificatory—gaze during this period was confined to signs and symptoms such that “paradoxically, in relation to that which he is suffering from, the patient is only an external fact; the medical reading must take him into account only to place him in parentheses” (p. 8). As a result, judgments about a patient’s condition could draw only from similarities and differences among sets of signs and symptoms laid out in pre-determined patterns—this sign goes here, that symptom goes there. Time and space have no role; never first this, then that, or here this, there that. The Shifting Gaze

The Birth of the Clinic: An Archaeology of Medical Perception ( Naissance de la clinique: une archéologie du regard médical, 1963), by Michel Foucault, presents the development of la clinique, the teaching hospital, as a medical institution, identifies and describes the concept of Le regard médical ("the medical gaze"), and the epistemic re-organisation of the research structures of medicine in the production of medical knowledge, at the end of the eighteenth century. Although originally limited to the academic discourses of post-modernism and post-structuralism, the medical gaze term is used in graduate medicine and social work. [1] The medical gaze [ edit ] This book is about space, about language, and about death; it is about the act of seeing, the gaze. Gutting, Gary (1989). Michel Foucault's Archaeology of Scientific Reason. Cambridge: CUP. ISBN 9780521366984. The gaze determined the scope of analysis possible in the clinic, which amounted to what could be seen and what could be stated, and the interdependency between these two dimensions, i.e., what could be stated was made possible by what could be seen, and what could be seen was made possible by what could be stated.