Foucault – Birth of the Clinic

Foucault’s second major publication follows the immense History of Madness, and precedes The Order of Things. Its focus on the medical gaze, and on the epistemic shift concurrent with the turn of the 18th century, emphasizes the themes that carry between those two texts. Staunchly archaeological, The Birth of the Clinic traces the moduli of language as evidence and archive, entryways into the probing questions of medical practice and assumption throughout the period. Remarkably, throughout this subtle and sensitive critique of a scientific logic that insists upon the technical objectivity of images and words of the body, Foucault’s own treatment of the body – as historically and socially embedded – avoids direct confrontation with the conditions of possible embodiment of the medical regard itself.

The text’s key concepts cluster around vision, though they supercede the metaphor of senses. Perception, for example, refers to both the act of seeing or beholding in general, and to Kantian transcendental apperception. The gaze or regard, in contrast, describes a specific practice of observation that relies upon medical expertise. Archaeology remains in force here, as the principal mode of investigation for Foucault. Institutions and social practices matter as deeply as do sensory input or uses of language for the evidence base of his argument. Most crucially, medicine transforms in the course of this book, from the practices of recognition and treatment of disease, to something akin to disease itself. Its existence both depends upon and structures its observational and descriptive capacity, so its investment in and entanglement with the body of the patient gives the doctor a voice, and a referent for signification. As medicine and disease make one another visible, they efface the distinctions between themselves.

Foucault returns to the the rise of the Classical historical period. This turn of the eighteenth century portends the restructuring of medical thought.  Its pivot from observation and speculation to prognostication and treatment grounds its further turn towards institutionalization and intervention. More than a catalog of the investments in medical attention over epistemic changes, the text takes on the challenge of treating medical discourse in its own terms – that is, of knowledge as a matter of health and disease. A healthy mind and a diseased mind remain indistinguishable in terms of their abstract knowledge. But what counts for healthy or unhealthy knowledge still carries social and epistemological — not to mention, when applied to the care of the body, physical — ramifications. So, knowledge and the thinking mind must become diagnostically available. This occurs when thoughts are ordered according to ontologically prior criteria, articulated on the body, and thereby placed in discourse.

So we encounter the twist to Foucault’s argument. By turning medical discourse upon itself, we find that medicine itself fits the description of disease. Its existence is tied to the body of the patient. Its characteristics are indistinguishable from that body’s functions, except through the interpretation of those functions through visual/linguistic discourse. These themes resonate as we continue to add technological prostheses and machinic translators to the already-fraught doctor-patient relationship. How we speak about the care of our bodies always put our bodies themselves at stake.

conclusion: trying to find language without ambiguity… oh well.

One thought on “Foucault – Birth of the Clinic

  1. Why “staunchly” archaeological? Yourlanguage implies a polemic. If so, where and on whose part?

    Do you think F’s failure to engage with the embodied gaze is itself Cartesian, or us excavating its logic critical (if latently) of Cartesianism?

    Wat do you mean by “medicine transforms [itself, since the verb should be reflexive in the active voice]”? And in what was is medicine comparable to disease beyond any easy claim about pathology? I don’t quite buy that the differences between them are effaced–at least not without your sketching the proof. Of course i am writing this before I reviewed the material, but what I recall is the way the medical gaze isolates not health but the signs of death. That diagnosis is a signifying act is of course right, though.

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