The Birth of the Clinic
Encyclopedia
The Birth of the Clinic: An Archaeology of Medical Perception (Naissance de la clinique: une archéologie du regard médical) is the second major work of twentieth-century French philosopher Michel Foucault
. First published in French in 1963, the work was published in English translation in 1973. Developing the themes explored in his previous work, Madness and Civilization
, Foucault traces the development of the medical profession, and specifically the institution of the clinique (translated as "clinic", but here largely referring to teaching hospitals). Its central points are the concept of the medical regard ("medical gaze") and the sudden re-organisation of knowledge at the end of the 18th century, which would be expanded in his next major work, The Order of Things
.
describing the creation of a field of knowledge of the body. The material and intellectual structures that made possible the analysis of the body were mixed with power
interests: in entering the field of knowledge, the human body also entered the field of power, becoming a possible target for manipulation. Originally, the "medical gaze" was confined to post-modern and post-structuralist academic use, but now frequently is used in graduate medical and social work courses.
The French and American revolutions that spawned modernity
also created a "meta-narrative" of scientific discourse
that held scientists, specifically medical doctors, as sages who would in time abolish sickness and so solve all of humanity's problems. For the nineteenth-century moderns, medical doctors replaced the discredited medieval clergy
; physicians save bodies, not souls. This myth was part of the greater discourse of the humanist
and Enlightenment
schools of thought that believed the human body to be the sum of a person: biological reductionism that became a powerful tool of the new sages: Through thorough examination (gazing) of a body, a doctor deduces symptom, illness, and cause, therefore achieving unparalleled understanding of the patient — hence, the doctor's medical gaze was believed to penetrate surface illusions, in near-mystical discovery of hidden truth.
Thus the empiricism of the 18th and 19th centuries is not a naive or naked act of looking and noting down what is before the doctor's eyes. The relationship between subject and object is not just the one who knows and the one who tells; the contact between the doctor and their individual patient does not pre-exist discourse as "mindless phenomenologies" would suggest. Rather, the clinical science of medicine came to exist as part of a wider structure of organising knowledge that allowed the articulation of medicine as a discipline, making possible "the domain of its experience and the structure of its rationality". In other words, the observations and analysis of an object (for instance a diseased organ) depended entirely upon the accepted practices as outlined in the contemporary organisation of knowledge. Investigation, diagnosis and treatment all followed that contemporary organisation, in which case the criteria that distinguishes a diseased organ from a healthy one is thoroughly historical.
Foucault would later formalise this notion in the episteme
, where one epistemological era gives way to another, thus allowing one concept of what is scientific to move aside for another. In this case, as outlined in The Order of Things, the taxonomic era gave way to the organic historical era; thus, the clinic was not simply founded upon the observation of truth, and therefore more correct than any preceding medicinal practice, but rather an artefact of a theory of knowledge inserted within a specific discursive period. The authority of the clinician relies on a relationship to the then current organisation of knowledge, instead of a relationship to a non-discursive state of affairs ('reality'). Because of this, an early 18th century doctor could observe an organ with exactly the same disease as a 19th century doctor, with both doctors coming to vastly different conclusions about what caused the disease and how to treat it. Despite this difference, both accounts would be 'true', since they were both spoken in an episteme that considered such statements to be true.
This means that anatomists like Morgagni
and Bichat were not students of the same discipline, even though their work was only thirty years apart. The epistemic change meant that the bodies, diseases, tissues and pathologies that each cut open and explored were articulated in completely different and discontinuous discourse
s from one another. Thus anatomy's claim to be a privileged empirical science that can observe and determine a true bodily schema cannot stand when its beginnings were not in a discovery of a way of coming to know what was real, but rather emerged amongst a new philosophical way of granting meaning and organising certain objects. Hence the use of "birth" in the title; the clinic had no origins, but simply and suddenly arrived.
Michel Foucault
Michel Foucault , born Paul-Michel Foucault , was a French philosopher, social theorist and historian of ideas...
. First published in French in 1963, the work was published in English translation in 1973. Developing the themes explored in his previous work, Madness and Civilization
Madness and Civilization
Madness and Civilization: A History of Insanity in the Age of Reason by Michel Foucault, is the English edition of Histoire de la folie à l'âge classique, a 1964 abridged edition of the 1961 Folie et déraison: Histoire de la folie à l'âge classique. An English translation of the complete 1961...
, Foucault traces the development of the medical profession, and specifically the institution of the clinique (translated as "clinic", but here largely referring to teaching hospitals). Its central points are the concept of the medical regard ("medical gaze") and the sudden re-organisation of knowledge at the end of the 18th century, which would be expanded in his next major work, The Order of Things
The Order of Things
The Order of Things is a book by Michel Foucault first published in 1966. The full title is Les Mots et les choses: Une archéologie des sciences humaines...
.
The medical gaze
Foucault coined the term "medical gaze" to denote the dehumanizing medical separation of the patient's body from the patient's person (identity); (see mind-body dualism). He uses the term in a genealogyGenealogy
Genealogy is the study of families and the tracing of their lineages and history. Genealogists use oral traditions, historical records, genetic analysis, and other records to obtain information about a family and to demonstrate kinship and pedigrees of its members...
describing the creation of a field of knowledge of the body. The material and intellectual structures that made possible the analysis of the body were mixed with power
Power (sociology)
Power is a measurement of an entity's ability to control its environment, including the behavior of other entities. The term authority is often used for power perceived as legitimate by the social structure. Power can be seen as evil or unjust, but the exercise of power is accepted as endemic to...
interests: in entering the field of knowledge, the human body also entered the field of power, becoming a possible target for manipulation. Originally, the "medical gaze" was confined to post-modern and post-structuralist academic use, but now frequently is used in graduate medical and social work courses.
The French and American revolutions that spawned modernity
Modernity
Modernity typically refers to a post-traditional, post-medieval historical period, one marked by the move from feudalism toward capitalism, industrialization, secularization, rationalization, the nation-state and its constituent institutions and forms of surveillance...
also created a "meta-narrative" of scientific discourse
Discourse
Discourse generally refers to "written or spoken communication". The following are three more specific definitions:...
that held scientists, specifically medical doctors, as sages who would in time abolish sickness and so solve all of humanity's problems. For the nineteenth-century moderns, medical doctors replaced the discredited medieval clergy
Clergy
Clergy is the generic term used to describe the formal religious leadership within a given religion. A clergyman, churchman or cleric is a member of the clergy, especially one who is a priest, preacher, pastor, or other religious professional....
; physicians save bodies, not souls. This myth was part of the greater discourse of the humanist
Humanism
Humanism is an approach in study, philosophy, world view or practice that focuses on human values and concerns. In philosophy and social science, humanism is a perspective which affirms some notion of human nature, and is contrasted with anti-humanism....
and Enlightenment
Age of Enlightenment
The Age of Enlightenment was an elite cultural movement of intellectuals in 18th century Europe that sought to mobilize the power of reason in order to reform society and advance knowledge. It promoted intellectual interchange and opposed intolerance and abuses in church and state...
schools of thought that believed the human body to be the sum of a person: biological reductionism that became a powerful tool of the new sages: Through thorough examination (gazing) of a body, a doctor deduces symptom, illness, and cause, therefore achieving unparalleled understanding of the patient — hence, the doctor's medical gaze was believed to penetrate surface illusions, in near-mystical discovery of hidden truth.
The Epistemic Change
Foucault's understanding of the development of the clinique is primarily opposed to those histories of medicine and the body that consider the late 18th century to be the dawning of a new "supposed" empirical system, "based on the rediscovery of the absolute values of the visible." In Foucault's view, the birth of modern medicine was not a common sensical movement towards simply seeing what was already there (and therefore a science without a philosophy), but rather a decisive shift in the structure of knowledge. That is to say, modern medicine is not a mere progression from the late 18th century wherein an understanding of the true nature of the body and disease is gradually acquired. Foucault recommends a view of the history of medicine, and clinical medicine in particular, as an epistemological rupture, rather than result of a number of great individuals discovering new ways of seeing and knowing the truth:
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.
Thus the empiricism of the 18th and 19th centuries is not a naive or naked act of looking and noting down what is before the doctor's eyes. The relationship between subject and object is not just the one who knows and the one who tells; the contact between the doctor and their individual patient does not pre-exist discourse as "mindless phenomenologies" would suggest. Rather, the clinical science of medicine came to exist as part of a wider structure of organising knowledge that allowed the articulation of medicine as a discipline, making possible "the domain of its experience and the structure of its rationality". In other words, the observations and analysis of an object (for instance a diseased organ) depended entirely upon the accepted practices as outlined in the contemporary organisation of knowledge. Investigation, diagnosis and treatment all followed that contemporary organisation, in which case the criteria that distinguishes a diseased organ from a healthy one is thoroughly historical.
Foucault would later formalise this notion in the episteme
Episteme
Episteme, as distinguished from techne, is etymologically derived from the Greek word ἐπιστήμη for knowledge or science, which comes from the verb ἐπίσταμαι, "to know".- The Concept of an "Episteme" in Michel Foucault :...
, where one epistemological era gives way to another, thus allowing one concept of what is scientific to move aside for another. In this case, as outlined in The Order of Things, the taxonomic era gave way to the organic historical era; thus, the clinic was not simply founded upon the observation of truth, and therefore more correct than any preceding medicinal practice, but rather an artefact of a theory of knowledge inserted within a specific discursive period. The authority of the clinician relies on a relationship to the then current organisation of knowledge, instead of a relationship to a non-discursive state of affairs ('reality'). Because of this, an early 18th century doctor could observe an organ with exactly the same disease as a 19th century doctor, with both doctors coming to vastly different conclusions about what caused the disease and how to treat it. Despite this difference, both accounts would be 'true', since they were both spoken in an episteme that considered such statements to be true.
This means that anatomists like Morgagni
Morgagni
Morgagni can refer to:*Giovanni Battista Morgagni, an Italian anatomist.**Morgagni's hernia**Foramina of Morgagni**Hydatid of Morgagni...
and Bichat were not students of the same discipline, even though their work was only thirty years apart. The epistemic change meant that the bodies, diseases, tissues and pathologies that each cut open and explored were articulated in completely different and discontinuous discourse
Discourse
Discourse generally refers to "written or spoken communication". The following are three more specific definitions:...
s from one another. Thus anatomy's claim to be a privileged empirical science that can observe and determine a true bodily schema cannot stand when its beginnings were not in a discovery of a way of coming to know what was real, but rather emerged amongst a new philosophical way of granting meaning and organising certain objects. Hence the use of "birth" in the title; the clinic had no origins, but simply and suddenly arrived.