Read El nacimiento de la clínica. Una arqueología de la mirada médica by Michel Foucault Free Online
Book Title: El nacimiento de la clínica. Una arqueología de la mirada médica|
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The author of the book: Michel Foucault
Edition: Siglo XXI
Date of issue: February 1st 1998
ISBN 13: 9789682300684
Format files: PDF
The size of the: 32.89 MB
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This is a remarkably interesting book. In many ways it is a working out of the same ideas presented in The Order of Things: An Archaeology of the Human Sciences this time in relation to the development of what Foucault refers to as the clinical gaze. This isn’t so much a history of the clinic, but rather of the clinical, a history of medicine from nearly the time of the French Revolution through to about the 1850s or so, I guess. Some of the ideas here are very clever.
I don’t want to map out the whole book – although, it probably deserves to be mapped out in detail. What I want to talk about are some of the ideas that really struck me and hopefully that might encourage people to have a read this rather short book. It is also a remarkably readable book too. There are novels that are harder to read this this – I’m saying that because Foucault is often labelled as a very difficult read – and sometimes he really is – but not this time. Foucault is also interested in the history of ideas – in fact, you could say that he is only interested in how ideas are shaped over time. And he is interested in power and how power structures how we relate within contexts as his double barrel concept of ‘subject’ – you know, ourselves as subjects with agency and choices and ourselves as the subjects that are on the receiving end of power relationships. The subject and the subjected.
“So, Mr Smith, what seems to be the problem?”
“Well, Doctor, I have this pain right here…”
In many ways this book is a structuralist analysis of the kinds of discourses that go on in medicine. There is some incredibly interesting stuff at the start where the disadvantages of putting people into hospitals prior to the French Revolution is discussed by doctors at the time because they understood illness as something needing to be explained in relation to the patient’s entire life as lived and in the hospital a person stops being a person and becomes merely an example of an illness. This shifting relationship between what one is and what one becomes due to where one is, how one is being observed, is really interesting and still relevant today. I think it is also interesting in relation to more than just medicine – also education, workplaces, the courts and so on.
If this is a structuralist account we can expect some talk about signs, signifiers and the signified. And, being medicine, some talk of symptoms also seems inevitable. But what is the difference between a sign and a symptom? The problem is that we have a fairly limited vocabulary of signs – ‘my stomach hurts, I’ve a sore head, it’s a kind of stabbing pain here” – and putting these signs together so as they add up to symptoms defining a disease can be anything but obvious. Particularly given a disease is generally temporal in nature and therefore changes over time.
There is also a discussion on how the use of language employed around illnesses has changed over time. There was a time when clarity and transparency of language use seemed appropriate if both doctor and patient were to understand each other. In part a move away from such transparency is about limiting access to knowledge to those in the know, creating a special caste with privileges due to their access to special and esoteric knowledge. But this is also a way to show the trained doctors have an ability to bring the unseen to the surface. Only those properly trained to appropriately employ the medical gaze are able to interpret signs into symptoms and from there to ascertain the lifecycle of the disorder at issue (with disorder being the right word – this being a classification system more than anything else). People stop being ‘people’ and become networks of symptoms. These symptoms are then related according to their normal temporal manifestations – you know, how the disease generally plays out. The idea of time is interesting here. The more I learn about modern philosophy the more I think of Einstein’s notion of space-time. Whenever you hear time mentioned you should expect a discussion of space to be just around the corner, and Foucault starts this book by saying it is a book about space. This notion of space comes into the discussion with the discovery that the body is made up of similar tissues which occur at multiple sites of the body and that these tissues are often affected by diseases in very similar ways. So a classification system of tissues becomes an essential part of understanding disease. Disease then stops being purely temporal and suddenly becomes spatial, but spatial in a truly hidden sense. The tissues that make disease spatial are hidden inside the bodies of patients and therefore require a very special gaze to make them visible - but knowing of the diseases that affect particular tissues means literally being able to see the unseen.
This means that the clinical gaze moves from the literally superficial – the doctor can look at your skin or in your mouth and so on – to a gaze in the broadest sense, one where the doctor can listen to your breathing or feel your temperature or pulse, and from this ‘gaze’ interpret what is going on under the surface to tissue there. The shift to a classification system of tissues is essential for this movement and such a shift fundamentally changes how medicine will be carried out.
Foucault’s discussion of autopsy goes on to explain some of the complications involved in learning what is going on under the surface of the body. We have been trained by shows on television that it is easy to be abundantly clear about what kills people – all you need for absolute certainty is a highly trained individual and a particularly sharp knife applied to a dead body. But you have to open a lot of bodies to know what is ‘normal’ and even so, bodies decay very quickly once they are dead – and a decayed body can look confusingly like a sick body would be expected to look. The bit I really hadn’t thought about before was that most illness is a kind of irritation of tissue – so, the disease affected tissues while the patient is alive might be red and sour looking – but that will only be true while blood is flowing to that part of the body and thereby illuminating the irritation. Once you die that irritation of tissue disappears. So, just what it is that you are looking at when you cut open a body isn’t exactly transparently obvious. There is no neon sign flashing 'heart attack' when you open a dead body - but a confusion of signs that must be once again interpreted as symptoms. Died bodies don’t stop changing just because we have drawn a line between life and death – they go on changing all they way back to dust. The other thing that is interesting here is that no one is asking the patient where it hurts anymore – the body becomes a text that is absolutely dependent on the gaze of the doctor, it becomes a text to be read, interpreted and understood with no assistance from the patient at all.
There is also a very interesting discussion on the provision of hospitals for the poor and how these were sites of medical research and therefore of a kind of exchange – effectively, the way the poor repaid the kindness of the rich was to be guinea pigs for the rich in relation to treatments. Naturally, the gratitude of the poor for being made guinea pigs was also an essential component of this trade. Such could almost be the Republican Party’s new health policy.
Like I said, this is a fascinating book – by looking at the history of the changes in the way the body has been read as a text by medical science and how the body is viewed as a list of symptoms, then as a series of underlying tissues and then as a series of essential physical processes disrupted by disease what we are seeing are the impacts of shifting paradigms on our understanding. What is disease literally changes with these changes of paradigms.
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Read information about the authorMichel Foucault was a French philosopher, social theorist and historian of ideas. He held a chair at the Collège de France with the title "History of Systems of Thought," and lectured at the University at Buffalo and the University of California, Berkeley.
Foucault is best known for his critical studies of social institutions, most notably psychiatry, medicine, the human sciences and the prison system, as well as for his work on the history of human sexuality. His writings on power, knowledge, and discourse have been widely influential in academic circles. In the 1960s Foucault was associated with structuralism, a movement from which he distanced himself. Foucault also rejected the poststructuralist and postmodernist labels later attributed to him, preferring to classify his thought as a critical history of modernity rooted in Immanuel Kant. Foucault's project was particularly influenced by Nietzsche, his "genealogy of knowledge" being a direct allusion to Nietzsche's "genealogy of morality". In a late interview he definitively stated: "I am a Nietzschean."
Foucault was listed as the most cited scholar in the humanities in 2007 by the ISI Web of Science.