"In the eighteenth century, medicine underwent a mutation. For the first time, medical knowledge took on a precision that had formerly belonged only to mathematics. The body became something that could be mapped. Disease became subject to new rules of classification. And doctors begin to describe phenomena that for centuries had remained below the threshold of the visible and expressible. In The Birth of the Clinic the philosopher and intellectual historian who may be the true heir to Nietzsche charts this dramatic transformation of medical knowledge. As in his classic Madness and Civilization, Michel Foucault shows how much what we think of as pure science owes to social and cultural attitudes - in this case, to the climate of the French Revolution. Brilliant, provocative, and omnivorously learned, his book sheds new light on the origins of our current notions of health and sickness, life and death."--
Some random points of interest and my thoughts:
- Like a lot of scientific sight, the vision of what Foucault calls the "clinic" purports that to see things as they are, you need an understanding of theories first: "Clinical medicine is not, therefore, a medicine concerned only with the first degree of empiricism, seeking to reduce, by some kind of methodical scepticism, all its knowledge and teaching to observation of the visible alone. At this first stage, medicine is not defined as clinical unless it is also defined as encyclopedic knowledge of nature and knowledge of man in society" (72).
- Foucault draws a distinction between different forms of scientific sight in the realm of medicine: "The practice required of the officer of health was a controlled empiricism: a question of knowing what to do after seeing; experience was integrated at the level of perception, memory, and repetition, that is, at the level of the example." Theory doesn't help you treat simple illnesses, experience does. On the other hand, "In the clinic, it was a question of a much more subtle and complex structure in which the integration of experience occurred in a gaze that was at the same time knowledge, a gaze that exists, that was master of its truth, and free of all example, even if at times it had made use of them" (81-2).
- Sometimes Foucault makes my points so straightforwardly it makes me wonder if I have any point of my own to make at all: "'One must, as far as possible, make science ocular'. So many powers, from the slow illumination of obscurities, the ever-prudent reading of the essential, the calculation of times and risks, to the master of the heart and the majestic confiscation of paternal authority, are just so many forms in which the sovereignty of the gaze gradually establishes itself-- the eye that knows and decides, the eye that governs" (88-9).
- Also consistent with my own interests is the idea that seeing humans scientifically is quite difficult: "Medicine as an uncertain kind of knowledge is an old theme [...]. It was to be found, reinforced by recent history, in the traditional opposition between the art of medicine and the knowledge of inert things: 'The science of man is concerned with too complicated an object, it embraces a multitude of too varied facts, it operates on too subtle and too numerous elements always to give the immense combinations of which it is capable the uniformity, evidence, and certainty that characterize the physical sciences and mathematics'*" (96-7).
- Foucault discusses the different forms observation takes in the clinic; one way that it manifests is not in the sight of the eye per se but in asking questions to build observations. Foucault describes one four-stage method of observation: first you observe with the eye, question the patient about what they feel, and re-observe; second, you ask general questions about the patient's past; third, you observe over time, as the disease progresses; and last, you prescribe during convalescence. "In this regular alternation of speech and gaze, the disease gradually declares its truth [...]. [T]he questionnaire without the examination and the examination without the interrogation were doomed to an endless task: it belongs to neither to fill the gaps within the province of the other" (112). This actually reminds me a lot of the method of detection Arthur Conan Doyle would perfect in the Sherlock Holmes stories-- you must both ask questions and see carefully to find truth.
* Foucault is here quoting the French doctor Charles-Louis Dumas's Discours sur les progrès futurs de la science de l'homme (1804).