Review: The Birth of the Clinic by Michel Foucault

Trade paperback, 215 pages
Published 1994 (originally 1963)

Acquired May 2013
Read December 2014

The Birth of the Clinic: An Archaeology of Medical Perception
by Michel Foucault

This Foucault monograph charts the emergence of what we might call "scientific medicine" across the eighteenth century, a way of seeing the body that is more rational and systematic than what came before. Of course, since this is Foucault, it's all about politics and power, and he both invents new words and redefines old ones and alternates between the deeply profound and the frustratingly obscure, and spends a lot of time telling you that things are the way he says they are without doing what a contemporary Anglophone critic might consider the necessary legwork to back it up. But it's all about cultivating a way of seeing that is ethically superior to the untrained eye, making it basically my jam. So: use with caution.

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.

I do kind of wonder what was wrong with my dissertation committee, that no one ever told me to read this book when I was in grad school. Like, generally, if you're an academic and Foucault has written on your topic of interest, you're obligated to know about it, even if so you can justify not using it. I eventually picked it up on my own, and dropped an unconvincing passing reference in a footnote in my introduction. Hey, if they didn't care whether I'd read Foucault, neither did I.

* Foucault is here quoting the French doctor Charles-Louis Dumas's Discours sur les progrès futurs de la science de l'homme (1804).