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The Birth of the Clinic: An Archaeology of Medical Perception

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Foucault has been interpreted in the US as a pretentious standard-bearer of postmodernism - as an almost "evil" figure who threatens to undermine the foundations of Western knowledge with his problematisation of conceptual categories. It doesn't help that his work has been taken up to justify just about any subversive perspective, whether well-conceived or not. This is only a pitifully small perspective on the man and his work. Foucault should be seen first as a historian, not a philosopher; second, his work should be lauded for the contribution it makes to Western knowledge rather than the superficial "threats" it makes to perspectives whose time has come in any event. Every revolution of perception has been accompanied by vociferous resistance, yet a great many of those sounding their disapproval loudly probably don't really understand what the late Michel was really on to.

The Birth of the Clinic, MF's most accessible work, is a well-researched, brilliantly interpreted account of the development of the clinical "gaze" in the wake of modern medical knowledge and practice. Foucault problematises the institution of the clinic, showing how clinical perception is the result of a historically specific constellation of knowledge and power. His ultimately emancipatory analysis is substantiated every step of the way with textual and historical examples. No metaphysics here, just a radical questioning of the nature of knowledge within institutional practice.

So, sorry (Objectivists!) if this is too much to handle. It's good research, plain and simple. Don't dismiss Foucault as a lightweight postmodernist - try to see him where he would situate himself, in the tradition of reflexive historical sociology.

In this short book that forms a worthy companion to his classic "Madness and Civilisation," Michel Foucault first traces the history of medical care from the days when people were usually treated at home by their families, to the early nineteenth century, when public health became a political issue. The outcome of this process was the "clinic," which Foucault defines a field of confinement where those labelled ill, the Other, were monitored and treated to further the reciprocally-linked goals of the health of society and the furtherance of medical knowledge.

Foucault's well-documented narrative concerning the evolving socio-political perception of health and medicine, however, pales in erudition and philosophical significance when compared to the primary thrust of the book ; namely, in detailing how the medical profession ordered and analyzed not only disease, but later the human experience itself. Both seeming to have pushed back the finality ! of death through conjoining to it to the experience of life, and isolating disease not as a phenomenon in itself, but like life and death, simply as a discursive manifestation of visible and invisible symptoms, the medical profession acquired for itself the mantle of positivism that is still basically unquestioned by the public even today.

This book examines our cultural tendency to elevate the authority of the physician. It introduces the concept of the clinical gaze and describes the way the myth of this gaze was developed in the early Enlightenment atmosphere and fostered the birth of the clinic. A detailed online summary by Lois Shawver, with excerpts and page numbers, can be found through some of the standard search engines.

Birth of the Clinic is a partner to Discipline and Punish: Birth of the Prison. They are both about political economy and the irony of how the modern 'free' world is as confining as previous historical eras just in an opposite way. This is kind of Foucault's whole mission, to show us just how confined we really are and wake us up to reality. But he is always subtle about it. In a way his 'philosophy' and 'methodology' and the wild theoretical tangents the academies have taken it to, are a mask for his very powerful and even dangerous political indictments. In Discipline and Punish (Surveil in French) Foucault shows historically how individual time and space have been controlled by the ever evolving, profit-driven, techno-efficiency of the panopticon-state and the distracted aquiescence of its subjects. In Birth of the Clinic he will show historically how the individual person and their body have become property of the state via consensus (law) and the same somnambulent aquiescence. In many ways Foucault is a major conservative showing us empirically, through historical evidence, how the power-play of today is an interiorization of past power-relationships, interiorized to the point of invisibility and largely unacknowledged by the manipulated masses.

" The birth of the Clinic " is an attempt by the philosopher and the learned historian to decipher the secret of medical perception. Only when the chaotic and subjective clinical experience is transcended to the objective language, we have the medicine as a scientific subject as today. As a physician myself , I think understanding " clinical gaze " helps me to define the place of modern medicine, of doctors and patients and of medical organisation in this fast changing world.

Wow, Foucault is truly a literary genius. Getting a small glimpse into his wonderful genius is pleasure enough to warrant reading this book. However that said The Birth of the Clinic lacks in certain areas. Obviously, Foucault is writing in the postmodern era, thus his ideas are not nearly as groundbreaking as they would have been had he been writing 30-40 years earlier. This book, as Foucault explicitly states, is not so much about the birth of the clinic, as it is about the birth of ideas and knowledge - how conceptions of good and bad science come to be. In that regard the book, unfortunately the book falters in comparison to some others. The one I have in mind is Thomas Kuhn's "Structure of Scientific Revolutions". The main difference between the two is in time of release. Kuhn's book was released immediately after the Second World War. Subsequently, due to the nascent phase of the field, his book sets the foundation for the literature to follow in its tradition - such as The Birth of the Clinic. Therefore, readers interested in the development of scientific knowledge would be better served to pick up Kuhn's book first, then move onto The Birth of the Clinic.

While an introduction to the topic is somewhat helpful, the value of this book must not be overlooked. Your impression of medicine will not be the same.

Michel Foucault's determination to trace the historical growth and impact of institutionalized incarceration on those on the outer periphery of power began with Madness and Civilization (1961) and continued two years later with The Birth of the Clinic. In the former, Foucault sees an inverse relation between the construction of hospitals and the ability of the insane to retain their freedom to walk about without fear of enforced incarceration by doctors who are less interested in the mental health of their patients than in accumulating raw power. As the former increases, the latter decreases. The clinic as we generally think of it today is, according to Foucault, a direct result of a rapid change in the way that doctors prior to the 18th century practiced medicine. Before the Age of Reason, doctors tended to treat diseases rather than patients, who were of interest only insofar as the patients gave doctors an opportunity to expand the vistas of knowledge by zeroing in on how disease affected a patient rather than how a patient overcame a disease. Advances in medicine and science combined with a concomitant surge in the primacy of reason to convince doctors that the patient should be placed on a higher level than his disease. In order to accommodate an upsurge in dissection and vivisection, new buildings called "clinics" were constructed that were later used to forcibly house those patients diagnosed as mentally incompetent. Foucault considered this early concept of the clinic as an unfortunate marker of patient degradation. As soon as doctors discovered that they could require incarceration of patients merely by certifying them as in dire need of immediate medical care, they could scarcely resist the god-like power to do so. It is precisely here that one of Foucault's major theses appears: power and knowledge are inextricably intertwined in a legal and philosophical bear hug that requires the one with the power to exercise it against the one without it.

One problem with this thesis is that power, to Foucault, is an end unto itself. Doctors must then accumulate power to use in ways that they make up as they go along. And since Foucault had an abiding interest in the fate of the marginalized--gays, the mad, criminals, etc--it seemed natural to him to assume that anyone who uses power must use it to gain dominion over those who cannot resist. It is this sole focus that made Foucault such a darling of the academic left. Yet, if history has taught us anything it is that those who seek power do not do so solely to emulate O'Brien's torturing of Winston Smith in 1984 just to control others; power must have a measurable payoff, most often in wealth, lust, territory, and personal aggrandizement. Foucault's power has nothing to do with any of these basic drives. Power leads to control leads to repression, and so on in a dreary world that is made drearier if the entire structure of society is modeled after the paradigm of the clinic. And this is the true point of The Birth of the Clinic. Foucault envisions the root cause of repression of the entire spectrum of western society--schools, prisons, hospitals, and the like--are no more than repressive variations of the basic clinic model. Once people have been conditioned en masse to submit themselves to the control of others in such rigidly controlled environments, then the cost of control declines even as the power to control increases. This book is indeed a dreary interpretation of society that can easily accommodate competing theories. But for those who are entranced by the misguided precepts of Michel Foucault, none other will do.

Here is a commentary:

Reviewer: A reader from California May 17, 1998 "Again, Foucault shatters our illusions.This book examines our cultural tendency to elevate the authority of the physician..." This reviwer's summary of the book is incorrect because the work is not a study of power or "authority" (themes which would be important in Foucault's later works). In "The Birth of the Clinic" we see how Foucault MIGHT HAVE made a crticism of clinical medicine as an authoritarian institution, but in fact this is NOT the focus of the book. This book is not the attempt to dispel a "myth", it is a description of the reality of the development of the clinical gaze as a discursive formation distinct from its historical predecessors.

Reviewer: spandex9@aol.com from Barbaraville, Manitoba (Canada) July 21, 1998. "Structures of Perception and Positivism Questioned". This review is much closer to the mark than the first one. In particular, in the second paragraph the reviewer touches on the implications of the development of anatomo-clinical medicine for "the human experience itself". In the conclusion to the book Foucault himself stated that "the experience of individuality in modern culture is linked to the experience of death" and that is one reason why we should be interested in this work.

Reviewer: Dr. W Y Wan from Hong Kong "A book with special insight-- one that you cannot miss. I agree that this book can be of value to physicians who are genuinely interested in human welfare, and it's unfortunate that most physicians never study the humanities during their educations.