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You will need to bring an interest in the history of economic thought, the history of linguistic thought, the history of thinking about art, the history of biological thought, and other such histories, though you don't need a college level background in each to be able to get full value from reading the book. He ranges both deep and wide in all these histories, and presents them in a completely new way - you'll feel as if your feet have been yanked from underneath you.
Imagine the normal way a history of a single science is presented: you see the progression of ideas, there is the old idea, the growing realisation of a problem inherent in the old idea, a key person grows up and comes up with a new idea, and we see how the new idea came about and how it gained support and took hold and how the old idea lost out, quickly or after a protracted struggle. This is such a familiar framework that we completely take it for granted. Maybe we shouldn't, says Foucault.
He claims to have found something remarkable when looking at all these different histories of thought side by side. He says major changes in the very way that economics was conceived had a counterpart in major changes in the way linguistics was conceived and biology and so on, in a very narrow span of years. This leads him to distinguish three eras such that within each era the thinking in economics, biology, linguistics, etc was more similar to each other than e.g. the thinking in economics from one era to the next. Each of these eras, which he calls "epistemes", comes to a fairly sudden end all across Europe.
In each episteme, there are certain ways of looking at knowledge, but also ways of looking at what is worth knowing and what is worth asking and what is taken for granted, that are typical of that episteme and are shared across the various subjects of study. Once in a new episteme, the questions and concerns of the previous episteme become exasperatingly quaint (like "how could they waste their time arguing about the number of angels who can dance on the head of a pin").
Foucault traces his three epistemes in great detail, doing a wonderful detective-novel job at bringing you along and keeping you interested in the essential weirdness of the previous epistemes, till he gets to the modern episteme, and then you slake a sigh of relief because everything suddenly sounds so eminently reasonable. But by now you can see the contingency of the modern way of thinking - why, for example, modern man would structure his history of sciences the way he does. In a sense, modern man, embedded like a tar baby in the current episteme could never have come up with Foucault's theory of epistemes. Fittingly, Foucault, at the end of the book, drops some tantalizing hints that the current episteme may be close to an end as well, and what might replace it.
Time to throw some of your favorite answers away and start asking some new questions!
Confession: even in my young age, I have read this book 8 times. I hope to read it many more times. With each reading the book opens up new and unexplored territories. Riddles reveal themselves as words of a sage. The sheer beauty and economy of the writing moves me.
Perhaps in this book, that is, hidden in this book, the other Foucault emerges here and there. The other Foucault who is not reducible as the theoretician of power, pomo revelry, or the modern heretic but the bold thinker of history who always has one foot in tradition and the other foot reaching in the darkness for a new ground.
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