The Birth of the Clinic
Cover of the first edition
|Original title||Naissance de la clinique|
|Preceded by||Madness and Civilization|
|Followed by||The Order of Things|
The Birth of the Clinic: An Archaeology of Medical Perception (French: Naissance de la clinique: une archéologie du regard médical) is a 1963 book by the French philosopher Michel Foucault. First published in French in 1963, the work was published in English translation by Alan Sheridan Smith in the United States in 1973, followed in the UK in 1976 by Tavistock Publications as part of the series World of Man edited by R. D. Laing. In continuous publication since 1963, the book has become a locus classicus of the history of medicine, with admirers and critics in equal measure.
Developing the themes explored in his previous work, Madness and Civilization, Foucault traces the development of the medical profession, and specifically the institution of the clinique (translated as "clinic", but here largely referring to teaching hospitals). Its central points are the concept of the medical regard ("medical gaze") and the sudden re-organisation of knowledge at the end of the 18th century, which would be expanded in his next major work, The Order of Things.
The medical gaze
Foucault coined the term "medical gaze" to denote the dehumanizing medical separation of the patient's body from the patient's person (identity). He uses the term in a genealogy describing the creation of a field of knowledge of the body. The material and intellectual structures that made possible the analysis of the body were mixed with power interests: in entering the field of knowledge, the human body also entered the field of power, becoming a possible target for manipulation. Originally, the term "medical gaze" was confined to post-modern and post-structuralist academic use, but it is now frequently used in graduate medical and social work courses.
Foucault also argued that the French and American revolutions that spawned modernity also created a "meta-narrative" of scientific discourse that held scientists, specifically medical doctors, as sages who would in time abolish sickness and so solve all of humanity's problems. For the nineteenth-century moderns, medical doctors replaced the discredited medieval clergy; physicians save bodies, not souls. This myth was part of the greater discourse of the humanist and Enlightenment schools of thought that believed the human body to be the sum of a person: biological reductionism that became a powerful tool of the new sages: through thorough examination (gazing) of a body, a doctor deduces symptom, illness, and cause, therefore achieving unparalleled understanding of the patient—hence, the doctor's medical gaze was believed to penetrate surface illusions, in near-mystical discovery of hidden truth.
The epistemic change
Foucault's understanding of the development of the clinique is primarily opposed to those histories of medicine and the body that consider the late 18th century to be the dawning of a new "supposed" empirical system, "based on the rediscovery of the absolute values of the visible". In Foucault's view, the birth of modern medicine was not a commonsensical movement towards simply seeing what was already there (and therefore a science without a philosophy), but rather a decisive shift in the structure of knowledge. That is to say, modern medicine is not a mere progression from the late 18th century wherein an understanding of the true nature of the body and disease is gradually acquired. Foucault recommends a view of the history of medicine, and clinical medicine in particular, as an epistemological rupture, rather than result of a number of great individuals discovering new ways of seeing and knowing the truth:
The clinic—constantly praised for its empiricism, the modesty of its attention, and the care with which it silently lets things surface to the observing gaze without disturbing them with discourse—owes its real importance to the fact that it is a reorganization in depth, not only of medical discourse, but of the very possibility of a discourse about disease.
Thus the empiricism of the 18th and 19th centuries is not a naive or naked act of looking and noting down what is before the doctor's eyes. The relationship between subject and object is not just the one who knows and the one who tells; the contact between the doctor and their individual patient does not pre-exist discourse as "mindless phenomenologies" would suggest. Rather, the clinical science of medicine came to exist as part of a wider structure of organising knowledge that allowed the articulation of medicine as a discipline, making possible "the domain of its experience and the structure of its rationality". In other words, the observations and analysis of an object (for instance a diseased organ) depended entirely upon the accepted practices as outlined in the contemporary organisation of knowledge. Investigation, diagnosis and treatment all followed that contemporary organisation, in which case the criteria that distinguishes a diseased organ from a healthy one is thoroughly historical.
Foucault would later formalise this notion in the episteme, where one epistemological era gives way to another, thus allowing one concept of what is scientific to move aside for another. In this case, as outlined in The Order of Things, the taxonomic era gave way to the organic historical era; thus, the clinic was not simply founded upon the observation of truth, and therefore more correct than any preceding medicinal practice, but rather an artefact of a theory of knowledge inserted within a specific discursive period. The authority of the clinician relies on a relationship to the then current organisation of knowledge, instead of a relationship to a non-discursive state of affairs ('reality'). Because of this, an early 18th-century doctor could observe an organ with exactly the same disease as a 19th-century doctor, with both doctors coming to vastly different conclusions about what caused the disease and how to treat it. Despite this difference, both accounts would be 'true', since they were both spoken in an episteme that considered such statements to be true.
This means that anatomists like Morgagni and Bichat were not students of the same discipline, even though their work was only thirty years apart. The epistemic change meant that the bodies, diseases, tissues and pathologies that each cut open and explored were articulated in completely different and discontinuous discourses from one another. Thus anatomy's claim to be a privileged empirical science that can observe and determine a true bodily schema cannot stand when its beginnings were not in a discovery of a way of coming to know what was real, but rather emerged amongst a new philosophical way of granting meaning and organising certain objects. Hence the use of "birth" in the title; the clinic had no origins, but simply and suddenly arrived.
- Foucault, Michel (1973). The Birth of the Clinic. New York: Pantheon Books.
- Foucault, Michel (1976). The Birth of the Clinic. London: Tavistock Publications Ltd. ISBN 0422761907.
- Jones, Colin; Porter, Roy, eds. (1994). Reassessing Foucault: power, medicine, and the body. London: Routledge. ISBN 0415075424.
- St. Godard, E. E. (2005). "A better reading". Canadian Medical Association Journal. 173 (9): 1072–1073. doi:10.1503/cmaj.051067.
- Michel Foucault, The Birth of the Clinic: An Archaeology of Medical Perception (London, 1973), p. xii.
- Foucault, Birth of the Clinic, p. xix.
- Foucault, Birth of the Clinic, p. xiv.
- Foucault, Birth of the Clinic, p. xv.
- Foucault, Birth of the Clinic, pp. 128-133