Birth of Clinic, Ch. 4 & 5: 10/29 meeting

 

The group began with questions:

[1]          Why is Chapter 4 its own chapter? What is the distinctive point of chapter 4? Chapters 4-7 lay out history of emergence of clinic along two vectors: (i) epistemology (chapters 6 & 7), (ii) institutional history (chapter 5). Is that a good reading? On pp. 80 MF refers to the Ideologues. Does this clarify his earlier use of the term ideology? The medicine wing of the philosophy of ideology.

[2]          pp. 54-56 MF seems to be taking on another voice. Which perspective is he adopting? The distinction between the subject of disease versus the interiority of disease. What is the significance of this distinction?

[3]          Towards the end of Ch. 5 MF offers a more general discussion of liberalism and utilitarianism. In what ways could this critique of the gaze and its violence related to these schools? In what way is liberalism problematized?

[4]          On pp. 83, MF notes a problem: how is it that a poor person becomes an object of clinical observation? Is this a problem that MF is pointing out? How do these categories emerge? How is this model sustainable (i.e., how can the financing of the hospital be sustainable if the point is for the poor to not really get better?)

[5]          MF employs the language of the contract (pp. 83-5). This is unspoken but present. He describes the relation between doctors and patients as non-contractual. Can we trace these relationships?

[6]          On pp. 81 MF notes a distinction between the practical and the clinical. What does this distinction involve and how does it emerge?

Discussion ensued.

PP. 54-56: What is the “ideal account” of the history of medicine that MF is recounting? It involves several features. (i) the bedside is the pre-theoretical “given” which is then interpreted through theory. (ii) medical speech (theory) ends up obscuring immediate observation of disease (or pain), (iii) it takes on a universal character, (iv) a way of looking at medicine that is blind because it has no gaze.

What is this account about? If it is also about how to think about history, what do we learn about archaeology here? In part, MF’s critique of the “ideal history” is just that it is not based on historical fact. In telling itself this story, it shows how heavily it valued the institution of the clinics.

What MF is doing in Ch. 4: laying out an overview of the proto-clinic.

What is the relation between the proto-clinic and the clinic (chapter 5)?

Chapter 5 seems to be about the “institutional reorganization of medicine” organized into three parts. This language occurs on pp. 69.

MF begins chapter 5 by mentioning the figure of the child: acquiring knowledge through the senses, not through language: “A language that did not owe its truth to speech but to the gaze along” (69). The childlike nature of the gaze at the beginning of the chapter seems to come into tension with MF’s remark on pp. 84 that the gaze involves violence.

What could explain why medicine would be reliant on this universal account of the patient’s immediate access to their disease/pain?

Can we think of the various reforms that MF describes as demonstrating different kinds of “mediations” which ultimately complicate the initial “ideal” history of medicine he discusses in chapter 4?

The distinction between two categories of object (79) seems perplexing. Presumably the medical act is of this second type?

Questions for next week:

What kind of interests do the rich have in the hospital?

How does the proto-clinic relate to the clinic?

How does this institutional history relate to the more epistemically-oriented chapters which follow?

Birth of Clinic, Ch. 3: 10/22 meeting

 

The meeting began with questions.

[1] MF’s terminology takes up the vocabulary of dialectic and ideology in the last passages of the chapter. How should we understand this critical theory-type language?

[2] Pp. 51: There seems to be a notion of inevitability operating in the first full paragraph. How is MF thinking about the change here?

[3] How do social aspects factor into MF’s discussion in this chapter (continuing our discussion from last week)? Why does the focus on knowledge seem to be downplayed?

[4] What is MF referring to when he uses the term ‘ideology’? Is this a descriptive reference to De Tracy and the French theorists after the revolution (or is he using the term analytically)? Can we use MF’s notion of problematization to make sense of the emergence of the clinic at the end of the chapter? This two-year period in the French Revolution presupposes a lot of background knowledge (it would be worth discussing this context). Isn’t this the case?

[5] pp. 52: “the medical gaze had not been given its technological structure”: what does “technological structure” involve here? Is this a kind of non-discursive conditioning?

[6] MF seems to be tracking a continuity: a transformation in the technical structure does not occur (despite theoretical changes). What is that structure? What does he mean by medical technology?

[7] MF characterizes the hospital (space of obscurity that needs to be done away with; but also anachronistic solution). Why is it anachronistic?

[8] pp. 51 MF argues that the technological/pedagogical reorganization foundered on a lack of unity. In what sense was a unity lacking when it came to the medicine of species?

Then there was a discussion.

PP. 50: MF notes that given the fact that questions of policy, pedagogy, etc., had been discussed for so long, it is surprising that they remained difficulties.

He points to a lacuna: Missing structure; Absence of a model, Technological structure.

What is the relationship between the gaze and medical knowledge? What does MF mean by technological structure?

Perhaps this is an anticipatory concept of an episteme (dispositif)? The structure which would give unity is his attempt to theorize the depth knowledge?

Where does this gap come from? Given there was conceptual mastery/ solutions? It wasn’t until there was a technological apparatus that these various problems (i.e., pedagogy, medical funding) could be unified.

Is MF calling attention to the dark side of the enlightenment? Is MF calling attention to the myth of the free gaze. But he is also tracking the “light” sides or the stabilization of the myth. What’s mythical is not the thought that it exists, but that it presents itself as self-standing or philosophically correct (and not historically generated). The interplay between the family and nation seems important. We can still recognize many of these debates within our own social context.

If this is a historical account of the emergence of empiricist epistemology, how is he inquiring into the emergence of this epistemology?

Perhaps MF’s intervention is a direct response to the “Encyclopedic” school (Diderot, Lambert) of scientific knowledge, in order to show that these structures are historical?

The translation of “technological structure” is misleading (pp. 52). (Fr. “Condition of exercise”)

We can read this chapter is a historical account of the emergence of the myth of the free gaze—underwriting the birth of the hospital/clinic (i.e., the system of clinical medicine as a site for the production of knowledge). In other words: this “free gaze” epistemology underlies clinical practices.

What is the relationship between what MF calls generalized medical knowledge and the free gaze?

Finally, we raised questions for next week:

[1] How is MF understanding the Free Gaze? Is this understood from the doctor’s perspective? What about how the patient is mediated through the gaze?

[2] Does MF continue to discuss liberalism in further chapters? What about economic liberalism?

[3] What does “condition of exercise” do in the remaining chapters? What is he talking about here?

Birth of the Clinic, Ch. 2: 10/15 meeting

 

First, there were questions:

1. How does an anthropology work into medicine at this point in Foucault’s work? What is truth? He mentions truth a lot in this chapter in terms of its origins and so on. What does it mean in this context?  

2. What does Foucault mean by generalized medical consciousness? (31) How do we understand this term especially in light of his criticisms of other forms of the history of ideas--e.g. commentary--which he outlines in the preface.

3. What do we make of what F says about the connection between the state (and policing and the police) and the emergence of medicine as a positive project?  (positive in the sense of normalizing---the production of normalized subjects etc.)

4. Let’s talk about how Foucault addresses epidemics (especially in the first part of the chapter), Information, the Normal/ Healthy (especially in the latter parts of the chapter). There is a philosophy of science context in the background of the normal and pathological distinction (Canguilhem) that we might talk a bit about.

5. Thinking about non-medical approaches to health in this context: Can there be an approach to medicine that is non-normalizing? That is not based in these Christian ideas that MF is talking about? That perhaps takes something from ancient ethics? Is that even possible?

6. F talks about three transformations, two of which are 1) medical gaze (30-1) and 2) medical space. What do we make of these transformations and their links with the emergence of a certain kind of medicine? (note the emergence of the royal society of medicine in 1776)

7. What is the causal relation between the transformation of styles of info as well as forms of totalization, and broader changes in medicine. What is the relationship here?

8. The two styles of ch 1 an ch 2 seem very different. Ch2 seems concerned with epistemic structures and ch 2 has very different feel i.e.  normal and abnormal pairing as opposed to looking at epistemes. How do we see the relation between these two chapters?

 

Then, there was discussion:

When F says “international” (28) is this one of the few places where he addresses something other than mainland Europe? Is talking about French colonies? Perhaps we need to read the discussion of clergy & medical practices alongside the development of medicine in the colonies. What do we do with omissions in Foucault’s work such as his lack of consideration of the French colonial context?

What is Foucault’s approach to science and to medicine? Some people do read him as an anti-modern, anti-science thinker. Even if you do not read him like that, it is difficult to understand how medicine can be saved from its own problems.

There seem to be continuities between this text and Discipline and Punish as well as the History of Sexuality volumes. These are links people are interested in tracing further through the text.

Foucault as a reader of “discontinuities” and ruptures, and Foucault as emphasizing continuities. He seems to point to some interesting continuities between Christianity (the clergy figure) and medicine (the doctor). The discussion of medical clergy also seems to specifically be raised in the context of the French revolution—to what extent does what F addresses here link up with discussions and debates reformers where having at the time?

It seems that the “tertiary space” Foucault describes is a kind of space of information.

Is Foucault positing an anthropology or is he indicating a moment when a particular model of “man” emerges?

Is F tracking a transformation that is internal to medicine or something that is more socially diffuse?

Page 26. The medicine of epidemics as opposed at every point to a medicine of classes. Yet in the final analysis it seems like he is saying that there is almost this fight or competition between these two kinds of medicine. At the end of the day it is a political battle.

Page 19 (in the preface). Foucault describing what an analysis of depth epistemology looks like. Though at times through BoC this analysis is a bit ambiguous. It seems to be epistemological but at other times it looks at the social.

Foucault takes depth analysis one step further. You cannot take the social as itself the thing that explains why it is because the social itself also has depths. In BoC the stuff about normalization seems much more about the social and yet at other points it seems to be much more about dispositifs.

Is MF tracking P/K before it is in his methodology? Power/knowledge concept emerges in 70-1 (7 years after this book).

Foucault’s depth analysis of power knowledge is why he is so important! 

Birth of the Clinic, Ch. 1: 10/8 meeting

The group began, as usual, with questions: 

 1. “The ‘glance’ has simply to exercise its right of origin over truth” (4). How is Foucault understanding origin and truth in this chapter/book?

2. Shift from classificatory medicine. How is Foucault explaining shift from classificatory to pathological-anatomical medicine? How does this relate to tertiary spatialization (16)? How do MF’s methodological commitments from the preface limit/constrain what kinds of explanations he can offer?

3. Clarity on spatialization vs. spaces (20), as part of the transition.

4. Tertiary spatiailzation (16) vis-a-vis primary and secondary spitalization (17). What is TS? What kind of concepts is Foucault operating with here? Historical epistemological postulates? Or a kind of metaphysical nominalism?

5. Space of localization of illness verus configuration of illness. Thinking about illness prior to, or outside of, individual patient, person, etc..

6. Relating space of localization to space of configuration. Causality as a link. 

7. MF’s anti-modern rhetoric visible in some of the sentences. What do we make of this? Is this part of an intentional polemics on MF’s part to draw attention to the dark sides of modernity? If not, what can we infer about MF’s practice of critique from this? Does his work achieve his ends?

Discussion then ensued: 

 Eighteenth-century classificatory medicine involves three kinds of spatialization.

* Primary spatialization - locating disease on a table or via classification on a table in terms of homologies, a flat “two-dimensional space” (9) - “spatialization of configuration” (3)

* Secondary spatialization - problem of locating a classified disease “in an organism” (10) - “spatialization of localization” in the body (3).

* Tertiary spatialization - social setting [but we need to say more here, or maybe MF does]; “forms of a social space” (16); “a whole corpus of medical practices and institutions confronts the primary and secondary spatializations with forms of a social space” (16) - MF locates the explanation for the shift here, in the tertiary spatialization’s shift from a family-located practice of assistance to a nationalization of medicine and the birth fo the clinic [“hospital”] (18-19)

Later on, chapter 2 will track other kinds of spatializations, with rise of anatamo-clinical medicine. 

In classificatory medicine, the tertiary spatialization is amorphous, often located in the family (but not only there), whereas in later clinical medicine the tertiary spatialization gets consolidated in the hospital.

We ended by marking a few reminders of questions we have for ch. 2 and beyond: 

What happens with the spatializaiton category in ch. 2 (and beyond)?

Will MF highlight, or attend to, the possible continuities from 18c. medicine to 19c. medicine in later chapters? Or will he only highlight discontinuities. Transition from classificatory to clinical medicine vis-a-vis MF’s claim that classificatory opened up the possibility for clinical medicine (4).

How will MF track multiple registers of knowledge/perception? (E.g., the two spatializations.)

How does the social/political (what MF will later call power) intersect as another register?

What happens to the amorphous space of the social and how it relates to consolidation of medicine in the hospital?

Birth of the Clinic, Preface: 10/1 meeting

The group began, as usual, with questions:

1. Can we explore what MF means by a "psychoanalysis" of medical knowledge? (late 18th, early 19th century) (p. x; xvii)?

2. Speech, signifier, signified, -- commentary (xvi)

3. Concrete apriori (xv) - "new experience of disease".

4. Foundations (xv) vis-a-vis antifoundationalism.  Foundations of knowledge?  What does MF mean by this?

5. seeable / sayable -- clinic -- 'carving up' and 'verbalization' (xviii)

6. transition from 'what is the matter with you' to 'where does it hurt' (xviii) -- role of subjective experience

7. A discourse based neither on csns. of clinicians nor even on a repeition of what they once might have said (xv) -- how does MF understand this detour?  Is the detour purposefully veering away from narratives of the origins of modern medicine told by the clinicians/'insiders' themselves?

8. Methodological status of origins here -- is MF relying on a notion of origins here? (Interesting if so, because later this gets rejected.)

9. Methodologically, what makes this an archaeology rather than a genealogy -- 1. historical bookends (at start), 2. medical rationality and medical practice (  ), 3. framing in terms of inquiry into conditions of possibility of medical experience [is this a problematization?]

10. MF has this target of a certain positivist notion of positivities or facts (xii) - positivities as always already perceivable -  ch. 7 takes this up again in terms of both a critique but also an explanation of the emergence of this kind of epistemology.  "rediscovery" versus "reorganization".



Discussion then began:

We began with questions of epistemology and MF’s relation to foundationalism.  Ref to “foundations of our discourse” (xv).  We asked: does this shift in MF’s later work?  (Does this track a shift from a more Kantian Foucault to a more Hegelian Foucault?)  Are these foundations secure foundations?

Is this a methodological point?  Or is it more MF trying to establish/secure foundations?

Distinguish epistemological foundationalism from methodological foundations.

If MF is not foundationalist how can we think of ‘conditions of possibility’ and the ‘apriori’ of concrete apriori in a non-foundationalist way?

Is there a connection to MF on being “doomed historically to history” (xvi)?

We discussed the conjunction of “historical” and “critical” (xv; xix).

Two targets for MF: medical experience and medical knowledge.