Birth of Clinic, Ch. 10: 12/10

 

The group began, as per usual, with questions, preceded by a little silence and a cough:

-        What happens with psychiatric illnesses?  Do these get incorporated or excluded in anatomo-clinical method?

-        Constitution of the historical and concrete apriori of the modern medical gaze (192).  How does this notion fit into Foucault’s method?  And how does its place in his method in this book fit into his wider corpus?

-        Why is there a “crisis” in fevers?

-        Tripartite stages of medicine of sick organs (190); how was this documented and registered and kept as information?  Could this have formed a template for documentation?

-        Dissolution of the ontology of fever (190, 191); how does this fit with the vitalism (in a strongly positivistic form) Foucault had earlier ascribed to anatomo-clinical medicine (154-5)?  And do we believe Foucault about this?  Is he right about this?  When he goes on to talk about relationship of organ with an agent and/or environment (191), is this not ontological?

-        How are we understanding archaeology in Foucault?  How are we understanding the distinction between Foucault’s voice and when he is writing in the voice of another?  How does this fit in with Foucault’s attribution or description of myths in medicine?

-        Why a focus on Broussais as the singular personage in whom is condensed or in whom converges a multiplicity of structures (184)?

-        Why does the archaeology end here?  Why does it not persist into the struggles/conflicts which Broussais faced, as noted by Foucault (192)?

-        To what extent is this historical apriori of the modern medical gaze (191) related primarily to medicine, and to what extent is this related to or central to modern culture general?  Is this archaeology a regional archaeology of medicine, or is it a more general archaeology of modernity as such?

 

Discussion ensued:

-        Is Foucault’s focus on Broussais playing into a myth?  Or is he asserting?

-        When Foucault is taking up a different voice than his own, is he trying to convey the myth, that is, is he trying to convey the experience itself?  In Ch. 7 and ch. 8 when he talks about “epistemological myths” and “illusions” – it’s an illusion that does some work?

-        In contrast to the later genealogical works, is Foucault here more occupying the terrain he is describing?  Is he more focused here on taking on the voice of the field he is describing?

o   A good test case for this would be to ask: do the actors in the history he is describing here use a term like “anatomo-clinical gaze”?  And: do the actors in the genealogies use a term like “discipline”?   Foucault’s own conceptual overlays – his neologisms for the apriori

o   This raises the following question: what is of interest in the history itself?  What is of interest in this outside of the way it reflects certain philosophical and methodological moves?

-        Foucault’s methodology: constitution of a historical and concrete apriori (192).

o   Question of domain scope in archaeology?  Is the apriori regional or is it more of a cultural/social totality?

o   In some ways it seems more like a regional analysis, but in other ways it points to the more generalizable/universalizable dimensions.

o   Cf. “What is Enlightenment?” on both specificity and generality.

§  This is a major theme that runs throughout Foucault’s work.

o   Broussais as the figure in whom all this comes together (184), or as the exemplar or representative.

§  But how does a single person like Foucault stand as an exemplar?  What’s the assumption here?

-        Dissolution of ontology (191);

o   What does Foucault mean here?  Does he mean that there really is no ontological assumption here?  Or does he mean there is a kind of ‘de-ontologization’ of a positive science insofar as certain ontological questions that are previously debated are no longer up for grabs, are no longer conteste?

o   Is the ‘depth knowledge’ in Foucault a kind of ontology?  Or is it a kind of ‘historical predecessor’?

o   Are the settled ontological questions always there waiting to be asked?  Do they continue to organize?

Birth of a Clinic Ch 9: 12/3

We started with questions:

1. What is the overall relation between the parts before the break on 159 and after the break. What is the role that death plays in the first few sections? And what are the consequences of this move to pathological anatomy in the last half of the chapter. 

2. Discussion about death: it seems like Foucault is usually bracketing death and focused on life. And it seem like that in HOS v 1 (end) as well as here. So what is the function of death here, both for Foucault, and for Bichat (and others) in the text.

3. 164 and 165 - the shift of the priority of sight, to the triplicate, to the remaining priority of sight. 

4. The difference between the stethoscope and the microscope--and how do these technologies differ

5. 164-164, alongside a disgust, a history of medical perception but technology does not fit into this in an intuitive way. Technology is taken up or rejected for curious reasons. How do these technologies fit into the history of medical perception? 

6. 153 - life is to pathological anatomy as nature was to nosology”--so is this notion of life something like an episteme? 

7. 155 - Bichat is a non-vitalist that he gives life so fundamental a status. Wait, how is this not vitalistm?

8. A discussion of individuality on 168 and 169 -- so something like illnesses only exist in the individual? So the subject of illness is in the individual. Where does this leave epidemiology? This is a medicine of the individual but is that an epistemic obstacle to the development of epidemiology? So it seems like he’s not dealing with epidemics. 

9. 163 - What’s the relationship between the epistemological and the moral? 

10. What’s the relation between this text and merleau ponty (since the title is obviously Pontian) 

Question 7: Start with question 

• If Bichat only concerned with life, perhaps he’s understanding vitalism as only a relation between life and death.

• Pg 154-- “if vitalism is a schema of specific interpretation of healthy or morbid phenomena in the organism, it is too feeble a concept to account for the event of significance…”

• Same page, “life is not the form of the organism, but the visible form of the organism” 

• Life seems to replace “nature” as the absolute. 

• So maybe they weren’t vitalists in the sense like this: they can’t take themselves to be vitalist (not doing metaphysics). Bichat doesn’t even need to make a case about vitalism in a context, because he is just assuming it. 

• Interestingly, Merleau Ponty has a text on the relation between vitalism and mechanistic. So as soon as life was thought not in terms of physical forms, then life is no longer tied to the problem of physical forms but of something else. 

And now connecting this to death…

Question 2: last sentence of 155 

• Death is disease made possible in death.

• The question of killing and the question of life are interrelated in interesting ways. 

• 171 - Shift from a renaissance of the macabre to a later conception of the morbid, which is about where the rise of biopolitical emerges . 

• 7th line from the bottom on 170 (with Aristotle)--the whole obsession with death is connected with biopoltics. So his discussion of death here is consistent with his line about letting live and making die to making live and letting die

• It’s from death that we get knowledge of life--that is, looking at dead bodies, and processes of death, you also tracking how life is happening. 

• So rather than thinking about scaling up from the individual, but how they understand pathology in general, that the entrance of the cadaver makes this stuff possible. If you were using a different way of knowing the human body, it might be harder to identify cholera. But starting from the dead makes sense here.

• In his 1974 lectures: 

• (from the 1st lecture) “Actually, one must not think that medicine up until now has remained an individual or contractual type of activity that takes place between patient and doctor, and which has only recently taken social tasks on board. On the contrary, I shall try to demonstrate that medicine has been a social activity since the eighteenth century. In a certain sense, ‘social medicine’ does not exist because all medicine is already social. Medicine has always been a social practice. (p. 8) 

What does not exist is non-social medicine, clinical individualizing medicine, medicine of the singular relation. All this is a myth that defended and justified a certain form of social practice of medicine: private professional practice. Thus, if in reality medicine is social, at least since its great rise in the eighteenth century, the present crisis is not really new, and its historical roots must be sought in the social practice of medicine.

• From the second lecture: 

• The question is whether the modern-that is, scientific-medicine born at the end of the

eighteenth century between Giambattista Morgagni and Xavier Bichat, with the introduction of pathological anatomy, is or is not individual. Can we affirm, as some people do, that modern medicine is individual because it has worked its way into market relations? That modern medicine, being linked to a capitalist economy, is an individual or individualistic medicine amenable only to the market relation.. One could show that this is not the case. Modern medicine is a social medicine whose basis is a certain technology of the social body; medicine is a social practice, and only one of its aspects is

individualistic and valorizes the relations between the doctor and the patient..

• Biopower targets populations but it also works in concert with discipline. You get something like a public health crisis, and you get biopolitical push for vaccination and also a disciplinary highly specific set of particular hygiene practices.  

• So it’s also the case that he’s talking about individual experiences, and looking at the way the clinic emerges to address individuals. 

• The individuality of a disease is no longer understood as a genus, but as something with it’s own history and trajectory. Such that a disease takes on a life of its own 152. 

• So first, disease becomes connected to life, and then it’s understood as the model of the individual. And he’s also talking about disease here, not medicine per say. 

• So where’s transmission and contagious infection? 

Question 3- 

• The triangulation of the eyes, hearing, and touching that also fit with the idea of the individual

• It’s difficult to retain a notion of individuality in the sense that was in the pathological anatomy, when the senses of the physician are crossing those boundaries. 

• The individual sense become intermeshed in this one medical gaze.

• What does this mean for how we understand an individual body if the body is being studied through polymorphous perception? 

• Diseases that don’t reside in tissues aren’t diseases--

Microscope and stethoscope -- 

What are the perceptual affordances are that it’s okay, the audibility that it makes possible is okay, where as the perceptual affordances of the microscope aren’t okay. 

• Foucault’s also describing a set of commitments that seem optional. 

• Do you we need to read this book as a form of medical epistemology that is still with us? 

• What’s the implicit modality of the “wink”--how do we know if this is where we are or not where we are? 

• The idea that the only way you can get at something is through a tissue is no longer with us. 

Major takeaway: We decide that, at sometime in the future, we will write a paper entitled "The Implicit Modality of Foucault's Wink.