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. 

Birth of Clinic Ch. 8: 11/19 meeting

The group began with questions.

[1] What is the overall historical trajectory of the book so far? What is the relationship between savoir and connaissance?

[2] Page 137: MF seems to position his historical method against another (teleological) methods or approaches? What do we make of this contrast? How can we make sense of historical transformation?

[3] Can we give an account of (i) the significance of “conceptual trinity of life, disease and death” (144); (ii) importance of vitalism that Foucault finds in Bichat? How are these ideas connected to the history of the clinic?

[4] Page 145: “knowledge of life…”. How is the distinction between savior and connaissance related to the “conceptual trinity.”

[5] This is the second time where MF mobilizes the notion of “historical myth” or “illusion.” How do these myths get identified? What kind of critical work does identifying something as a myth perform on this account?

 

Discussion ensued.

Why does MF call certain views myths? The critique seems not so much to be about the facts, but what is said about them. Rather, he is saying that these sentences operate in a certain way when it comes to medicine’s self-understanding. [pp. 125; 117]. Myths have a positive function.

How is MF using history in this chapter?

There seem to be some “proto-genealogical” ideas in this chapter. These myths seem to be sedimented fairly quickly. What he is reconstituting is not our current views but past historical writings.

John Hunter: part of a cluster of “strange Hegelians” influenced by a paleontological view of history. Studying changes in anatomy over a long period of time which rejects a kind of vitalism that might see changes in organisms which occur from an immanent force. The writers to whom MF is referring are often-cited thinkers of historical change.

What is the significance of the “rediscovery” of the body.

We read from 135.

Myths not only seem to sustain a set of practices, but the myths also undermine the practices?

MF outlines a myth about the emergence of anatomo-clinical experience, and then offers a very detailed explanation of his own take on the transformation.

Towards the beginning of the chapter, MF suggests that pathological anatomy needed to be accompanied by (i) “new geographical lines” and (ii) a “new reading of time” (126). See also page 142. This latter “kind” of time seems to be more multiplitous as opposed linear? Perhaps we can trace this idea in the next chapter. The way in which death is understood coincides with a new sense in which doctors understand time?

 

Questions for next time:

[1] continue discussion of death, disease, time.

[2] continue talking about how MF understands historical transformation. Are there latent concepts here?

[3] Possible title for paper: “The Birth of (late) Foucault in ‘The Birth of the Clinic’”

[4] Possible connection between the next chapter title and Merleau-Ponty’s book. Is there an engagement with Merleau-Ponty’s work on organs, tissues?

 Birth of Clinic Ch 7: 11/12

1) Methodological question- perhaps based on an interpretive question: Chapter 5 offered an analysis of the institution of the clinic and hospitals and that chapters 6 and 7 offer an analysis of the epistemology of the gaze? If that’s right (or something like that), then methodologically, how does Foucault square these parallel lines off of one another? Like, what are the connections between these lines of inquiry? But also, where do they come into contact with each other in the text? How is he putting these different veins of analysis into play with one another?

2) (More interesting question) Perhaps what Foucault’s tracking here is the same as Seller’s Myth of the Given (classical empiricist epistemology). Hegelian critique of immediacy (and Sellers also has a kind of Hegelian critique of Kant). So are there close ties between Foucault’s critique and Seller’s critique. If they are similar, then how are they different?

3) Critique of immediacy—can we situate this critique more in Foucault scholarship? Not only in relation to his own work, folks who read him as a positivist. But there’s also a theme in Foucault scholarship that he’s an historical positivist, that there’s a kind of immediacy to the archive or to history.

4) The initial ways of organizing the clinic outlined 111-116. These three aspects of the initial form of the clinic are actually part of the clinic or just false starts? Are they early attempts that don’t work out? Do these three attempts on these pages count as part of clinical experience?

5) 4 epistemological myths (117): are these parts of clinical experience? Or distractions from clinical experience? The clinic isn’t monolithic but developed over time. Do these things form stabilized role in clinical practice? Or are they forgotten about.

6) Map out the idea of the domain of the clinic (that appears in ch. 6 and 7). What are these chapters doing with respect to the sequence of the argument. 114—"description is to see and to know” and how this relates to the epistemological myths. How this becomes a way to reject the other ways of seeing?

And then discussion began.

Starting with Question 6: 

Key theme of the epistemology in this chapter as clinical experience is “balancing” seeing and saying. The relation between seeing and saying is what becomes knowing. Both seeing and saying are constitutive of knowing, perhaps. (“balance” shows up on 115)

Pg 109 - once the idea of the hospital comes in as this neutral space where events can be assessed probabilistically becomes possible.  But it seems like the philosophy of language plays a bigger role in this chapter. 

Is the idea that the clinician who sees the patient describes an event in a series? The hospital serves the function of being a test site (110 bottom). Because things happen in the neutral space of the hospital, it becomes possible to apply statistical analysis to the events, rather than seeing the events as standing for some essence. 

This neutrality, and truth becoming determined by frequency and repetition, permits the emergence of a pedagogical domain. 

So the hospital is a purified space where the disease can appear without the distorting environmental factors. 

But this then gives rise to the problem (111): how does the clinic limit knowledge? The initial practical and theoretical problem is that there’s now an open domain. The clinic initially tries to bring these things together through interrogation and examination. 

Its that these three things help to define and give the clinic its boundaries so that it could have organization. 

Visual, language, perception, speech--the clinician goes back and forth between all of these.  

So the picture’s function is to integrate the seeable and the sayable (pg 112, just after the start of #2)

The nievelly geometrical architecture is that he was referring to in the prior section (#2). But now it’s a matter of the structure of the language itself (rather than just plotting or mapping it on to the disease). 

There’s an exhaustive description (of the patient and the disease) that is what perception is. 

Species medicine doctors were using Latin words to legitimize themselves, but now the difficulty of the language, and relation between words, has a different epistemological relation. 

Foucault’s view is that this is an effect of training. But do the clinicials take it to be natural? 

The manifestation of things is conditioned by a form of initiation into the truth of things (vis a vis the clinical language). 

Pg 121--so there were some who believed that diseases were just out there in the world, and those who believed one needed a specialized knowledge, but then these two come together in a particular way in the clinic. 

So is this something that’s natural or trained? The observation at the bedside is the training. The observational skills themselves allow a sensibility that can be understood within this language. The hospital acts as the condition for those who can understand and observe. Even though they might represent this to themselves differently. 

The gaze works by non-intervention (at the beginning of the chapter). Training onese senses is also to train yourself not to be distracted. 

There’s a way of reading this section as an analysis of the relation between power and the gaze. He always comes back to this idea of mastery, to the violence of the gaze. So it’s not just about epistemology, but about power. How a certain form of power gives rise to a certain way of looking at things. It seems to be a critique of the power the gaze practices. 

Think about how everything hangs on the different factions within the french evolution. There’s definitely conflict in the background (which is essential to his sense of power in the later work). 

But is he attributing this to the actors of the time? To recognize this themselves? 

If there’s a parallel between Sellars and Foucault, here, there’s a sense that knowledge and justification are mediated by social institutions. 

Once you give up on a pure epistemology, you have to analyze the social and political aspects of knowledge. So it’s a more political conception of epistemology. 

Once you emphasize this political aspect, there’s possibly a way to understand this whole exercise as engaged in an analysis of power and mastery. 

Mastery is obviously about power, and Foucault uses the language of mastery quite a bit. This should be explored. It’s almost like Foucault discussing a transition between self mastery and the mastery of others over the body in medicine, in the clinic. 

The terms appear in this chapter, at least on 114 and 115. 

If the doctor masters the patient, it doesn’t wear domination on its sleeve. It’s a different way of thinking about power that might still be about domination. 

Possible question for next week: do the same connotations that he attributes to the gaze also get attributed to the glance? Lets track the gaze, the glance, and the touch (it’s the touch by the end of the chapter). 

And that’s where we are today: the “where does it hurt” question. 

A clinic is organized that creates a purified and neutral space for disease in terms of symptoms. But the clinic stays, and instead the symptoms get replaced by organs. In modern medicine, the symptom is an expression of a problem with the organ, but not a symptom of an essence. Organs come to dominate the clinic. 

Pg 109: “one no longer needs a natural environment” to understand the disease. But then the clinic comes to be the space where it’s pure patient in front of you. 

The clinic is set up as a space where the environment doesn’t intrude, but that’s in part why they had difficulty understanding pandemics, epidemiologically speaking.