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?