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.