Michel Foucault - Birth of the Clinic, Ch. 2

 

Questions

Q1 - What does Foucault mean by the "two great myths"? (pp. 31-32)

Q2 - What is the relevance of the 2nd myth and "war against bad government"? (p. 33)

Q3 - In relation to the"medicine of species, what are the "systemic intersection of two series of information"? (p. 30)

Q4 - What is the distinction between medical gaze and medical consciousness?

Q5 - What is the "true sense" of epidemics within the medicine of epidemics? (p. 24)

Q6 - What is the relationship of the medicine of epidemics to sovereignty (esp. the police)? (p. 25)

Q7 - Implicit reference to Canguilhem's The Normal and the Pathological 

Discussion 

• Medicine of epidemics now actual spaces, not abstract spaces [Q5; Q6]
• Movement away from "general form" of disease
• Specific disease in a historical-physical location (Paris, 1785)
• "Historical individuality" (p. 24)
• "collective perception" of an epidemic as opposed to individual perception of the medicine of species (p. 26)
• Observation moved from doctor to the police 
• Broader state bureaucracy of reporting versus doctor
• Socialization of the disease 
• "botanical model," nosology, framing as species (Ch. 1, p. 7)
• Now, framing as social-political model (Ch. 2)
• "The specific disease is always more or less repeated, the epidemic is never quite repeated." (p. 24) - medicine of series which becomes the clinical model
• Population appears as a concept - something you manage 
• Hospital, family (Ch. 1)
• Police/inspectors, university (Ch. 2) 
• Is this sovereign power or disciplinary power? [Q6]
• It is the state apparatus - but its not about killing, it's about saving/producing
• Not yet a formation of disciplinary power (some examples below)
• "But its support was not the perception of the patient in his singularity, but a collective consciousness, with all the information that intersects in it, growing in a complex, ever-proliferating way until it finally achieves the dimensions of a history, a geography, a state." (p. 29) 
• "And yet they played an important role: by linking medicine with the destinies of states, they revealed in it a positive significance. Instead of remaining what it was, ‘the dry, sorry analysis of millions of infirmities’, the dubious negation of the negative, it was given the splendid task of establishing in men’s lives the positive role of health, virtue, and happiness; it fell to medicine to punctuate work with festivals, to exalt calm emotions, to watch over what was read in books and seen in theatres, to see that marriages were made not out of self-interest or because of a passing infatuation, but were based on the only lasting condition of happiness, namely, their benefit to the state." (p. 34)
• Still assumption is the state - in Discipline and Punish, this change in power will not be told in terms of institutions but rather techniques/technologies (sovereign power vs. disciplinary power)
• BUT detach connotations of sovereignty from "police"
• Two series of information [Q3] 
• Earlier account - map - "In the eighteenth century, the fundamental act of medical knowledge was the drawing up of a ‘map’ (repérage): a symptom was situated within a disease, a disease in a specific ensemble, and this ensemble in a general plan of the pathological world." (p. 29)
• But now: "What defines the act of medical knowledge in its concrete form is not, therefore, the encounter between doctor and patient, nor is it the confrontation of a body of knowledge and a perception; it is the systematic intersection of two series of information, each homogeneous but alien to each other—two series that embrace an infinite set of separate events, but whose intersection reveals, in its isolable dependence, the individual fact." (p. 30)
• What are two series of information? 
• Series of information about diseases & series of information about demographic information (of populations) (?)
• One example: 
• Judiciary - court determines professional abuses
• Executive - function of policing 
• System of communication between doctors - state now concerned with medical knowledge 
• There does not seem to be a top-down organization, but a structure which emerges from struggle
•  Two great myths 
• "the myth of a nationalized medical profession, organized like the clergy" and "the myth of a total disappearance of disease in an untroubled, dispassionate society restored to its original state of health" (pp. 31-32)
• Myth as ideal - this is what they told themselves they were doing
• By getting a nationalized medical profession, we eliminate disease
• Do we care about other nations? 
• How cohesive is this? - Foucault points out that its all struggle
• Tracks the two myths in p. 32
• Linked health and state (p. 34)
• Sets up norm or model of health - healthy man, non-sick man, model man (p. 34)
• What is actually produced is a society of normality? 
• "Nineteenth century medicine, on the other hand, was regulated more in accordance with normality than with health." (p. 35)

Michel Foucault – Birth of the Clinic, Preface & Chapter 1

 

Questions

Preface

Q1. How does one look at ‘things’ and ‘words’ through an archeological method? (p. xi) How should we relate these given the idea of conceptuality discussed by Tiisala?

Q2. In relation to Tiisala’s “making explicit” and savoir, is the study of systematization this “making explicit,” and is that the historical a priori? (p. xix)

Q3. What happens to the patient’s confession as a site/technique/experience of truth-telling/saying/speech within the historical and formal reorganization of medicine? (p. xiv)

Q4. Is Foucault engaging in a meta-critique of the Critique of Pure Reason? Is he asking about the conditions of possibility for the constitution of the Kantian subject? (p. xix)

Q5. How does Foucault think that the signifier can exist without the signified? (p. xvi)

Chapter 1

Q6. To what extend does the medical truth of classificatory thought/the medical gaze depend upon what is visible, and so what remains hidden? (p. 9) 

Q7. What are primary, secondary, and tertiary spatialization? (pp. 10, 15, 16)

Discussion

• Preface – change between Pomme and Bayle is “both tiny and total” (p. x)
• French Revolution demarcates the two periods
• Signifier-signified passage is a criticism of a mode of analysis of language. (p. xvi). Foucault’s voice comes back at “To speak about the thought of others” (Q5) 
• Discussion of sovereignty? (p. 4)
• Is there a Heideggerian notion of disclosure? OR Question of empiricism and its relation to language (pp. x-xi)
• How does language turn into rational discourse? – Two different “metaphorical descriptions” of        the brain.
• Question of the relation of linguistic shift as more rational as a result of being more                                     empirical 
• What gives modern empiricism its epistemological foothold? 
• OR it isn’t empiricism – it’s some kind of positive science (?)
• Modern science doesn’t see the act of seeing – doesn’t see how it constitutes subjects
• “Experience” or “appearance” as phenomenological issue – how experience has been reduced to a rational discourse
• What is the order before the order of the subject? (Q4)
• Progression of the disease being separate from the individual to them being brought together
• “What made clinical experience possible” (p. xiv) is tied to the “sovereign power of the empirical gaze” (p. xiii) (Q2)
• Discourse is the conditions of possibility for experience
• New distinction – “What is the matter with you?’, with which the eighteenth-century dialogue between doctor and patient began (a dialogue possessing its own grammar and style), was replaced by that other question: ‘Where does it hurt?’, in which we recognize the operation of the clinic and the principle of its entire discourse.” (p. xviii)
• Some non-linguistic structure – “the non-verbal conditions on the basis of which it can speak” (p. xix) (Q1 & Q2)
• How does the structure relate to power? Is there underlying pouvoir operating?
• Are there vectors of power that we can track such that this is genealogical even though Foucault is doing archaeology, here? 
• The tactical battle of hysteric and doctor in Psychiatric Power more genealogy rather than archeology (he uses the word power there)
• So, can we retroactively describe these as instances of power?
• “Play” rather than “struggle” (p. 15)
• Chapter 1 begins with criticism of perception as self-evident (epistemological foundationalism)
• “The exact superposition of the ‘body’ of the disease and the body of the sick man is no more than a historical, temporary datum. Their encounter is self-evident only for us, or, rather, we are only just beginning to detach ourselves from it.” (p. 3)
• Nosological, classification of species
• Analogies define diseases – for instance, a resemblance of symptoms 
• Before anatomical pathological, sexuality is abstracted from bodily sex – bodily sex constructed within the moment of the anatomical regime 
• Resemblances define essences, it supposedly uncovers the rational order of things, both natural and             ideal 
• Disease exists in space of essences (p. 9) 
• Disease is understood independently of the body, the body distorts the essence of disease (probably, psychological thought is like this today – we look how well you fix the essence of OCD, ADHD, etc.)
• Concrete space of perception (p. 9) 
• Primary, secondary, tertiary spatializations (pp. 15-16) 
• Primary – “the medicine of species situated the disease in an area of homologies in which the individual could receive no positive status”
• Essence of disease separated from the individual
• Secondary – “in secondary spatialization, on the other hand, it required an acute perception of the individual, freed from collective medical structures, free of any group gaze and of hospital experience itself.” 
•  “Doctor and patient are caught up in an ever-greater proximity, bound together, the doctor by an ever-more attentive, more insistent, more penetrating gaze, the patient by all the silent, irreplaceable qualities that, in him, betray—that is, reveal and conceal—the clearly ordered forms of the disease.” (p. 14)
• Cannot perceive the disease unless in the “spatial synthesis” or “density” of the patient,
• Tertiary – “Let us call tertiary spatialization all the gestures by which, in a given society, a disease is circumscribed, medically invested, isolated, divided up into closed, privileged regions, or distributed throughout cure centres, arranged in the most favorable way.” 
• “But to a greater extent than the other forms of spatialization, it is the locus of various dialectics: heterogeneous figures, time lags, political struggles, demands and utopias, economic constraints, social confrontations. In it, a whole corpus of medical practices and institutions confronts the primary and secondary spatializations with forms of a social space whose genesis, structure, and laws are of a different nature.” (p. 16)
• Are secondary and tertiary spatialization at different times or within the same discourse
• Three aspects occurring at the same time – doctors essentializing, doctors treating, and the distributed medicine of tertiary
• Different spaces of the same discursive period