Michel Foucault – Birth of the Clinic, Chapter 3

 Questions

1. How are we to understand the hospital as a "duplication" of the family that reproduces as a "microcosm, the specific configuration of the pathological world" (42)? Is this similar to the role of "exchanger" or "hinge" that the family operates in his genealogical period?

2. What kind of account of the French Revolution is this? It seems to be broader than an archaeology, but is it? Is it closer to a genealogy? What kind of "deeply rooted convergence between the requirements of political ideology and those of medical technology" (38) is Foucault tracking?

3. How is the medical gaze connected to the Enlightenment? What does Foucault means when he writes that the medical gaze "was only one segment of the dialectic of the Lumières transported into the doctor's eye" (52)?

4. "A free state that wishes to maintain its citizens free from error and from the ills that it entails cannot authorize the free practice of medicine" (46). What does he mean by free here? Are there two contesting conceptions of freedom at play? Liberty versus freedom?

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Discussion

His objects of study are "decrees" (an archive of the French Revolution) and he is trying to understand them in the context of the changes in the discourse, practices, and institutions of medicine.

In some sense, his history of "the birth of the clinic" is also not a linear history but a very complex web of issues that intersect, move back and forth (dialectically)? It is significant in this context his interesting discussion between the push for revolutionary abolition ("the abolition of state help demanded by the Girondists", p. 43) but also the requirement of protecting from disease (p. 42). This tension is predominant throughout the chapter. It seems that a "free practice" of medicine (revolutionary) does not entail a "healthy citizenry" (see p. 46).

We can see this is a history of the French Revolution that shows, through a microscopic focus on medicine, that it is not one of "progress" or mere transformation but of tensions, rifts, dissent, messiness, and that is also a history of how the revolutionary government handled or met "demands" and practical problems of health. The challenges to revolution and/or reformism? Revolutionary thinking versus "reformist thinking" (48)?

Perhaps we can think of Foucault as working through or archivally dealing with the problem of "transition" that is a constant debate among revolutionary theorists or Marxists. What happens once revolution is achieved? How does transition happen? How can we assess it functionally? What does this kind of assessment (i.e, non-moral, non-ideologically driven) tell us about political practice?

It is interesting that, without using the language (or an analytic) of power, we can see some seeds or preliminary gesture towards biopower. For example, he talks about a "corpus of knowledge about the health of the population" (38) and mentions the challenges to manage health of people (42). At the same time, he mentions a differentiation of the space of the hospital according to "two principles": 'training' and 'distribution', which refer to the disciplinary dispositif developed in Discipline and Punish. 

In this chapter, we see a lot of discussion about the university and the role of medicine faculties not only in terms of knowledge production/dissemination, but also as institutions of social organization themselves (later, sites of power-knowledge). If we think of Foucault as a Kantian, is this his way of address the conditions for the possibility of medical concepts, discourses, and practices? Maybe there is an underlying relation between The Birth of the Clinic and Kant's The Contest of Faculties.

Foucault ends by noting that his history is, in some sense, a counter-history that challenges "a historical view that relates the fecundity of the clinic to a scientific, political, and economic liberalism" (52) and that conveniently "forgets" that it was liberalism what "prevented the organization of clinical medicine" (52). It seems the Foucault equates here liberalism and revolution...