Notes on Reading Foucault's
The Birth of the Clinic 
Lois Shawver 
05/16/98

Check out a book by 
the author of this site Nostalgic Postmodernism: Postmodern Therapy

or

Read an excerpt from the same book called How the West Became Postmodern.

 

People disagree as to whether Foucault was postmodern, but if we use Lyotard's compelling definition of postmodernism, then Foucault makes a distinctly postmodern statement at the beginning of his book, The Birth of the Clinic.  Lyotard (1993) defines postmodernism as an  incredulity towards metanarratives.  A metanarrative is a theory or story that passes itself off as a truth without exception, generalized truths that pretend to be true for all objects in a category, such as all Priests are pure, all people in a certain country think a certain way, or science is the best approach to solving all human problems.  Metanarratives, it seems to the postmodern, are myths belonging to modernity, myths that simplify and blind us to subtleties and exceptions around us, myths that are often more false than true, but seldom completely true.  In the following quotation, Foucault expresses such a postmodern skepticism early in his book, The Birth of the Clinic, by challenging such a myth of modernity.  The "Revolution" he speaks of is the French Revolution.  It is generally understood that the French and the American revolutions are powerful events helping to launch modernity with its new breed of myths, although modernity had been breeding more than a century before that.  Articulating an postmodern skepticism, Foucault says:

The years preceding and immediately following the Revolution saw the birth of two great myths with opposing themes and polarities: the myth of a nationalized medical profession, organized like the clergy, and invested, at the level of man's bodily health, with powers similar to those exercised by the clergy over men's souls; and the myth of a total disappearance of disease in an untroubled, / dispassionate society restored to its original state of health. (p.31/32.)

The study of these particular metanarrative myths form the centerpiece of The Birth of the Clinic.  According to these myths, Foucault tells us...

the first task of the doctor is ... political: the struggle against disease must begin with a war against bad government." Man will be totally and definitively cured only if he is first liberated...p.33.

The idea was that the doctor was such a remarkable sage that he could lead the community to a utopia. Foucault rejects these myths saying:

All of this is so much day-dreaming; the dream of a festive city, inhabited by an open-air mankind, in which youth would be naked and age know no winter,...--all these values were soon to fade." (p. 34)

But here is a puzzle that will take us back into Lyotard's definition of postmodernism: How can modernity be credulous?  Modernity emerged during the Enlightenment era (17th century) when moderns rejected the superstitions of medieval time.  Modernity billed itself as the "enlightenment," and saw itself as having finally awakened from dark superstitions. Now, Foucault's postmodern complaint is that although the moderns threw off the yoke of medieval superstitions, they developed their own myths, and the moderns bought these new myths with equally little critical questioning. Foucault tells us, one of those myths had to do with the wisdom of doctors.   According to the myths of modernity, doctors were amazingly wise.  They could see past distractions into the truth of things.  We could tell them our problems and their wisdom would lead us to a better life.  The relationship between a good life and good health blurred, and the doctors became the carrier's of cultural wisdom. But how could this be?  The Enlightenment rejected medieval superstition. How did the physician escape the Enlightenment rejection of esoteric knowledges?  Foucault put these questions like this:

How can the free gaze that medicine, and, through it, the government, must turn upon the citizens be equipped and competent without being embroiled in the esotericism of knowledge and the rigidity of social privilege?" p. 45

The answer, Foucault explained, had to do with this notion of a "gaze,".  Gaze is a technical term for Foucault.  He calls it a "clinical gaze" at times, and an "observing gaze" at others.  The people of modernity thought that with this powerful gaze the physician could penetrate illusion and see through to the underlying reality, that the physician had the power to see the hidden truth. But how did the doctor acquire this remarkable ability?  Not from books.  Books still had the quality of esoteric knowledges of the elite, something the moderns had rejected.   No, this remarkable wisdom of the doctor was to have been acquired through his observation of patients.  The wisdom was a practical wisdom that was supposedly learned through internships and apprentiseships not by dipping into the texts that told of professional secrets. Once the doctor acquired this ability to look with a clinical gaze the doctor could diagnose problems, design solutions, and speak about all things wisely.  There was no way for anyone to challenge the doctor's experience.  It just was. The doctor could only tell us the truth and what to do about it.  With such powerful wisdom, it was not possible to be wrong. There were a number of supporting stories that testified to the power of doctor's clinical gaze.  If the doctor had no such a clinical gaze, one might ask, why was modern medicine so much more powerful than ancient medicine.  Did the ancient doctor not have such a gaze?  Foucault said that the modern myth was that the ancient doctor did have such a gaze and the ancient doctor was also wise.  It was only the theory behind the gaze that changed with modernity.  But the belief in the doctor's gaze, that had not changed.   In Foucault's words:

 

Medicine had tended, since the eighteenth century, to recount its own history as if the patient's bedside had always been a place of constant, stable experience, in contrast to theories and systems, which had been in perpetual change and masked beneath their speculation the purity of clinical evidence. The theoretical, it was thought, was the element of perpetual change, the starting point of all the historical variations in medical knowledge, the locus of conflicts and disappearances; it was in this theoretical element that medical knowledge marked its fragile relativity. The clinic, on the other hand, was thought to be the element of its positive accumulation: it was this constant gaze upon the patient, this age-old, yet ever renewed attention that enabled medicine not to disappear entirely with each new speculation, but to preserve itself, to assume little  by little the figure of a truth that is definitve, if not completed, in short, to develop, below the level of the noisy episodes of its history, in a continuous historicity. In the non-variable of the clinic, medicine, it was thought, had bound truth and time together. (p.54/55)

But how did modernity foster this notion of clinical wisdom in an era of devoted to dispelling non-scientific superstition?   It shifted the mythology of the gaze away from scientific knowledge, into another category, that of practical knowledge.  Foucault says:

It presented [the practical knowledges of medicine] as the restitution of an eternal truth in a continuous historical development in which events alone have been of a negative order: oblivion, illusion, concealment. In fact, this way of rewriting history itself evaded a much truer but much more complex history. It masked that other history by assimilating to clinical method all the study of cases, in the old sense of the word; and, therefore, it authorized all subsequent simplifications whereby clinical medicine became simply the examination of the individual. (p. 57)

By saying that this clinical wisdom had always existed behind the screen of superficial knowledges, the Enlightenment glorified the clinical gaze and convinced itself of its penetrating ability and thus promoted this exaggerated trust in the wisdom of the doctor.  How easy it was to recast this belief in the doctor's gaze over to the psychiatrist who, even in modernity, was then seen to read minds and souls. What do we know about this powerful observing or clinical gaze? What is its character?  How were doctors behaving when they were seen to use this special gaze?

The observing gaze refrains from intervening: it is silent and gestureless. Observation leave things as they are; there is nothing hidden to it in what is given. The correlative of observation is never the invisible, but always the immediately visible, once one has removed the obstacles erected to reason by theories and to the senses by the imagination. In the clinician's catalogue, the purity of the gaze is bound up with a certain silence that enables him to listen. The prolix discourses of systems must be interrupted: 'all theory is always silent or vanishes at the patient's bedside.' (p. 107)

So, the physician may study the esoteric and privileged texts during schooling, but all of that is put aside at the patient's bedside. Here the wisdom of the gaze interrupts and replaces all other systems of knowledge.  This belief in the gaze is, therefore, a rejection of the overly intellectual and, at the same time,  a glorification of the sensible and practical. Foucault says:

The clinical gaze is not that of an intellectual eye that is able to perceive the unalterable purity of essences beneath phenomena. It is a gaze of the concrete sensibility, a gaze that travels from body to body, and whose trajectory is situated in the space of sensible manifestation. For the clinic, all truth is sensible truth; ' (p. 120)  [T]he gaze implies an open field, and its essential activity is of the successive order of reading; it records and totalizes; it gradually reconstitutes immanent organizations; it spreads out over a world that is already the world of language, and that is why it is spontaneously related to hearing and speech." p.121

Another way this myth of the gaze was perpetrated in the nineteenth century was by creating a supporting myth that held that prior to the nineteenth century doctors should not examine corpses and thus were denied any real observation of bodies. Any failure in their gaze, therefore, was attributable to their lack of ability to dissect the human body. This revision of history, Foucault tells us, was a falsification.

[T]here was no shortage of corpses in the eighteenth century, no need to rob graves or to perform anatomical black masses; one was already in the full light of dissection. This reconstitution is historically false....By means of an illusion widespread in the nineteenth century, and one to which Michelet gave the dimensions of a myth history painted the end of the Ancien Regime in the colours of the last years of the Middle Ages, confusing the upheavals of the Renaissance with the struggles of the Enlightenment. p.125

And the prestige of the clinical gaze was enhanced, too, by the the invention of a nosology and science of nosography, that is, a system of disease description that made it appear that all illnesses fit within a definitive network of disease classification.

Hence the appearance that pathological anatomy assumed at the outset: that of an objective, real, and at last unquestionable foundation for the description of diseases: 'A nosography based on the affection of the organs will be invariable.' p.129.

This new nosography, supposedly, not only informs the wise physician of the sick patient's problem, but it also enables the mortician to discern the cause of death just by looking at the corpse.

In order to overcome the first series of objects, there did not seem to be any need to modify the structure of the clinical gaze itself: was it not enough simply to observe the dead as one observes the living and to apply to corpses the diacritical principle of medical observation: the only pathological fact is comparative fact? p.134

And so, whereas for centuries, disease had been mysterious and followed obscure and esoteric paths, during the Enlightenment period of pre-modernity, the physician was seen as able to penetrate the body's secrets just by looking, and to diagnose and to speak wisely about its treatment.  Moreover, not only physical ailments, but all misfortune yielded is secrets to the clinician's gaze.

In the depths of its being, disease follows the obscure, but necessary ways of tissue reactivations. But what now becomes of its visible body, that set of phenomena without secrets that makes it entirely legible for the clinician's gaze: that is, recognizable by its signs, but also decipherable in the symptoms whose totality defined its essence without residue. p.159

 

And the glorification of this medical gaze was also fostered by the invention of new tests and signs, or the belief that these signs and tests were new. These new tests and signs allowed the physician to gaze upon the naked body, to place the hand upon the heart, to listen with an instrument, to examine the urine of the patient. These new doctors

"...criticized ... 'false modesty', ...[and] 'excessive restraint' (p.163)

New rules were invented that allowed the patient to be touched and prodded in the name of our culture's belief in the physicians' diagnostic wisdom. (164-5)  And so, with the nineteenth century invention of the clinical gaze:

What was fundamentally invisible suddenly offered to the brightness of the gaze, in a movement of appearance so simple, so immediate that it seems to be the natural consequence of a more highly developed experience. It is as if for the first time for thousands of years, doctors, free at last of theories and chimeras, agreed to approach the object of their experience with the purity of an unprejudiced gaze. (p.195)

And this new belief in the power of the medical gaze to expose the hidden truth, became the myth, or metanarrative, that allowed for the Birth of the Clinic as modern day seer.

To site this online article use standard style Shawver, L. (1998). Notes on reading the Birth of the Clinic. Retrieved 12/14/06 from the World Wide Web: http://www.california.com/~rathbone/foucbc.htm or use MLA style which lists date of publication rather than retrieval Shawver, L.  Notes on reading the Birth of the Clinic. 16 May 1998. http://www.california.com/~rathbone/foucbc.htm

 
 

References: Foucault, Michel. (1975). Birth of the Clinic, The : An Archaeology of Medical Perception (Vintage). (A. M. Sheridan Smith, trans.)New York: Vintage Books.  Lyotard, Jean-Francois. (1993). The Postmodern Condition: A Report on Knowledge (Theory and History of Literature). Minneapolis: Universityof Minnesota Press. (Geoff Bennington and Brian Massumi, trans)

 

Look at a searchable copy of Foucault's  Archaeology of Knowledge.  The Archaeology of Knowledge & The Discourse on Language

or, if you're really serious about studying Foucault, bookmark this dictionary of Foucault's terms.