The Birth of the Clinic: An Archaeology of Medical Perception

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Cunningham FG, et al. Normal labor. In: Williams Obstetrics. 25th ed. McGraw-Hill; 2018. https://www.accessmedicine.com. Accessed Oct. 28, 2021.

The history of illness to which he is reduced is necessary to his fellow men because it teaches them by what ills they are threatened. MRI scan; brain cancer (glioma). Credit: Wellcome Collection. Attribution 4.0 International (CC BY 4.0) In the genealogy of medicine—knowledge about the human body—the term Le regard médical (The medical gaze) identifies the doctor’s practice of objectifying the body of the patient, as separate and apart from his or her personal identity. In the treatment of illness, the intellectual and material structures of la clinique, the teaching hospital, made possible the inspection, examination, and analysis of the human body, yet the clinic was part of the socio-economic interests of power. Therefore, when the patient’s body entered the field of medicine, it also entered the field of power where the patient can be manipulated by the professional authority of the medical gaze. [2] How long it lasts: Early labor is unpredictable. For first-time moms, the average length varies from hours to days. It's often shorter for subsequent deliveries. Foucault jumps in during the mid-eighteenth-century period of “classificatory medicine,” when “…disease is given an organization, hierarchized into families, genera, and species,” (p. 4) akin to botanical classifications, offering doctors “a gardener’s gaze” (p. 119). Diseases were accorded their own existence independent of the individual body, and so knowledge of particular bodies only interfered with discerning true diseases. Botanical classification; 227 figures of plant anatomical segments with descriptive text. Colour process print. Wellcome Collection. Public Domain MarkWhat you can do: Push! Your health care provider will ask you to bear down during each contraction or tell you when to push. Or you might be asked to push when you feel the urge to do so. A member of your health care team may massage your abdomen. This may help the uterus contract to decrease bleeding. This means that the clinical gaze moves from the literally superficial – the doctor can look at your skin or in your mouth and so on – to a gaze in the broadest sense, one where the doctor can listen to your breathing or feel your temperature or pulse, and from this ‘gaze’ interpret what is going on under the surface to tissue there. The shift to a classification system of tissues is essential for this movement and such a shift fundamentally changes how medicine will be carried out. In many ways this book is a structuralist analysis of the kinds of discourses that go on in medicine. There is some incredibly interesting stuff at the start where the disadvantages of putting people into hospitals prior to the French Revolution is discussed by doctors at the time because they understood illness as something needing to be explained in relation to the patient’s entire life as lived and in the hospital a person stops being a person and becomes merely an example of an illness. This shifting relationship between what one is and what one becomes due to where one is, how one is being observed, is really interesting and still relevant today. I think it is also interesting in relation to more than just medicine – also education, workplaces, the courts and so on.

The clinic—constantly praised for its empiricism, the modesty of its attention, and the care with which it silently lets things surface to the observing [medical] gaze without disturbing them with discourse—owes its real importance to the fact that it is a reorganization-in-depth, not only of medical discourse, but of the very possibility of a discourse about disease. [5] The Doctor by Sir Luke Fildes (1891) Thomas Eakins 1875-1876 Watercolor on cardboard Creative Commons CC0 1.0 Universal Public Domain Dedication Modern medicine begins for Foucault around the time of the French Revolution, at a time when the gaze newly encompasses other factors. Time and space now mattered. If you're having an uncomplicated pregnancy, you may spend most of your early labor at home until your contractions start to increase in frequency and intensity. Your health care provider will instruct you on when to leave for the hospital or birthing center. If your water breaks or you experience significant vaginal bleeding, call your health care provider right away. Active laborthe development of clinical medicine, of pathology (this part is quite tenuous to read especially if you are a doctor and know the actual state of the arts. because those whole "ancient" theories about tissues and diseases are nowadays outdated, you can read them and think of them as medical dystopies (HAHAHA). Nevertheless, the reasons for inventing the stethoscope are quite funny (as the doctor was not allowed to put his ear on the woman's chest) The CQC found that The Birth Company needed to make some improvements in areas of safety and being well-led and therefore the service was rated ‘Requires Improvement’ overall. At the beginning of the nineteenth century, doctors described what for centuries had remained below the threshold of the visible and the expressible, but this did not mean that, after over-indulging in speculation, they had begun to perceive once again, or that they listened to reason rather than to imagination; it meant that the relation between the visible and invisible—which is necessary to all concrete knowledge—changed its structure, revealing through gaze and language what had previously been below and beyond their domain. A new alliance was forged between words and things, enabling one to see and to say. Sometimes, indeed, the discourse was so completely ‘naive’ that it seems to belong to a more archaic level of rationality, as if it involved a return to the clear, innocent gaze of some earlier, golden age” (p.xii). Bahasa yang sederhana dan adunan ilmu perubatan dengan politik, sejarah dan falsafah yang diolah baik oleh penulis Perancis ini. Membaca karya Edward Said dan Michel Foucault pasti menimbulkan bibit-bibit akan pentingnya menguasai bahasa Perancis. Book Genre: Anthropology, Health, History, Medical, Medicine, Nonfiction, Philosophy, Psychology, Science, Sociology, Theory

Foucault's thesis about the birth of the clinic (teaching hospital) contradicts the histories of medicine that present the late 18th century as the beginning of a new empirical system "based on the rediscovery of the absolute values of the visible" material reality. [4] The birth of modern medicine was not a common-sense move towards seeing what already existed, but actually was a paradigm shift in the intellectual structures for the production of knowledge, which made clinical medicine a new way of thinking about the body and illness, disease and medicine: Yet, Foucault moves on a philosophical plane with his books, and there are certain rules you have to abide by if you want to play this game. For starters, there is the justification of claims. Foucault makes radical claims but he does not argue for them. He describes how different ways of seeing the world and speaking about it follow up one another; he describes how doctors viewed disease, life, death, etc. at each particular time. But describing is not explaining. And this is, of course, on purpose: Foucault is heavily inspired by phenomenology. Originally developed by Edmund Husserl it is a method of doing philosophy through describing how phenomena appear in themselves and leaving it at that. Supposedly, this circumvents the (age old) problem of explain the relationship between these phenomena and the consciousness observing them. But it handicaps the philosopher significantly, since it is impossible to argue for any position since it is simply description. Don't be surprised if your initial excitement wanes as labor progresses and your discomfort intensifies. Ask for pain medication or anesthesia if you want it. Your health care team will partner with you to make the best choice for you and your baby. Remember, you're the only one who can judge your need for pain relief.

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Learned [and] rewarding... The Birth of the Clinic continues [Focault's] brilliant history, not of ideas as such, but of the structures of perception."-- The New York Times Book Review Tip voor de lezer die net als ik geen filosofische achtergrond heeft: na de inleiding wordt het boek een stuk beter te begrijpen! (De inleiding is volstrekt logisch nadat je het boek uit hebt) . Prior to this time, diseases were viewed in a rather Aristotelean sense: they were viewed as beings (substances) themselves, to be classified according to their accidental properties. The physician’s task was to discover the disease, to classify it and to let it develop along a natural course. There is an almost exact analogy to be drawn with the botanist, who studies, classifies and cultivates plants. Within this structure of knowledge, the patient is a negative factor – his body distorts the way the disease manifests himself. The physician has to negate the patient, and himself as well (as observer), and view the disease in its pure manifestation. Over the ensuing two centuries, new technologies have taken the gaze deeper into bodies. Imaging technologies such as x-rays, CT scans, and PET scans see deeper into tissues and cells. Biological technologies see deeper into molecular structures including the human genome. Visualization technologies like miniature cameras and virtual reality see the once-hidden. Sensor technologies can see the invisible such as pulmonary artery pressures and blood glucose concentrations. Artificial intelligence and other analytical processes bring more precision to interpretations of what the gaze sees.