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ولادة الطب السريري
كتاب ولادة الطب السريري، وهو ترجمة إياس حسن لكتاب ميشيل فوكو Naissance de la Clinique. هذا الكتاب (336 صفحة بالقطع الوسط، موثقًا ومفهرسًا) مؤلف من مقدمة وعشرة فصول.
في المقدمة، يقول فوكو إن بحثه هذا يتضمن مشروعًا يُقصدُ به أن يكون تاريخيًا ونقديًا معًا، من باب أن الأمر منوطٌ، خارج كل مقصد موجَه، بتحديد شروطِ إمكان الخبرة الطبية مثلما أدركها العصر الحديث. ويجب القول بوضوح إن هذا الكتاب لم يُكتب لمصلحة طبّ دون آخر، أو ضدّ الطب لمصلحة غيابه، إنّما المقصود دراسة تسعى إلى أن تستخلص من سماكة الخطاب شروطَ تأريخه.
وعي مرضي
في الفصل الأول، أماكن وأصناف، يرى فوكو أن المرض، قبل أن يخرج من البدن، يتخذ تنظيمًا تراتبيًا ضمن عائلات وأجناس وأنواع، وقد يبدو في الظاهر أن الأمر لا يعدو كونه لوحة تساعد في تعلُّم ميدان تكامل الأمراض. لكن الطب التصنيفي يفترض تمظهرًا معينًا للمرض: لم يتم تشكله قط من أجل ذاته، لكن يمكنى تحديد مستلزماته الأساس. وكما أن شجرة الأنساب، في ما هو أبعد من المقارنة التي تتضمنها ومن جميع ثيماتها التخيلية، تفترض فضاء تكون القرابة فيه قابلة للتشكل، فإن اللوحة المنزولية تنطوي على صورة للأمراض، ليست سلسلةَ النتائج والأسباب، ولا السلسلة الزمنية للحوادث، ولا مسارها الظاهر في الجسد البشري. وبحسبه، المكان الطبيعي للمرض هو المكان الطبيعي للحياة، أي الأسرة.
في الفصل الثاني، وعي سياسي، يقول فوكو إن الوباء يملك نوعًا من الفردانية التاريخية، ويجب أن نستخدم معه طريقة معقدة في الملاحظة. فهو كظاهرة جماعية يتطلب معاينة متعددة، وكعملية مفردة، يجب وصفها بما لها من فرادةٍ وحدث عرضيين وطارئين. ينبغي وصف الحدث بتفصيلاته، وتبعًا للانسجام الذي ينطوي عليه الإدراك الحسي المتعدد: معرفة ملتبسة، ومزعزعة بمقدار ما هي جزئية، وعاجزة وحدَها عن بلوغ الجوهري.
تأريخ طويل
في الفصل الثالث، الحقل الحر، يتكلم فوكو على ظاهرة الالتقاء بين متطلبات الأيديولوجيا السياسية ومتطلبات التكنولوجيا الطبية. فقد طالب الأطباء ورجال الدولة، في جهد موحّد وبتعبير متشابه أحيانًا، لكن لأسباب متفاوتة في جذورها، بإلغاء ما يمكن أن يعيق تأسيس فضاء جديد: ثمة مستشفيات تُغيِّر القوانين الخاصة المتحكمة بالمرض، وتُفسِد القوانين التي لا تقل صرامة، والتي تحدد الصلات بين السلطة الملكية والغنى، وبين الفقر والعمل، وهناك الطوائف المهنية للأطباء التي تمنع تشكل وعي طبي متمركز، وتمنع ممارسة الخبرة على نحو حرّ ومن دون حدود، حيث تؤدي بنفسها إلى العالمية، كذلك ثمة كليات طب لا تعترف بالحقيقي إلا ضمن بُنيات نظرية، وتصنع من المعرفة امتيازًا اجتماعيًا.
في الفصل الرابع، تاريخ السريريات الطويل، يرى فوكو أن الطب بدأ منذ القرن الثامن عشر يميل صوب سرد تاريخه الخاص كما لو أن سرير المرضى كان مكانًا ثابتًا ومستقرًا للتجربة، خلافًا للنظريات والمنظومات التي بدت عرضةً لتبدلٍ مستمر وتخفي تحت تأملها صفاء الوضوح السريري. كان الشأن النظري عنصرَ التغيير المستمر ونقطةَ انتشار التنويعات التاريخية على المعرفة الطبية ومكانَ الصراعات والاضمحلال، ففي هذا العنصر النظري تكون المعرفة الطبية قد أشارت إلى نسبيتها الهشة. في المقابل، كان في إمكان السريريات أن تكون عنصر تراكمها الإيجابي، وكان في إمكان المعاينة الثابتة للمريض أن تسمح للطب بألا يختفي بالكامل مع كل تأمل جديد، بل أن يصونَ نفسه ويتطورَ بتأثير الفترات الصاخبة من تاريخه، ضمن تاريخانية كَونُ الشَيْءِ تاريخيًّا.
علامات وحالات ومستشفيات
في الفصل الخامس، درس المستشفيات، يجد فوكو أن لا غرابة في أن تصير ثيمةُ الطبّ المنظم بكامله حول السرير أشد طغيانًا على ثيمة الطب الذي أعيد إلى الحرية. ليس ما حصل ردة فعل على الرغم من أن عواقبه الاجتماعية كانت بشكل عام رجعية ولا تقدمًا، على الرغم من أن الطب أفاد منه على أكثر من صعيد، إنما المقصود إعادة بناء ثيمة الطب في الحرية، ضمن سياق تاريخي محدد. ففي ميدان متحرر، ستحدِّد الحاجةُ إلى الحقيقة المفروضة على المعاينة، بنياتِه المؤسساتية والعلمية.
في الفصل السادس، عن العلامات والحالات، يرى فوكو أن المرض كان، في الموروث الطبي للقرن الثامن عشر، يشاهَد بناءً على الأعراض والعلامات، ولم تكن هذه ولا تلك تتميز تبعًا لقيمتها الدلالية بمقدار خصائصها الشكلية. فالأعراض هي الشكل الذي يظهر به المرض، من بين كل ما هو مرئي، كانت تعتبر الأقرب إلى الجوهر، وإلى طبيعة المرض العصيّة على البلوغ، وهي انتساخه الأول، "فالسعال والحرارة والألم الجانبي وضيق التنفس ليست هي التهاب الجنب بالذات، ذلك أن هذا المرض لا يتاح للحواس ولا ينكشف إلا بالتفكير والتحليل، ولكنها تشكل عرَضه الجوهري لأنها تسمح بتعيين حالةٍ مرضية (مقابل الصحة)، وجوهرٍ مرضي (مختلف عن ذات الرئة)، وسببٍ مباشر (الانصباب المصلي). فالأعراض تشِفّ على صورة المرض الثابتة، المتأخرة قليلًا، المرئية والمخفية".
شرّحوا لتعرفوا
في الفصل السابع، أن ترى، أن تعرف، يقول فوكو إنّ المعاينة التي تشاهِد تمتنع عن التدخل، فهي خرساء وعديمة المبادرة. وفي ثيمات الطبيب السريري، تقترن نقاوة المعاينة بصمت معين يسمح بالإصغاء. ينبغي إذًا لخطابات المنظومات الثرثارة أن تتوقف. كذلك ينبغي التقليل من موحيات الخيال التي تستبق ما يتم إدراكه، وتكشف عن صلات موهِمة وتُنطِق ما هو عصيّ على الحواس. فالمعاينة تكتمل في حقيقتها الخاصة وتحصل على منفذ إلى حقيقة الأشياء إذا ما نظر إليها بصمت، والمعاينةَ السريريّة تسمع لغةً في اللحظة التي تبصر فيها مشهدًا.
في الفصل الثامن، افتحوا بضع جثث، يرى فوكو أن المؤرخين ربطوا بين الذهنية الطبية الجديدة واكتشاف التشريح المرضي؛ إذ بدا أنه يحددها من حيث الجوهر، ويدعمها ويغطيها، ويشكل منها في آن التعبير الأكثر حيوية والسبب الأكثر عمقًا، وبدا أن مناهج التحليل والفحص السريري، بل وإعادة تنظيم المدارس والمستشفيات، تستمد أهميتها من التشريح المرضي، الذي حظي بامتياز لافت ...
في المقدمة، يقول فوكو إن بحثه هذا يتضمن مشروعًا يُقصدُ به أن يكون تاريخيًا ونقديًا معًا، من باب أن الأمر منوطٌ، خارج كل مقصد موجَه، بتحديد شروطِ إمكان الخبرة الطبية مثلما أدركها العصر الحديث. ويجب القول بوضوح إن هذا الكتاب لم يُكتب لمصلحة طبّ دون آخر، أو ضدّ الطب لمصلحة غيابه، إنّما المقصود دراسة تسعى إلى أن تستخلص من سماكة الخطاب شروطَ تأريخه.
وعي مرضي
في الفصل الأول، أماكن وأصناف، يرى فوكو أن المرض، قبل أن يخرج من البدن، يتخذ تنظيمًا تراتبيًا ضمن عائلات وأجناس وأنواع، وقد يبدو في الظاهر أن الأمر لا يعدو كونه لوحة تساعد في تعلُّم ميدان تكامل الأمراض. لكن الطب التصنيفي يفترض تمظهرًا معينًا للمرض: لم يتم تشكله قط من أجل ذاته، لكن يمكنى تحديد مستلزماته الأساس. وكما أن شجرة الأنساب، في ما هو أبعد من المقارنة التي تتضمنها ومن جميع ثيماتها التخيلية، تفترض فضاء تكون القرابة فيه قابلة للتشكل، فإن اللوحة المنزولية تنطوي على صورة للأمراض، ليست سلسلةَ النتائج والأسباب، ولا السلسلة الزمنية للحوادث، ولا مسارها الظاهر في الجسد البشري. وبحسبه، المكان الطبيعي للمرض هو المكان الطبيعي للحياة، أي الأسرة.
في الفصل الثاني، وعي سياسي، يقول فوكو إن الوباء يملك نوعًا من الفردانية التاريخية، ويجب أن نستخدم معه طريقة معقدة في الملاحظة. فهو كظاهرة جماعية يتطلب معاينة متعددة، وكعملية مفردة، يجب وصفها بما لها من فرادةٍ وحدث عرضيين وطارئين. ينبغي وصف الحدث بتفصيلاته، وتبعًا للانسجام الذي ينطوي عليه الإدراك الحسي المتعدد: معرفة ملتبسة، ومزعزعة بمقدار ما هي جزئية، وعاجزة وحدَها عن بلوغ الجوهري.
تأريخ طويل
في الفصل الثالث، الحقل الحر، يتكلم فوكو على ظاهرة الالتقاء بين متطلبات الأيديولوجيا السياسية ومتطلبات التكنولوجيا الطبية. فقد طالب الأطباء ورجال الدولة، في جهد موحّد وبتعبير متشابه أحيانًا، لكن لأسباب متفاوتة في جذورها، بإلغاء ما يمكن أن يعيق تأسيس فضاء جديد: ثمة مستشفيات تُغيِّر القوانين الخاصة المتحكمة بالمرض، وتُفسِد القوانين التي لا تقل صرامة، والتي تحدد الصلات بين السلطة الملكية والغنى، وبين الفقر والعمل، وهناك الطوائف المهنية للأطباء التي تمنع تشكل وعي طبي متمركز، وتمنع ممارسة الخبرة على نحو حرّ ومن دون حدود، حيث تؤدي بنفسها إلى العالمية، كذلك ثمة كليات طب لا تعترف بالحقيقي إلا ضمن بُنيات نظرية، وتصنع من المعرفة امتيازًا اجتماعيًا.
في الفصل الرابع، تاريخ السريريات الطويل، يرى فوكو أن الطب بدأ منذ القرن الثامن عشر يميل صوب سرد تاريخه الخاص كما لو أن سرير المرضى كان مكانًا ثابتًا ومستقرًا للتجربة، خلافًا للنظريات والمنظومات التي بدت عرضةً لتبدلٍ مستمر وتخفي تحت تأملها صفاء الوضوح السريري. كان الشأن النظري عنصرَ التغيير المستمر ونقطةَ انتشار التنويعات التاريخية على المعرفة الطبية ومكانَ الصراعات والاضمحلال، ففي هذا العنصر النظري تكون المعرفة الطبية قد أشارت إلى نسبيتها الهشة. في المقابل، كان في إمكان السريريات أن تكون عنصر تراكمها الإيجابي، وكان في إمكان المعاينة الثابتة للمريض أن تسمح للطب بألا يختفي بالكامل مع كل تأمل جديد، بل أن يصونَ نفسه ويتطورَ بتأثير الفترات الصاخبة من تاريخه، ضمن تاريخانية كَونُ الشَيْءِ تاريخيًّا.
علامات وحالات ومستشفيات
في الفصل الخامس، درس المستشفيات، يجد فوكو أن لا غرابة في أن تصير ثيمةُ الطبّ المنظم بكامله حول السرير أشد طغيانًا على ثيمة الطب الذي أعيد إلى الحرية. ليس ما حصل ردة فعل على الرغم من أن عواقبه الاجتماعية كانت بشكل عام رجعية ولا تقدمًا، على الرغم من أن الطب أفاد منه على أكثر من صعيد، إنما المقصود إعادة بناء ثيمة الطب في الحرية، ضمن سياق تاريخي محدد. ففي ميدان متحرر، ستحدِّد الحاجةُ إلى الحقيقة المفروضة على المعاينة، بنياتِه المؤسساتية والعلمية.
في الفصل السادس، عن العلامات والحالات، يرى فوكو أن المرض كان، في الموروث الطبي للقرن الثامن عشر، يشاهَد بناءً على الأعراض والعلامات، ولم تكن هذه ولا تلك تتميز تبعًا لقيمتها الدلالية بمقدار خصائصها الشكلية. فالأعراض هي الشكل الذي يظهر به المرض، من بين كل ما هو مرئي، كانت تعتبر الأقرب إلى الجوهر، وإلى طبيعة المرض العصيّة على البلوغ، وهي انتساخه الأول، "فالسعال والحرارة والألم الجانبي وضيق التنفس ليست هي التهاب الجنب بالذات، ذلك أن هذا المرض لا يتاح للحواس ولا ينكشف إلا بالتفكير والتحليل، ولكنها تشكل عرَضه الجوهري لأنها تسمح بتعيين حالةٍ مرضية (مقابل الصحة)، وجوهرٍ مرضي (مختلف عن ذات الرئة)، وسببٍ مباشر (الانصباب المصلي). فالأعراض تشِفّ على صورة المرض الثابتة، المتأخرة قليلًا، المرئية والمخفية".
شرّحوا لتعرفوا
في الفصل السابع، أن ترى، أن تعرف، يقول فوكو إنّ المعاينة التي تشاهِد تمتنع عن التدخل، فهي خرساء وعديمة المبادرة. وفي ثيمات الطبيب السريري، تقترن نقاوة المعاينة بصمت معين يسمح بالإصغاء. ينبغي إذًا لخطابات المنظومات الثرثارة أن تتوقف. كذلك ينبغي التقليل من موحيات الخيال التي تستبق ما يتم إدراكه، وتكشف عن صلات موهِمة وتُنطِق ما هو عصيّ على الحواس. فالمعاينة تكتمل في حقيقتها الخاصة وتحصل على منفذ إلى حقيقة الأشياء إذا ما نظر إليها بصمت، والمعاينةَ السريريّة تسمع لغةً في اللحظة التي تبصر فيها مشهدًا.
في الفصل الثامن، افتحوا بضع جثث، يرى فوكو أن المؤرخين ربطوا بين الذهنية الطبية الجديدة واكتشاف التشريح المرضي؛ إذ بدا أنه يحددها من حيث الجوهر، ويدعمها ويغطيها، ويشكل منها في آن التعبير الأكثر حيوية والسبب الأكثر عمقًا، وبدا أن مناهج التحليل والفحص السريري، بل وإعادة تنظيم المدارس والمستشفيات، تستمد أهميتها من التشريح المرضي، الذي حظي بامتياز لافت ...
336 pages
First published January 1, 1963
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About the author
Michel Foucault
765 books6,513 followersPaul-Michel Foucault was a French philosopher, historian of ideas, writer, political activist, and literary critic. Foucault's theories primarily address the relationships between power and knowledge, and how they are used as a form of social control through societal institutions. Though often cited as a structuralist and postmodernist, Foucault rejected these labels. His thought has influenced academics, especially those working in communication studies, anthropology, psychology, sociology, criminology, cultural studies, literary theory, feminism, Marxism and critical theory.
Born in Poitiers, France, into an upper-middle-class family, Foucault was educated at the Lycée Henri-IV, at the École Normale Supérieure, where he developed an interest in philosophy and came under the influence of his tutors Jean Hyppolite and Louis Althusser, and at the University of Paris (Sorbonne), where he earned degrees in philosophy and psychology. After several years as a cultural diplomat abroad, he returned to France and published his first major book, The History of Madness (1961). After obtaining work between 1960 and 1966 at the University of Clermont-Ferrand, he produced The Birth of the Clinic (1963) and The Order of Things (1966), publications that displayed his increasing involvement with structuralism, from which he later distanced himself. These first three histories exemplified a historiographical technique Foucault was developing called "archaeology".
From 1966 to 1968, Foucault lectured at the University of Tunis before returning to France, where he became head of the philosophy department at the new experimental university of Paris VIII. Foucault subsequently published The Archaeology of Knowledge (1969). In 1970, Foucault was admitted to the Collège de France, a membership he retained until his death. He also became active in several left-wing groups involved in campaigns against racism and human rights abuses and for penal reform. Foucault later published Discipline and Punish (1975) and The History of Sexuality (1976), in which he developed archaeological and genealogical methods that emphasized the role that power plays in society.
Foucault died in Paris from complications of HIV/AIDS; he became the first public figure in France to die from complications of the disease. His partner Daniel Defert founded the AIDES charity in his memory.
Born in Poitiers, France, into an upper-middle-class family, Foucault was educated at the Lycée Henri-IV, at the École Normale Supérieure, where he developed an interest in philosophy and came under the influence of his tutors Jean Hyppolite and Louis Althusser, and at the University of Paris (Sorbonne), where he earned degrees in philosophy and psychology. After several years as a cultural diplomat abroad, he returned to France and published his first major book, The History of Madness (1961). After obtaining work between 1960 and 1966 at the University of Clermont-Ferrand, he produced The Birth of the Clinic (1963) and The Order of Things (1966), publications that displayed his increasing involvement with structuralism, from which he later distanced himself. These first three histories exemplified a historiographical technique Foucault was developing called "archaeology".
From 1966 to 1968, Foucault lectured at the University of Tunis before returning to France, where he became head of the philosophy department at the new experimental university of Paris VIII. Foucault subsequently published The Archaeology of Knowledge (1969). In 1970, Foucault was admitted to the Collège de France, a membership he retained until his death. He also became active in several left-wing groups involved in campaigns against racism and human rights abuses and for penal reform. Foucault later published Discipline and Punish (1975) and The History of Sexuality (1976), in which he developed archaeological and genealogical methods that emphasized the role that power plays in society.
Foucault died in Paris from complications of HIV/AIDS; he became the first public figure in France to die from complications of the disease. His partner Daniel Defert founded the AIDES charity in his memory.
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May 25, 2012
This is a remarkably interesting book. In many ways it is a working out of the same ideas presented in The Order of Things: An Archaeology of the Human Sciences this time in relation to the development of what Foucault refers to as the clinical gaze. This isn’t so much a history of the clinic, but rather of the clinical, a history of medicine from nearly the time of the French Revolution through to about the 1850s or so, I guess. Some of the ideas here are very clever.
I don’t want to map out the whole book – although, it probably deserves to be mapped out in detail. What I want to talk about are some of the ideas that really struck me and hopefully that might encourage people to have a read this rather short book. It is also a remarkably readable book too. There are novels that are harder to read this this – I’m saying that because Foucault is often labelled as a very difficult read – and sometimes he really is – but not this time. Foucault is also interested in the history of ideas – in fact, you could say that he is only interested in how ideas are shaped over time. And he is interested in power and how power structures how we relate within contexts as his double barrel concept of ‘subject’ – you know, ourselves as subjects with agency and choices and ourselves as the subjects that are on the receiving end of power relationships. The subject and the subjected.
“So, Mr Smith, what seems to be the problem?”
“Well, Doctor, I have this pain right here…”
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.
If this is a structuralist account we can expect some talk about signs, signifiers and the signified. And, being medicine, some talk of symptoms also seems inevitable. But what is the difference between a sign and a symptom? The problem is that we have a fairly limited vocabulary of signs – ‘my stomach hurts, I’ve a sore head, it’s a kind of stabbing pain here” – and putting these signs together so as they add up to symptoms defining a disease can be anything but obvious. Particularly given a disease is generally temporal in nature and therefore changes over time.
There is also a discussion on how the use of language employed around illnesses has changed over time. There was a time when clarity and transparency of language use seemed appropriate if both doctor and patient were to understand each other. In part a move away from such transparency is about limiting access to knowledge to those in the know, creating a special caste with privileges due to their access to special and esoteric knowledge. But this is also a way to show the trained doctors have an ability to bring the unseen to the surface. Only those properly trained to appropriately employ the medical gaze are able to interpret signs into symptoms and from there to ascertain the lifecycle of the disorder at issue (with disorder being the right word – this being a classification system more than anything else). People stop being ‘people’ and become networks of symptoms. These symptoms are then related according to their normal temporal manifestations – you know, how the disease generally plays out. The idea of time is interesting here. The more I learn about modern philosophy the more I think of Einstein’s notion of space-time. Whenever you hear time mentioned you should expect a discussion of space to be just around the corner, and Foucault starts this book by saying it is a book about space. This notion of space comes into the discussion with the discovery that the body is made up of similar tissues which occur at multiple sites of the body and that these tissues are often affected by diseases in very similar ways. So a classification system of tissues becomes an essential part of understanding disease. Disease then stops being purely temporal and suddenly becomes spatial, but spatial in a truly hidden sense. The tissues that make disease spatial are hidden inside the bodies of patients and therefore require a very special gaze to make them visible - but knowing of the diseases that affect particular tissues means literally being able to see the unseen.
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.
Foucault’s discussion of autopsy goes on to explain some of the complications involved in learning what is going on under the surface of the body. We have been trained by shows on television that it is easy to be abundantly clear about what kills people – all you need for absolute certainty is a highly trained individual and a particularly sharp knife applied to a dead body. But you have to open a lot of bodies to know what is ‘normal’ and even so, bodies decay very quickly once they are dead – and a decayed body can look confusingly like a sick body would be expected to look. The bit I really hadn’t thought about before was that most illness is a kind of irritation of tissue – so, the disease affected tissues while the patient is alive might be red and sour looking – but that will only be true while blood is flowing to that part of the body and thereby illuminating the irritation. Once you die that irritation of tissue disappears. So, just what it is that you are looking at when you cut open a body isn’t exactly transparently obvious. There is no neon sign flashing 'heart attack' when you open a dead body - but a confusion of signs that must be once again interpreted as symptoms. Died bodies don’t stop changing just because we have drawn a line between life and death – they go on changing all they way back to dust. The other thing that is interesting here is that no one is asking the patient where it hurts anymore – the body becomes a text that is absolutely dependent on the gaze of the doctor, it becomes a text to be read, interpreted and understood with no assistance from the patient at all.
There is also a very interesting discussion on the provision of hospitals for the poor and how these were sites of medical research and therefore of a kind of exchange – effectively, the way the poor repaid the kindness of the rich was to be guinea pigs for the rich in relation to treatments. Naturally, the gratitude of the poor for being made guinea pigs was also an essential component of this trade. Such could almost be the Republican Party’s new health policy.
Like I said, this is a fascinating book – by looking at the history of the changes in the way the body has been read as a text by medical science and how the body is viewed as a list of symptoms, then as a series of underlying tissues and then as a series of essential physical processes disrupted by disease what we are seeing are the impacts of shifting paradigms on our understanding. What is disease literally changes with these changes of paradigms.
I don’t want to map out the whole book – although, it probably deserves to be mapped out in detail. What I want to talk about are some of the ideas that really struck me and hopefully that might encourage people to have a read this rather short book. It is also a remarkably readable book too. There are novels that are harder to read this this – I’m saying that because Foucault is often labelled as a very difficult read – and sometimes he really is – but not this time. Foucault is also interested in the history of ideas – in fact, you could say that he is only interested in how ideas are shaped over time. And he is interested in power and how power structures how we relate within contexts as his double barrel concept of ‘subject’ – you know, ourselves as subjects with agency and choices and ourselves as the subjects that are on the receiving end of power relationships. The subject and the subjected.
“So, Mr Smith, what seems to be the problem?”
“Well, Doctor, I have this pain right here…”
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.
If this is a structuralist account we can expect some talk about signs, signifiers and the signified. And, being medicine, some talk of symptoms also seems inevitable. But what is the difference between a sign and a symptom? The problem is that we have a fairly limited vocabulary of signs – ‘my stomach hurts, I’ve a sore head, it’s a kind of stabbing pain here” – and putting these signs together so as they add up to symptoms defining a disease can be anything but obvious. Particularly given a disease is generally temporal in nature and therefore changes over time.
There is also a discussion on how the use of language employed around illnesses has changed over time. There was a time when clarity and transparency of language use seemed appropriate if both doctor and patient were to understand each other. In part a move away from such transparency is about limiting access to knowledge to those in the know, creating a special caste with privileges due to their access to special and esoteric knowledge. But this is also a way to show the trained doctors have an ability to bring the unseen to the surface. Only those properly trained to appropriately employ the medical gaze are able to interpret signs into symptoms and from there to ascertain the lifecycle of the disorder at issue (with disorder being the right word – this being a classification system more than anything else). People stop being ‘people’ and become networks of symptoms. These symptoms are then related according to their normal temporal manifestations – you know, how the disease generally plays out. The idea of time is interesting here. The more I learn about modern philosophy the more I think of Einstein’s notion of space-time. Whenever you hear time mentioned you should expect a discussion of space to be just around the corner, and Foucault starts this book by saying it is a book about space. This notion of space comes into the discussion with the discovery that the body is made up of similar tissues which occur at multiple sites of the body and that these tissues are often affected by diseases in very similar ways. So a classification system of tissues becomes an essential part of understanding disease. Disease then stops being purely temporal and suddenly becomes spatial, but spatial in a truly hidden sense. The tissues that make disease spatial are hidden inside the bodies of patients and therefore require a very special gaze to make them visible - but knowing of the diseases that affect particular tissues means literally being able to see the unseen.
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.
Foucault’s discussion of autopsy goes on to explain some of the complications involved in learning what is going on under the surface of the body. We have been trained by shows on television that it is easy to be abundantly clear about what kills people – all you need for absolute certainty is a highly trained individual and a particularly sharp knife applied to a dead body. But you have to open a lot of bodies to know what is ‘normal’ and even so, bodies decay very quickly once they are dead – and a decayed body can look confusingly like a sick body would be expected to look. The bit I really hadn’t thought about before was that most illness is a kind of irritation of tissue – so, the disease affected tissues while the patient is alive might be red and sour looking – but that will only be true while blood is flowing to that part of the body and thereby illuminating the irritation. Once you die that irritation of tissue disappears. So, just what it is that you are looking at when you cut open a body isn’t exactly transparently obvious. There is no neon sign flashing 'heart attack' when you open a dead body - but a confusion of signs that must be once again interpreted as symptoms. Died bodies don’t stop changing just because we have drawn a line between life and death – they go on changing all they way back to dust. The other thing that is interesting here is that no one is asking the patient where it hurts anymore – the body becomes a text that is absolutely dependent on the gaze of the doctor, it becomes a text to be read, interpreted and understood with no assistance from the patient at all.
There is also a very interesting discussion on the provision of hospitals for the poor and how these were sites of medical research and therefore of a kind of exchange – effectively, the way the poor repaid the kindness of the rich was to be guinea pigs for the rich in relation to treatments. Naturally, the gratitude of the poor for being made guinea pigs was also an essential component of this trade. Such could almost be the Republican Party’s new health policy.
Like I said, this is a fascinating book – by looking at the history of the changes in the way the body has been read as a text by medical science and how the body is viewed as a list of symptoms, then as a series of underlying tissues and then as a series of essential physical processes disrupted by disease what we are seeing are the impacts of shifting paradigms on our understanding. What is disease literally changes with these changes of paradigms.
December 24, 2025
لطالما كانت ومازالت لغة العلوم مباشِرة و واضحة و إن افتقرت للجمال والأدب وأعتقد يجب كذلك لكنها بسيطة (نعم بسيطة) وهذا هو تخصصي وبحثي، فبطبيعة الحال ستنعكس على كتاباتي ومراجعاتي وأفكاري، هُنا جاء الفيلسوف فوكو ليتفلسف في هذا المجال وهو المجال الطبي عامة وفي المجال الإكلينيكي/السريريّ خاصة، كونه فرنسي فهذا الكتاب مكتنز في سريريات فرنسا وتاريخها، يتحدث فوكو عن بدء الطب السريري وعن أغلبية الفلاسفة الفرنسيين وآرائهم حول العيادات الطبية وكيفية التشخيص عن المرضى وتاريخ المعاينة والفحص، والتقصي عن الجثث، الفلسفة في هذا المجال أعتبره مشين لكنه بطبيعة الحال هذه "فلسفة" وأعتقد إنني لا أفهم لغتها أو بالأحرى لا أرى جدوى من هذا الكلام، لكن بفضل الله الطب والعلوم تتغير وتتطور و(ستتطور) سواء أعجبهم الفلاسفة أم لا.
July 2, 2009
I finished this on the bus the other day and a couple things come to mind:
1. It's one of his most approachable, even if it is a bit clunky in spots.
2. I'd recommend reading it before On the Order of Things as it's a good introduction to his study of epistemological change.
3. There's some very sharp reminders in here of why Foucault is considered a descendent of Nietzsche. The one most important for me is that, unlike most philosophers, he's a damn good writer. His love of language shines almost as brightly.
4. The conclusion, wherein he writes about how death rose to be one of the defining points of knowledge, is worth the read alone.
5. There seem to be a lot of reviewers on here who jump the gun on the power thing. Excerpts perhaps? This isen't really about power as much is it is about how much of an effect HOW we interpret the same facts can have on what we learn from them. With that as a starting point we can then ask "what in the power structure makes us change how we interpret the same fact?"
1. It's one of his most approachable, even if it is a bit clunky in spots.
2. I'd recommend reading it before On the Order of Things as it's a good introduction to his study of epistemological change.
3. There's some very sharp reminders in here of why Foucault is considered a descendent of Nietzsche. The one most important for me is that, unlike most philosophers, he's a damn good writer. His love of language shines almost as brightly.
4. The conclusion, wherein he writes about how death rose to be one of the defining points of knowledge, is worth the read alone.
5. There seem to be a lot of reviewers on here who jump the gun on the power thing. Excerpts perhaps? This isen't really about power as much is it is about how much of an effect HOW we interpret the same facts can have on what we learn from them. With that as a starting point we can then ask "what in the power structure makes us change how we interpret the same fact?"
June 15, 2020
The Birth of the Clinic (1963) is Michel Foucault’s second major work, after Madness and Civilization (1961), but perhaps it’s his more important work of the two. This is because madness, perceived as a disease, is just one aspect of a more wider transition in the eighteenth century, i.e. the emerge of clinical medicine. In this sense, Madness and Civilization (which I read prior to Birth of the Clinic) started making sense only whilst I was reading through the second work.
In both books, Foucault basically elaborates the same point: during the Enlightenment there occurred a major change in how mankind viewed himself. This change was not a superficial movement towards a better understanding nor even an invention of a new method of doing science (with man himself as object). No, the change occurred on a more fundamental level: man developed a totally new linguistic structure with which to know – not just knowing as recognizing empirical facts, but really know on a structural level – the world.
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.
According to Foucault, during the eighteenth century this way of viewing diseases was transformed on a structural level. This development heralded the birth of the clinic, which itself is the birth of modern medicine.
During this period, hospitals were deemed to be economic and medicinal hindrances. They would distort the natural flow of capital through a society as well as distort the natural flow of a disease. The hospitals confounded disease. Reforms were introduced which closed the hospitals, limited the freedom of doctors, and send patients to their families. Medicine would now become family medicine.
Of course, there were many poor people in France at the time – people without a family or home. This led to the establishment of clinics funded by the rich. In these clinics, doctors would treat poor patients and this became one of the key factors in the establishment of the new medicine. The patients were admitted freely on the implicit agreement that doctors could observe them and, through comparative medicine, chart frequencies, general developments, etc. This benefitted the rich donators, since the establishment of general knowledge of disease would help them in the future when they would become sick. We see here a typical theme in Foucault: the coupling of economic, political and social developments with scientific knowledge.
In this new role doctors didn’t act like botanists anymore, but as scientists: they observed patients and formulated their observations in language. Seeing is saying. And not only this, saying is teaching – observations became a fundamental part of the training of new doctors. We see here a radical break with the past: from now on, the patient becomes an object for the doctor – spatiotemporal entity to study in all its aspects in order to understand disease better.
This period saw the attempt to model medicine on the chemical approach. In chemistry there had occurred huge breakthroughs through the method of analysis: breaking up substances in their elements and describe their relations and proportions through observation. Similarly, doctors started breaking down diseases into elements and their relations, trying to quantify these through the observation of huge amounts of patients. Medicine became statistics and observation – fitting neatly into the current trend of transforming almost everything into mathematical models.
But, Foucault, argues, this was only the first step in a two-fold process. Of course this positivist medicine is limited by the surface of the body itself. It can only deal with quantified data and statistical analyses. At the same time, anatomy entered a next stage: doctors started opening up corpses to study where, when and how diseases had originated in the patient. The patient was rendered almost trivial, the disease in its spatialization, location and origin became the central focus. Death became a functional entity and a means to understand both life and disease – not in an archaeological fashion (tracing back the development of disease) but in a projective fashion (predicting future development of disease through knowledge of spatiotemporal origins).
According to Foucault, when these two approaches came together in the ‘anatomo-clinical method’ modern medicine was born. From now on, the ‘medical gaze’ of the doctor plays a central role: like a searchlight it illuminates spatiotemporal phenomena, and like a computer it integrates theses positive observations into a linguistic structure that purports to capture things in their pure appearances. Seeing is saying; saying is knowing. Knowledge as a correlate of observation.
Of course, this is impossible, and this is Foucault’s main thesis in both Madness and Civilization and The Birth of the Clinic: we live in the illusion that our knowledge exists independent from us, while in reality all our scientific knowledge (medical knowledge in this case) is an explicit superstructure built on an implicit linguistic structure. It is this unconscious linguistic structure that orders our perceptions and thus our knowledge of the world. It is like a necessary, a priori set of rules that allows us to develop knowledge through looking at the world. This, of course, has the corollary that different sets of rules imply different systems of order and hence different bodies of knowledge. In other words: by switching linguistic structures (epistemes) we end up with a totally different outlook on the world – truth, knowledge, reality, etc. The change from an essentialist/botanic approach to a anatomo-clinical approach in medicine is exactly such a shift in linguistic structures. We develop a new set of rules in relation to disease, and this radically alters how we perceive, talk about, act on, and institutionalize disease.
Now, Foucault argues that these changes in epistemes, and thus all changes in how mankind looks at the world, are rooted in social, political and economic developments. Different times and places imply different systems of knowledge. This is, by definition, not a historical process – there is no temporality involved in all this, thus no causality, chronology, etc. For Foucault, there is just a long list of episteme after episteme and thus a long list of systems of knowledge. There is no deep reason (either ontological or epistemological) for us to prefer one over the other. We just invent new grids that we lay over reality, and which uncover new things and cover up other things – and that’s that.
I have to admit that whilst reading Madness and Civilization and The Birth of the Clinic, I grew steadily more impressed by Foucault’s genius. The man definitely was a gifted writer and an original thinker. I also agree, up to a point, with his main thesis that what we take as truth, knowledge or reality is simply a function of our spatiotemporal order that we impose on the world; and that the development of theories of knowledge is not necessarily a historical development but simply different ways of seeing and saying the world.
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.
Foucault simply describes how doctors looked at disease, life and death in different times. Yet between the lines, he makes claims about the status of these ways of seeing the world. His theory of epistemes is not simply a description since it does make truth claims about the way knowledge (scientific or not) is ordered and how it is a function of fundamental linguistic structures. And these claims remain unjustified.
Also, it leaves out the idea of scientific progress. As Newton (supposedly) claimed: “I stand on the shoulders of giants.” Science builds on earlier discoveries and theories, and in this is not simply a random change of epistemes but a directed evolution, lacking any final goal and yet building, though bottom-up processes, a more certain and comprehensive structure of knowledge. When Einstein offered the world relativity theory he did not simply invent a new episteme, but actively incorporated Newtonian physics in a broader and deeper theory.
Apart from Foucault’s hidden unjustified arguments, I have problems with the way he describes the phenomena – in this case, medical knowledge. He uses a language that is, at times, heavily ambiguous and is more literature than philosophy:
“The medical gaze must therefore travel along a path that had not so far been opened up to it: vertically from the symptomatic surface to the tissual surface; in depth, plunging from the manifest to the hidden; and in both directions, as it must continuously travel if one wishes to define, from one end to the other, the network of essential necessities. The medical gaze, which, as we have seen, was directed upon the two-dimensional areas of tissues and symptoms, must in order to reconcile them, itself move along a third dimension. In this way, anatomo-clinical range will be defined.” (p. 166)
I understand what he is trying to say, but I just think its bullshit. With the introduction of the anatomical method in the clinical practice, doctors now had to move from symptoms (as they manifest themselves in the total body of the patient through his behaviour) to the tissues of organs (wherefrom allegedly these symptoms originate). Now, symptoms as well as tissues were viewed by doctors in two dimensions – i.e. plane surfaces on bodies. Anatomy now adds a third dimension to this, depth, in trying to relate symptoms to diseased tissues in specific organs. And this constitutes the new anatomo-clinical method.
But as with almost everything I’ve read of Foucault thus far, my only response is: Why is this how it went, and not some other way? He only uses a very selective range of authors, and all the quotations from these works neatly fit Foucault’s descriptions. I am neither a medical expert nor a historian of medicine, but I’d bet my life that I can dig up countless of other scientific or medical treatises from the seventeenth and eighteenth century that had a totally different approach. If not for the simply fact that Foucault uses only French sources – as if French medicine was an isolated affair.
So, in ending this review, I’d like to conclude that Foucault’s works are definitely original and force one to look at the world differently (which is valuable in and of itself!), and they certainly have literary value (how much I leave to readers themselves); yet, from a philosophical perspective I find them very defective, selective and one-sided. I’m in a good mood right now, so I won’t play the role of sour grape, and give this book three stars.
In both books, Foucault basically elaborates the same point: during the Enlightenment there occurred a major change in how mankind viewed himself. This change was not a superficial movement towards a better understanding nor even an invention of a new method of doing science (with man himself as object). No, the change occurred on a more fundamental level: man developed a totally new linguistic structure with which to know – not just knowing as recognizing empirical facts, but really know on a structural level – the world.
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.
According to Foucault, during the eighteenth century this way of viewing diseases was transformed on a structural level. This development heralded the birth of the clinic, which itself is the birth of modern medicine.
During this period, hospitals were deemed to be economic and medicinal hindrances. They would distort the natural flow of capital through a society as well as distort the natural flow of a disease. The hospitals confounded disease. Reforms were introduced which closed the hospitals, limited the freedom of doctors, and send patients to their families. Medicine would now become family medicine.
Of course, there were many poor people in France at the time – people without a family or home. This led to the establishment of clinics funded by the rich. In these clinics, doctors would treat poor patients and this became one of the key factors in the establishment of the new medicine. The patients were admitted freely on the implicit agreement that doctors could observe them and, through comparative medicine, chart frequencies, general developments, etc. This benefitted the rich donators, since the establishment of general knowledge of disease would help them in the future when they would become sick. We see here a typical theme in Foucault: the coupling of economic, political and social developments with scientific knowledge.
In this new role doctors didn’t act like botanists anymore, but as scientists: they observed patients and formulated their observations in language. Seeing is saying. And not only this, saying is teaching – observations became a fundamental part of the training of new doctors. We see here a radical break with the past: from now on, the patient becomes an object for the doctor – spatiotemporal entity to study in all its aspects in order to understand disease better.
This period saw the attempt to model medicine on the chemical approach. In chemistry there had occurred huge breakthroughs through the method of analysis: breaking up substances in their elements and describe their relations and proportions through observation. Similarly, doctors started breaking down diseases into elements and their relations, trying to quantify these through the observation of huge amounts of patients. Medicine became statistics and observation – fitting neatly into the current trend of transforming almost everything into mathematical models.
But, Foucault, argues, this was only the first step in a two-fold process. Of course this positivist medicine is limited by the surface of the body itself. It can only deal with quantified data and statistical analyses. At the same time, anatomy entered a next stage: doctors started opening up corpses to study where, when and how diseases had originated in the patient. The patient was rendered almost trivial, the disease in its spatialization, location and origin became the central focus. Death became a functional entity and a means to understand both life and disease – not in an archaeological fashion (tracing back the development of disease) but in a projective fashion (predicting future development of disease through knowledge of spatiotemporal origins).
According to Foucault, when these two approaches came together in the ‘anatomo-clinical method’ modern medicine was born. From now on, the ‘medical gaze’ of the doctor plays a central role: like a searchlight it illuminates spatiotemporal phenomena, and like a computer it integrates theses positive observations into a linguistic structure that purports to capture things in their pure appearances. Seeing is saying; saying is knowing. Knowledge as a correlate of observation.
Of course, this is impossible, and this is Foucault’s main thesis in both Madness and Civilization and The Birth of the Clinic: we live in the illusion that our knowledge exists independent from us, while in reality all our scientific knowledge (medical knowledge in this case) is an explicit superstructure built on an implicit linguistic structure. It is this unconscious linguistic structure that orders our perceptions and thus our knowledge of the world. It is like a necessary, a priori set of rules that allows us to develop knowledge through looking at the world. This, of course, has the corollary that different sets of rules imply different systems of order and hence different bodies of knowledge. In other words: by switching linguistic structures (epistemes) we end up with a totally different outlook on the world – truth, knowledge, reality, etc. The change from an essentialist/botanic approach to a anatomo-clinical approach in medicine is exactly such a shift in linguistic structures. We develop a new set of rules in relation to disease, and this radically alters how we perceive, talk about, act on, and institutionalize disease.
Now, Foucault argues that these changes in epistemes, and thus all changes in how mankind looks at the world, are rooted in social, political and economic developments. Different times and places imply different systems of knowledge. This is, by definition, not a historical process – there is no temporality involved in all this, thus no causality, chronology, etc. For Foucault, there is just a long list of episteme after episteme and thus a long list of systems of knowledge. There is no deep reason (either ontological or epistemological) for us to prefer one over the other. We just invent new grids that we lay over reality, and which uncover new things and cover up other things – and that’s that.
I have to admit that whilst reading Madness and Civilization and The Birth of the Clinic, I grew steadily more impressed by Foucault’s genius. The man definitely was a gifted writer and an original thinker. I also agree, up to a point, with his main thesis that what we take as truth, knowledge or reality is simply a function of our spatiotemporal order that we impose on the world; and that the development of theories of knowledge is not necessarily a historical development but simply different ways of seeing and saying the world.
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.
Foucault simply describes how doctors looked at disease, life and death in different times. Yet between the lines, he makes claims about the status of these ways of seeing the world. His theory of epistemes is not simply a description since it does make truth claims about the way knowledge (scientific or not) is ordered and how it is a function of fundamental linguistic structures. And these claims remain unjustified.
Also, it leaves out the idea of scientific progress. As Newton (supposedly) claimed: “I stand on the shoulders of giants.” Science builds on earlier discoveries and theories, and in this is not simply a random change of epistemes but a directed evolution, lacking any final goal and yet building, though bottom-up processes, a more certain and comprehensive structure of knowledge. When Einstein offered the world relativity theory he did not simply invent a new episteme, but actively incorporated Newtonian physics in a broader and deeper theory.
Apart from Foucault’s hidden unjustified arguments, I have problems with the way he describes the phenomena – in this case, medical knowledge. He uses a language that is, at times, heavily ambiguous and is more literature than philosophy:
“The medical gaze must therefore travel along a path that had not so far been opened up to it: vertically from the symptomatic surface to the tissual surface; in depth, plunging from the manifest to the hidden; and in both directions, as it must continuously travel if one wishes to define, from one end to the other, the network of essential necessities. The medical gaze, which, as we have seen, was directed upon the two-dimensional areas of tissues and symptoms, must in order to reconcile them, itself move along a third dimension. In this way, anatomo-clinical range will be defined.” (p. 166)
I understand what he is trying to say, but I just think its bullshit. With the introduction of the anatomical method in the clinical practice, doctors now had to move from symptoms (as they manifest themselves in the total body of the patient through his behaviour) to the tissues of organs (wherefrom allegedly these symptoms originate). Now, symptoms as well as tissues were viewed by doctors in two dimensions – i.e. plane surfaces on bodies. Anatomy now adds a third dimension to this, depth, in trying to relate symptoms to diseased tissues in specific organs. And this constitutes the new anatomo-clinical method.
But as with almost everything I’ve read of Foucault thus far, my only response is: Why is this how it went, and not some other way? He only uses a very selective range of authors, and all the quotations from these works neatly fit Foucault’s descriptions. I am neither a medical expert nor a historian of medicine, but I’d bet my life that I can dig up countless of other scientific or medical treatises from the seventeenth and eighteenth century that had a totally different approach. If not for the simply fact that Foucault uses only French sources – as if French medicine was an isolated affair.
So, in ending this review, I’d like to conclude that Foucault’s works are definitely original and force one to look at the world differently (which is valuable in and of itself!), and they certainly have literary value (how much I leave to readers themselves); yet, from a philosophical perspective I find them very defective, selective and one-sided. I’m in a good mood right now, so I won’t play the role of sour grape, and give this book three stars.
January 7, 2025
سه ماه خوندنش طول کشید
و چه سه ماه شیرینی بود.
و چه سه ماه شیرینی بود.
May 1, 2024
"Naissance de la clinique" est sans doute la moins lue et la moins commentée de toutes les monographies foucaldiennes. Publiée pour la première fois en 1963, cette "archéologie du regard médical" n'a jamais suscité le même intérêt que des ouvrages désormais classiques comme "Les Mots et les choses" (1966) ou "Surveiller et punir" (1975).
Moi aussi, je suis venu à ce livre assez tardivement, un peu par hasard, après avoir lu une bonne part du reste de l'oeuvre foucaldienne. Il m'est difficile, dès lors, de l'évaluer sur ses propres mérites en faisant abstraction des multiples manières dont cette étude se rapporte au reste de l'oeuvre. Foucault soulignait d'ailleurs lui-même le rapport de continuité entre la recherche menée dans Naissance de la clinique et celle publiée auparavant sous le titre d'Histoire de la folie (1961). A en croire l'auteur, l'étude sur l'origine de la médecine moderne se serait composée avec "les chutes" de son premier grand ouvrage. Néanmoins, à lire le livre aujourd'hui, on est moins frappé par les similitudes entre l'étude sur la folie et celle sur la médecine moderne que par les multiples manières dont cette dernière préfigure les best-sellers qui suivront.
Dès la préface du livre, en effet, Foucault nous décrit son projet d'historien de la médécine moderne en des termes qui font penser à "l'Archéologie du savoir" (1969), le grand ouvrage méthodologique qui suit "Les Mots et les choses". Il s'agit pour l'auteur d'échapper à "la fatalité du commentaire" (p. 14), une pratique de lecture paradoxale mais très répandue dans le domaine de l'histoire des idées et qui consiste à essayer de traduire des textes anciens dans un langage plus contemporain tout en restant totalement fidèle à leur sens original. Ce que tente de faire ici Foucault n'a rien en commun avec une telle pratique plus reproductive que proprement productive d'analyse du discours. Bien loin de chercher à comprendre comment les pionniers de la médecine moderne comprenaient eux-mêmes leur contribution à l'histoire de leur discipline, Foucault s'interroge sur les conditions de possibilité et les limites de l'expérience médicale moderne. Autrement dit, il comprend la science médicale comme une pratique socialement et historiquement construite et dont la génèse et le développement ultérieur sont tributaire de certaines conditions contingentes. C'est cette même pratique de lecture à la fois historique et critique qu'il appliquera plus tard, dans "Les Mots et les choses", à des disciplines comme la biologie, la linguistique et l'économie. En ce sens, "Naissance de la clinique" peut effectivement se comprendre comme l'essai d'une méthode radicalement nouvelle dans le domaine de l'histoire des idées.
Quels sont les fruits de cette méthode? Négativement parlant, elle invalide le mythe d'un développement linéaire de la science et de la pratique médicales qui seraient à comprendre comme un raffinement des méthodes d'observation et des techniques de soin et comme une accumulation continue des connaissances à travers le temps. Du point de vue archéologique de Foucault, une telle conception de l'histoire de la médecine nie les ruptures paradigmatiques ou épistémiques qu'il y a eu entre le début du XVIIIe siècle et le temps présent. Si, de fait, la médecine s'est toujours posé pour but de guérir le corps malade, la façon d'appréhender ce corps et la maladie qui l'habite a été bouleversée de fond en comble en l'espace de quelques décennies. Foucault décrit ce boulversement en trois étappes.
Jusqu'au XVIIIe siècle, la médécine "classificatrice" ou "nosologique" conçoit la maladie sur un mode essentialiste, comme une pathologie qui a une existence propre, autonome et qui envahit le corps de l'extérieur. Pour le médecin d'avant la Révolution française, il existe diverses espèces de maladies, comme il existe diverses espèces de vertébrés. D'où l'idée que "pour connaître la vérité du fait pathologique, le médecin doit abstraire le malade." (p. 26) Plutôt que de s'attarder sur le corps concret agonisant devant lui, il doit tenter de reconnaître, à travers les symptômes que celui-ci exhibe, l'espèce de la pathologie dont il souffre. Pour ce faire, le médecin doit littéralement soustraire de son observation les particularités individuelles du patient qui ne font que contaminer son analyse. Il doit diriger son regard au-delà du malade concret vers la forme générale de la maladie. Pour Foucault, cette façon singulière d'appréhender le malade explique pourquoi la médecine pré-moderne ne s'intéresse que fort peu au déroulement de la maladie dans le temps. Elle explique aussi pourquoi, pendant toute cette période, on considère que l'hôpital constitue "un lieu artificiel où la maladie transplantée risque de perdre son visage essentiel." (pp. 37-38) Mieux vaut soigner le malade en famille, puisque "le contact avec les autres malades, dans ce jardin désordonné où les espèces s'entrecroisent, altère la nature propre de la maladie et la rend plus difficilement lisible." (p. 38)
C'est lors du XVIIIe siècle que commence à se développer, en marge de la médécine "classificatrice" ou "nosologique", une nouvelle conception de la maladie, centrée sur la notion d'épidémie. Celle-ci n'est plus comprise comme une manifestation concrète d'une pathologie invariable et essentielle mais comme un phénomène unique et jamais répété dont la prévalence dépend de certains déterminants liés à l'environnement physique et social. Au vu de son individualité historique, l'épidémie requiert un mode d'observation et de gestion particulier: "phénomène collectif, elle exige un regard multiple, processus unique, il faut la décrire sur ce qu'elle a de singulier, d'accidentel, d'inattendu." (p. 47) Afin de répondre à cette nécessité, à la fin du XVIIIe siècle, l'État met sur pied un imposant appareillage bureaucratique centralisé qui coordonne "la présence généralisée des médecins, dont les regards croisés forment un réseau et exercent en tout point de l'espace, en tout moment du temps, une surveillance constante, mobile, différenciée." (p. 55) En France, cette vision de la profession médicale nationalisée trouve son incarnation institutionnelle dans la Société royale de médecine, véritable point de centralisation du savoir ayant pour mandat de juger de la validité de la connaissance médicale et d'encadrer l'exercice de la pratique. Cette institutionalisation de la médecine de l'épidémie va de pair avec un élargissement de son mandat, faisant du médecin une espèce de prêtre du corps et de la pratique médicale une activité publique, désintéressée et contrôlée, prise en charge par l'État. En même temps, l'institutionalisation de la médecine donne lieu à l'élaboration d'un savoir axiologique sur l'homme sain, non malade. Dorénavant, la médecine prend appui sur "l'analyse d'un fonctionnement 'régulier' de l'organisme pour chercher où il est dévié, par quoi il est perturbé, comment on peut le rétablir." (p. 61) La médecine, de ce fait, prend une posture normative, s'appuyant sur l'opposition entre le normal et le pathologique.
C'est dans cet espace historique, social et institutionnel nouveau que se constituera, aux alentours de la Révolution, la médecine moderne, centrée sur le regard clinique. Évidemment, Foucault ne met pas en doute l'existence de cliniques beaucoup plus anciennes. Il souligne, néanmoins, que celles-ci avaient une fonction différente et étaient organisées tout autrement. Tout au long du XVIIe et du XVIIIe siècles, les cliniques ont pour fonction première de "réunir et de rendre sensible le corps organisé de la nosologie." (p. 89) Plutôt que de permettre au chercheur d'approfondir sa connaissance des pathologies connues ou d'en découvrir de nouvelles par le biais d'un examen rigoureux d'organismes malades, elles présentent l'état du savoir déjà acquis. Ces protocliniques n'admettent pas n'importe quel malade, mais sélectionnent des cas illustratifs des différentes pathologies connues afin de permettre aux maîtres d'enseigner leur savoir à des élèves nouveaux. A strictement parler donc, la protoclinique d'avant l'âge moderne "n'est pas en elle-même une expérience, mais le condensé, à l'usage des autres, d'une expérience antérieure." (p. 92)
Les cliniques modernes fondées un peu partout en France à partir de l'an III ont un tout autre rôle. Lieu de croisement entre le savoir théorique, l'enseignement et la pratique médicale, elles opèrent comme des institutions productrices de la connaissance médicale s'appuyant sur "un empirisme contrôlé" (p. 121). Dans la clinique, le regard du médecin constitue le corps du malade comme un objet de savoir qu'il pénètre pour en comprendre le dysfonctionnement. Or, il ne faut pas s'y méprendre: le regard du médecin n'est pas un regard naïf débarasé de toute préconception théorique antérieure. Le regard médical ne se contente pas de constater ce qui se donne à voir mais s'appuie sur un système général de connaissances de la nature et de l'homme en société. Ce n'est pas non plus un regard passif, mais celui d'un médecin supporté et jusitifié par une institution qui a un pouvoir de décision et d'intervention, un regard qui creuse, qui compare les malades entre eux, qui retrace l'évolution des symptômes à travers le temps, etc.
C'est donc dans le cadre de la clinique comme institution historiquement détérminée que s'est développée la médecine moderne selon Foucault. Elle atteint sa forme actuelle, au début du XIXe siècle, au moment où le regard pénétrant du médecin "s'enfonce dans l'espace qu'il [s'était] donné de parcourir" (p. 191) et que la méthode clinique se conjugue avec l'anatomie pathologique. Du coup, la maladie n'est plus conçue comme "un faisceau de caractères disséminés ici et là à la surface du corps et liés entre eux par des concomitances et des successions statistiquement observables; elle est un ensemble de formes et de déformations, de figures, d'accidents [...] qui s'enchaînent les uns aux autres selon une géographie qu'on peut suivre pas à pas." (p. 191) En somme, au regard de la médecine moderne "anatomoclinique", la maladie n'est plus "une espèce pathologique s'insérant dans le corps, là où c'est possible; c'est le corps lui-même devenant malade." (p. 191)
Bien évidemment, ce 'bref' résumé du développement historique de la science médicale decrit par Foucault ne permet pas de mettre en valeur la complexité et la subtilité de ses analyses. J'espère, toutefois, qu'il a permis d'illustrer la fécondité de son approche dite "archéologique" des textes. C'est en effet au niveau théorico-méthodologique que réside à mon sens l'intérêt durable de ce livre. Comme indiqué plus haut, en tant que historien des sciences, Foucault entend laisser de côté la pratique herméneutique traditionnelle qui consiste à essayer de comprendre les auteurs du passé 'mieux que ceux-ci se comprenaient eux-mêmes' et à faire dire aux textes anciens ce qu'ils disaient toujours dejà mais de manière plus claire et plus explicite. L'approche foucaldienne des textes a un objectif radicalement différent. Là où l'histoire des idées traditionelle veut nous rendre plus familiers les textes anciens, Foucault vise au contraire à les problématiser en insistant sur ce qui, en eux, ne nous est plus du tout familier, ce qui appartient à une époque révolue, un paradigme du savoir qui n'est plus le nôtre. Ce faisant, il brise les illusions de continuïté et de nécessité et montre que des disciplines comme la médecine se sont développées de manière discontinue, s'appuyant sur des conditions de possibilité historiques, institutionnelles et politiques contingentes. Comment se fait-il que tel type de discours ou tel type de pratique soient apparus à ce moment précis de l'histoire? Qu'est-ce qui les a rendu possible? Quelles possibilités de développement ultérieur produisent-ils à leur tour? Telles sont les questions foucaldiennes par excellence dès 1963 et, en un certain sens, elles le resteront tout au long de sa carrière.
Si le premier "essai de méthode" (p. 264) foucaldien s'intéresse à la médecine plutôt qu'à d'autres disciplines scientifiques ou d'autres pratiques discursives, c'est sans doute - comme il le suggère lui-même - parce que la médecine à joué un rôle de modèle, lors du XIXe siècle, pour bien d'autres disciplines comme la sociologie, la psychologie, etc. Il est évident, néanmoins, qu'une approche similaire peut produire des résultats fructueux dans bien d'autres domaines, comme l'ont démontré entre-temps plusieurs générations de chercheurs qui ont tous, dans des mesures variables mais toujours significatives, été inspirés par l'exemple foucauldien. Je pense notamment aux travaux de Michel Pêcheux sur l'idéologie, de Dominique Maingeneau sur le discours littéraire, de Marc Angenot sur le discours social et à bien d'autres.
Et pourquoi trois étoiles plutôt que quatre? J’ai trouvé que la structure du livre est nettement moins rigoureuse que celle des autres monographies foucaldiennes ce qui rend l’argumentation et la chronologie de l’histoire parfois difficile à suivre. Le style est aussi plus elliptique et obscure que d’habitude chez Foucault. Finalement, j’ai trouvé que la reconstruction de l’histoire de la médecine était trop franco-française.
Moi aussi, je suis venu à ce livre assez tardivement, un peu par hasard, après avoir lu une bonne part du reste de l'oeuvre foucaldienne. Il m'est difficile, dès lors, de l'évaluer sur ses propres mérites en faisant abstraction des multiples manières dont cette étude se rapporte au reste de l'oeuvre. Foucault soulignait d'ailleurs lui-même le rapport de continuité entre la recherche menée dans Naissance de la clinique et celle publiée auparavant sous le titre d'Histoire de la folie (1961). A en croire l'auteur, l'étude sur l'origine de la médecine moderne se serait composée avec "les chutes" de son premier grand ouvrage. Néanmoins, à lire le livre aujourd'hui, on est moins frappé par les similitudes entre l'étude sur la folie et celle sur la médecine moderne que par les multiples manières dont cette dernière préfigure les best-sellers qui suivront.
Dès la préface du livre, en effet, Foucault nous décrit son projet d'historien de la médécine moderne en des termes qui font penser à "l'Archéologie du savoir" (1969), le grand ouvrage méthodologique qui suit "Les Mots et les choses". Il s'agit pour l'auteur d'échapper à "la fatalité du commentaire" (p. 14), une pratique de lecture paradoxale mais très répandue dans le domaine de l'histoire des idées et qui consiste à essayer de traduire des textes anciens dans un langage plus contemporain tout en restant totalement fidèle à leur sens original. Ce que tente de faire ici Foucault n'a rien en commun avec une telle pratique plus reproductive que proprement productive d'analyse du discours. Bien loin de chercher à comprendre comment les pionniers de la médecine moderne comprenaient eux-mêmes leur contribution à l'histoire de leur discipline, Foucault s'interroge sur les conditions de possibilité et les limites de l'expérience médicale moderne. Autrement dit, il comprend la science médicale comme une pratique socialement et historiquement construite et dont la génèse et le développement ultérieur sont tributaire de certaines conditions contingentes. C'est cette même pratique de lecture à la fois historique et critique qu'il appliquera plus tard, dans "Les Mots et les choses", à des disciplines comme la biologie, la linguistique et l'économie. En ce sens, "Naissance de la clinique" peut effectivement se comprendre comme l'essai d'une méthode radicalement nouvelle dans le domaine de l'histoire des idées.
Quels sont les fruits de cette méthode? Négativement parlant, elle invalide le mythe d'un développement linéaire de la science et de la pratique médicales qui seraient à comprendre comme un raffinement des méthodes d'observation et des techniques de soin et comme une accumulation continue des connaissances à travers le temps. Du point de vue archéologique de Foucault, une telle conception de l'histoire de la médecine nie les ruptures paradigmatiques ou épistémiques qu'il y a eu entre le début du XVIIIe siècle et le temps présent. Si, de fait, la médecine s'est toujours posé pour but de guérir le corps malade, la façon d'appréhender ce corps et la maladie qui l'habite a été bouleversée de fond en comble en l'espace de quelques décennies. Foucault décrit ce boulversement en trois étappes.
Jusqu'au XVIIIe siècle, la médécine "classificatrice" ou "nosologique" conçoit la maladie sur un mode essentialiste, comme une pathologie qui a une existence propre, autonome et qui envahit le corps de l'extérieur. Pour le médecin d'avant la Révolution française, il existe diverses espèces de maladies, comme il existe diverses espèces de vertébrés. D'où l'idée que "pour connaître la vérité du fait pathologique, le médecin doit abstraire le malade." (p. 26) Plutôt que de s'attarder sur le corps concret agonisant devant lui, il doit tenter de reconnaître, à travers les symptômes que celui-ci exhibe, l'espèce de la pathologie dont il souffre. Pour ce faire, le médecin doit littéralement soustraire de son observation les particularités individuelles du patient qui ne font que contaminer son analyse. Il doit diriger son regard au-delà du malade concret vers la forme générale de la maladie. Pour Foucault, cette façon singulière d'appréhender le malade explique pourquoi la médecine pré-moderne ne s'intéresse que fort peu au déroulement de la maladie dans le temps. Elle explique aussi pourquoi, pendant toute cette période, on considère que l'hôpital constitue "un lieu artificiel où la maladie transplantée risque de perdre son visage essentiel." (pp. 37-38) Mieux vaut soigner le malade en famille, puisque "le contact avec les autres malades, dans ce jardin désordonné où les espèces s'entrecroisent, altère la nature propre de la maladie et la rend plus difficilement lisible." (p. 38)
C'est lors du XVIIIe siècle que commence à se développer, en marge de la médécine "classificatrice" ou "nosologique", une nouvelle conception de la maladie, centrée sur la notion d'épidémie. Celle-ci n'est plus comprise comme une manifestation concrète d'une pathologie invariable et essentielle mais comme un phénomène unique et jamais répété dont la prévalence dépend de certains déterminants liés à l'environnement physique et social. Au vu de son individualité historique, l'épidémie requiert un mode d'observation et de gestion particulier: "phénomène collectif, elle exige un regard multiple, processus unique, il faut la décrire sur ce qu'elle a de singulier, d'accidentel, d'inattendu." (p. 47) Afin de répondre à cette nécessité, à la fin du XVIIIe siècle, l'État met sur pied un imposant appareillage bureaucratique centralisé qui coordonne "la présence généralisée des médecins, dont les regards croisés forment un réseau et exercent en tout point de l'espace, en tout moment du temps, une surveillance constante, mobile, différenciée." (p. 55) En France, cette vision de la profession médicale nationalisée trouve son incarnation institutionnelle dans la Société royale de médecine, véritable point de centralisation du savoir ayant pour mandat de juger de la validité de la connaissance médicale et d'encadrer l'exercice de la pratique. Cette institutionalisation de la médecine de l'épidémie va de pair avec un élargissement de son mandat, faisant du médecin une espèce de prêtre du corps et de la pratique médicale une activité publique, désintéressée et contrôlée, prise en charge par l'État. En même temps, l'institutionalisation de la médecine donne lieu à l'élaboration d'un savoir axiologique sur l'homme sain, non malade. Dorénavant, la médecine prend appui sur "l'analyse d'un fonctionnement 'régulier' de l'organisme pour chercher où il est dévié, par quoi il est perturbé, comment on peut le rétablir." (p. 61) La médecine, de ce fait, prend une posture normative, s'appuyant sur l'opposition entre le normal et le pathologique.
C'est dans cet espace historique, social et institutionnel nouveau que se constituera, aux alentours de la Révolution, la médecine moderne, centrée sur le regard clinique. Évidemment, Foucault ne met pas en doute l'existence de cliniques beaucoup plus anciennes. Il souligne, néanmoins, que celles-ci avaient une fonction différente et étaient organisées tout autrement. Tout au long du XVIIe et du XVIIIe siècles, les cliniques ont pour fonction première de "réunir et de rendre sensible le corps organisé de la nosologie." (p. 89) Plutôt que de permettre au chercheur d'approfondir sa connaissance des pathologies connues ou d'en découvrir de nouvelles par le biais d'un examen rigoureux d'organismes malades, elles présentent l'état du savoir déjà acquis. Ces protocliniques n'admettent pas n'importe quel malade, mais sélectionnent des cas illustratifs des différentes pathologies connues afin de permettre aux maîtres d'enseigner leur savoir à des élèves nouveaux. A strictement parler donc, la protoclinique d'avant l'âge moderne "n'est pas en elle-même une expérience, mais le condensé, à l'usage des autres, d'une expérience antérieure." (p. 92)
Les cliniques modernes fondées un peu partout en France à partir de l'an III ont un tout autre rôle. Lieu de croisement entre le savoir théorique, l'enseignement et la pratique médicale, elles opèrent comme des institutions productrices de la connaissance médicale s'appuyant sur "un empirisme contrôlé" (p. 121). Dans la clinique, le regard du médecin constitue le corps du malade comme un objet de savoir qu'il pénètre pour en comprendre le dysfonctionnement. Or, il ne faut pas s'y méprendre: le regard du médecin n'est pas un regard naïf débarasé de toute préconception théorique antérieure. Le regard médical ne se contente pas de constater ce qui se donne à voir mais s'appuie sur un système général de connaissances de la nature et de l'homme en société. Ce n'est pas non plus un regard passif, mais celui d'un médecin supporté et jusitifié par une institution qui a un pouvoir de décision et d'intervention, un regard qui creuse, qui compare les malades entre eux, qui retrace l'évolution des symptômes à travers le temps, etc.
C'est donc dans le cadre de la clinique comme institution historiquement détérminée que s'est développée la médecine moderne selon Foucault. Elle atteint sa forme actuelle, au début du XIXe siècle, au moment où le regard pénétrant du médecin "s'enfonce dans l'espace qu'il [s'était] donné de parcourir" (p. 191) et que la méthode clinique se conjugue avec l'anatomie pathologique. Du coup, la maladie n'est plus conçue comme "un faisceau de caractères disséminés ici et là à la surface du corps et liés entre eux par des concomitances et des successions statistiquement observables; elle est un ensemble de formes et de déformations, de figures, d'accidents [...] qui s'enchaînent les uns aux autres selon une géographie qu'on peut suivre pas à pas." (p. 191) En somme, au regard de la médecine moderne "anatomoclinique", la maladie n'est plus "une espèce pathologique s'insérant dans le corps, là où c'est possible; c'est le corps lui-même devenant malade." (p. 191)
Bien évidemment, ce 'bref' résumé du développement historique de la science médicale decrit par Foucault ne permet pas de mettre en valeur la complexité et la subtilité de ses analyses. J'espère, toutefois, qu'il a permis d'illustrer la fécondité de son approche dite "archéologique" des textes. C'est en effet au niveau théorico-méthodologique que réside à mon sens l'intérêt durable de ce livre. Comme indiqué plus haut, en tant que historien des sciences, Foucault entend laisser de côté la pratique herméneutique traditionnelle qui consiste à essayer de comprendre les auteurs du passé 'mieux que ceux-ci se comprenaient eux-mêmes' et à faire dire aux textes anciens ce qu'ils disaient toujours dejà mais de manière plus claire et plus explicite. L'approche foucaldienne des textes a un objectif radicalement différent. Là où l'histoire des idées traditionelle veut nous rendre plus familiers les textes anciens, Foucault vise au contraire à les problématiser en insistant sur ce qui, en eux, ne nous est plus du tout familier, ce qui appartient à une époque révolue, un paradigme du savoir qui n'est plus le nôtre. Ce faisant, il brise les illusions de continuïté et de nécessité et montre que des disciplines comme la médecine se sont développées de manière discontinue, s'appuyant sur des conditions de possibilité historiques, institutionnelles et politiques contingentes. Comment se fait-il que tel type de discours ou tel type de pratique soient apparus à ce moment précis de l'histoire? Qu'est-ce qui les a rendu possible? Quelles possibilités de développement ultérieur produisent-ils à leur tour? Telles sont les questions foucaldiennes par excellence dès 1963 et, en un certain sens, elles le resteront tout au long de sa carrière.
Si le premier "essai de méthode" (p. 264) foucaldien s'intéresse à la médecine plutôt qu'à d'autres disciplines scientifiques ou d'autres pratiques discursives, c'est sans doute - comme il le suggère lui-même - parce que la médecine à joué un rôle de modèle, lors du XIXe siècle, pour bien d'autres disciplines comme la sociologie, la psychologie, etc. Il est évident, néanmoins, qu'une approche similaire peut produire des résultats fructueux dans bien d'autres domaines, comme l'ont démontré entre-temps plusieurs générations de chercheurs qui ont tous, dans des mesures variables mais toujours significatives, été inspirés par l'exemple foucauldien. Je pense notamment aux travaux de Michel Pêcheux sur l'idéologie, de Dominique Maingeneau sur le discours littéraire, de Marc Angenot sur le discours social et à bien d'autres.
Et pourquoi trois étoiles plutôt que quatre? J’ai trouvé que la structure du livre est nettement moins rigoureuse que celle des autres monographies foucaldiennes ce qui rend l’argumentation et la chronologie de l’histoire parfois difficile à suivre. Le style est aussi plus elliptique et obscure que d’habitude chez Foucault. Finalement, j’ai trouvé que la reconstruction de l’histoire de la médecine était trop franco-française.
October 10, 2014
This is one of those books in which it feels like the author is intentionally obscure -- almost in a self-aggrandizing way. To use one of Foucault's favorite (or at least most frequent) criticisms against others (in this text), this book is needlessly prolix; he throws that word around like it's going out of style. Oh, wait.
In it, Foucault examines the emergence of the clinic as a teaching hospital as opposed to a hospital intended solely to cure the sick. If you're going to tackle this work, you're going to need a decent amount of outside reading, knowledge of obscure 17th to 19th century medical practices, a decent latin dictionary, and a rudimentary working knowledge of French (occasionally, when a word in English can have more than one French word that it is translated from, the translator will put the English word, and the original French word in order to clarify... it's helpful to know the meaning of the original French word). If you can't do all that, at least be a Google master.
Plan to spend at least a little time looking up Bichat, Pinel, Sauvages, and a host of other medical figures in order to understand what's happening in this book and why he references these figures.
Real genius would have been to write this book in a less pompous, more straightforward way.
This book isn't a skip in the park. You have been warned.
In it, Foucault examines the emergence of the clinic as a teaching hospital as opposed to a hospital intended solely to cure the sick. If you're going to tackle this work, you're going to need a decent amount of outside reading, knowledge of obscure 17th to 19th century medical practices, a decent latin dictionary, and a rudimentary working knowledge of French (occasionally, when a word in English can have more than one French word that it is translated from, the translator will put the English word, and the original French word in order to clarify... it's helpful to know the meaning of the original French word). If you can't do all that, at least be a Google master.
Plan to spend at least a little time looking up Bichat, Pinel, Sauvages, and a host of other medical figures in order to understand what's happening in this book and why he references these figures.
Real genius would have been to write this book in a less pompous, more straightforward way.
This book isn't a skip in the park. You have been warned.
May 16, 2023
Great stuff, everyone should read this. In short, because here Foucault is at his most finest and this book is a gem amongst gems in detailing a concept I am most fond of, that was described in even simpler words in some Rick and Morty episode:
"Sometimes Science is more Art than science, a lot of people don't get that."
This book is a philosophical compendium of the progression of medical history and ethical discourses, language development, aesthetical theories and medical system of thoughts that led to the development of the clinical gaze, a non-language beyond languages that physicians have been deploying to read the human body, instead of the former Aristotelean way of simply classifying symptoms and illnesses.
"Disease is perceived fundamentally in a space of projection without depth, of coincidence without development. There is only one plane and one moment. The form in which truth is originally shown is the surface in which relief is both manifested and abolished—the portrait: ‘He who writes the history of diseases must… observe attentively the clear and natural phenomena of diseases, however uninteresting they may seem. In this he must imitate the painters who when they paint a portrait are careful to mark the smallest signs and natural things that are to be found on the face of the person they are painting.'
The patient is the rediscovered portrait of the disease."
"Sometimes Science is more Art than science, a lot of people don't get that."
This book is a philosophical compendium of the progression of medical history and ethical discourses, language development, aesthetical theories and medical system of thoughts that led to the development of the clinical gaze, a non-language beyond languages that physicians have been deploying to read the human body, instead of the former Aristotelean way of simply classifying symptoms and illnesses.
"Disease is perceived fundamentally in a space of projection without depth, of coincidence without development. There is only one plane and one moment. The form in which truth is originally shown is the surface in which relief is both manifested and abolished—the portrait: ‘He who writes the history of diseases must… observe attentively the clear and natural phenomena of diseases, however uninteresting they may seem. In this he must imitate the painters who when they paint a portrait are careful to mark the smallest signs and natural things that are to be found on the face of the person they are painting.'
The patient is the rediscovered portrait of the disease."
Read
February 26, 2023I hate how this dude fucking writes
June 16, 2010
In "Reading Capital" Althusser defines philosophical work as an intervention in science, an exposing of what the object of a science is. "The Birth of the Clinic" is a philosophical work in this sense.
"The Birth of the Clinic" does not make as clear use of the power/knowledge paradigm that characterizes Foucault's other work. Modern medicine is hardly some absolute, objective science that we, after years of struggling with medieval medicines, happened to stumble upon; but neither was it borne more or less purely out of a desire to govern and control, as was criminal science and the prison. I must recommend "The Birth of the Clinic" to anyone who does research in the field of medicine; for those interested in Foucault because of his influence on other fields - political science and philosophy especially - "The Birth of the Clinic" can be skipped. This latter group should, however, still check out some of Foucault's other writings on the politics of health, which explain the relationship between modern forms of government, medicine, and population control, which are not quite the concern of "The Birth of the Clinic." Some I recommend: "Governmentality" is available in "Secutirty, Territory, Population," "Power: The Essential Works of Michel Foucault Volume III," and "The Foucault Effect"; "The Politics of Health in the 18th Century" can be found in "The Foucault Reader" and "Power/Knowledge"; and "Space, Knowledge, and Power" can be found the "The Foucault Reader" and "Language, Counter-Memory, Practice." "The Order of Things" is also worth checking out for this line of thought.
There is one extremely interesting break Foucault notices between medieval and modern medicine, and that is in their attitude towards death. I will do my best to outline it. The analysis does not justify reading "The Birth of the Clinic" in its entirety; check out Barry Smart's book on Foucault, perhaps. Medieval medicine, Foucault says, saw death as something accidental, something that descended upon man from the outside; modern medicine is characterized by its view of death as something essential to man, something that is part of the core of his being. A possible line of research: in what was does the birth of modern medicine pre-figure, make possible, what we now call existentialist philosophy? Could we have had Heidegger without the clinic? Sartre? Kierkegaard? Hegel, even, for whose master-slave dialectic death plays a key role?
"The Birth of the Clinic" does not make as clear use of the power/knowledge paradigm that characterizes Foucault's other work. Modern medicine is hardly some absolute, objective science that we, after years of struggling with medieval medicines, happened to stumble upon; but neither was it borne more or less purely out of a desire to govern and control, as was criminal science and the prison. I must recommend "The Birth of the Clinic" to anyone who does research in the field of medicine; for those interested in Foucault because of his influence on other fields - political science and philosophy especially - "The Birth of the Clinic" can be skipped. This latter group should, however, still check out some of Foucault's other writings on the politics of health, which explain the relationship between modern forms of government, medicine, and population control, which are not quite the concern of "The Birth of the Clinic." Some I recommend: "Governmentality" is available in "Secutirty, Territory, Population," "Power: The Essential Works of Michel Foucault Volume III," and "The Foucault Effect"; "The Politics of Health in the 18th Century" can be found in "The Foucault Reader" and "Power/Knowledge"; and "Space, Knowledge, and Power" can be found the "The Foucault Reader" and "Language, Counter-Memory, Practice." "The Order of Things" is also worth checking out for this line of thought.
There is one extremely interesting break Foucault notices between medieval and modern medicine, and that is in their attitude towards death. I will do my best to outline it. The analysis does not justify reading "The Birth of the Clinic" in its entirety; check out Barry Smart's book on Foucault, perhaps. Medieval medicine, Foucault says, saw death as something accidental, something that descended upon man from the outside; modern medicine is characterized by its view of death as something essential to man, something that is part of the core of his being. A possible line of research: in what was does the birth of modern medicine pre-figure, make possible, what we now call existentialist philosophy? Could we have had Heidegger without the clinic? Sartre? Kierkegaard? Hegel, even, for whose master-slave dialectic death plays a key role?
December 22, 2019
This was a very challenging book to read. Foucault's narrative is very meandering and tortuous, sometimes I had the feeling that the phrases made no sense at all, but they looked well altogether through the type of used words.
Some parts were really boring, especially because of the phraseology.
Nevertheless, there are also very interesting parts, which, as a doctor for human medicine, i appreciated a lot.
- the becoming of the clinical medicine, the whole narrative around "the gaze" made me realize again how important this step was in the development of modern medicine.
- the development of hospitals, the whole philosophy around hospital and disease (before that step, people were treated at home, and after that step, the rich were still treated at home and the hospital was just a mean of treating / isolating the poor)
- the 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)
Interestingly, I found out more about the contributions of Bichat, Morgagni, Dupuytren and so on, names that nowadays only depict some syndromes, diseases or anatomical parts (Bichat's Bullae, Morgagni tubercles, Dupuytren contracture).
But to look in order to know, to show in order to teach, is not this a tacit form of violence, all the more abusive for its silence, upon a sick body that demands to be comforted, not displayed?Can pain be a spectacle?
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.
...By what right can one transform into an object of clinical observation a pacient whose poverty has compelled him to seek assistance at the hospital?
Medical doctors nowadays could find in this book things that they (me included) forget along the way (because medicine is also a job, and, as any job, it turns to routine which produces emotional detachment and automatisms) - to stop for a second and think at the concept of disease, diseased fellow man, suffering and pain, death, hospital as a mean of isolation, of controlling of the disease, teaching of this profession.
Some parts were really boring, especially because of the phraseology.
Nevertheless, there are also very interesting parts, which, as a doctor for human medicine, i appreciated a lot.
- the becoming of the clinical medicine, the whole narrative around "the gaze" made me realize again how important this step was in the development of modern medicine.
- the development of hospitals, the whole philosophy around hospital and disease (before that step, people were treated at home, and after that step, the rich were still treated at home and the hospital was just a mean of treating / isolating the poor)
- the 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)
Interestingly, I found out more about the contributions of Bichat, Morgagni, Dupuytren and so on, names that nowadays only depict some syndromes, diseases or anatomical parts (Bichat's Bullae, Morgagni tubercles, Dupuytren contracture).
But to look in order to know, to show in order to teach, is not this a tacit form of violence, all the more abusive for its silence, upon a sick body that demands to be comforted, not displayed?Can pain be a spectacle?
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.
...By what right can one transform into an object of clinical observation a pacient whose poverty has compelled him to seek assistance at the hospital?
Medical doctors nowadays could find in this book things that they (me included) forget along the way (because medicine is also a job, and, as any job, it turns to routine which produces emotional detachment and automatisms) - to stop for a second and think at the concept of disease, diseased fellow man, suffering and pain, death, hospital as a mean of isolation, of controlling of the disease, teaching of this profession.
March 15, 2014
Well, that was certainly a thrilling ride through the medicine of the ca. 1760s—1820s. I wasn't able to read it all at once — several tries ended in exhaustion and pretending that the book does not even exist :) I always needed to take a deep breath before diving back into it — it's a dense text. Though, I finished the second half in a week and it's been great.
I'd recommend to read this book to anyone who wants to use the word „science“. Yes. The book describes in painful detail everything related to illness, its diagnosis and treatment, but all that information is needed only to understand how those people understood the illness (and human body). It's about creating, constructing & painfully transforming the structure of knowledge. (Interesting point is seeing my own (popular, common-sensical) understanding of the topic and seeing various layers of (often deprecated) professional knowledge in it.)
Wonderful book about how science works — especially when the people are its focus — and how we understand the world.
I'd recommend to read this book to anyone who wants to use the word „science“. Yes. The book describes in painful detail everything related to illness, its diagnosis and treatment, but all that information is needed only to understand how those people understood the illness (and human body). It's about creating, constructing & painfully transforming the structure of knowledge. (Interesting point is seeing my own (popular, common-sensical) understanding of the topic and seeing various layers of (often deprecated) professional knowledge in it.)
Wonderful book about how science works — especially when the people are its focus — and how we understand the world.
December 3, 2022
" این بازسازی واقعیت از لحاظ تاریخی نادرست است."
" این همان بازی پیشین اما تکامل یافتهتر، نبود، بلکه اساسا بازی دیگری بود."
فوکو میخواهد پشت پرده را به ما نشان دهد. هیچ چیز آن طور که به نظر میرسد نیست. در این کتاب خواننده در انبوهی از اطلاعات ( بسیار سخت قابل فهم) تاریخی و تاریخ پزشکی فرانسه غرق می شود تا فوکو به این نتیجه برسد:
" این امر که نخستین گفتار علمی فرهنگ ما دربارهی فرد میبایست از مرحلهی مرگ گذر کند، بی تردید بر این فرهنگ تاثیری تعیین کننده داشته و خواهد داشت؛ چرا که انسان غربی فقط با تکیه بر ویرانی خویش توانست خود را در نگاه خود به منزلهی ابژهی علم بنا نهد، درون زبان خود لحاظ کند و در آن و به واسطهی آن زبان وجودی گفتاری به خود بدهد."
کتابهای فوکو مثل رمانهای کارآگاهی همراه با "تویست" است. قاتل هیچ وقت آن کسی نیست که به نظر میرسد. البته از نوع رمان های کش دار و غیرقابل فهم و کسل کننده.
August 11, 2011
This short but dense text should be read in conjunction with Discipline and Punish and Madness and Civilization. More specifically, it should probably be read after them, given how complicated and important (as well as "important") it is. Here we have Foucault's account of a series of "scientific revolutions" (although he would not use the term as such) in which the nature of discourse-derived "scientificity" changed for the field of clinical medicine on account of sometimes profound, sometimes subtle shifts in the texts and treatment manuals used by leading practitioners (i.e., the Linnaean nosologists of the late 17th/early 18th century gave way to clinicians who sought the outward signs of the disease who in turn were followed by autopsy-happy doctors who redefined the relationship between disease, death, and the body--yet, per the author's big takeaway message, all of these physicians, regardless of period, should be understood as being "scientific" in regard to the study and practice of medicine). The real difficulty with the text is Foucault's lack of exposition: names like Bichat, Pinel (who also appears in M & C), and Morgagni are dropped as if they are the author's best friends, and outdated medical terms appear throughout (which is why this book is best read as an e-book, because even if one needs to pause to look up "phthisis," the built-in dictionary means that the delay won't prove substantial). What's truly stunning about the Birth of the Clinic isn't so much Foucault's very clear but heavy-handed deployment of his Big Theory; it's how much he actually knows about a century's worth of incremental and highly technical medical research (and how he maintains a distance from the "success" or "failure" of such measures; even useful techniques like auscultation and useful devices like the stethoscope merely constitute tiny parts of the grand narrative of the episteme).
August 12, 2018
Πρόκειται για ένα εξαιρετικό ανάγνωσμα. Ο Μισέλ Φουκώ φανερώνει τη λαμπρή σκέψη του σε όλο το μεγαλείο και την αρτιότητά της. Το πρώιμο αυτό έργο μπορεί να ενταχθεί στον κλάδο της ιστορίας της ιατρικής. Υφίσταται μια ομοιότητα με την Η ιστορία της τρέλας, αλλά εδώ η ανάλυση επικεντρώνεται στις κλινικές εν γένει. Βέβαια, ο συγγραφέας έχει μια εμμονή με την έκφραση "ιατρικό βλέμμα" -κάτι που ο ίδιος αργότερα αναγνώρισε ως μειονέκτημα-, αλλά κατά τα άλλα το έργο του είναι έξοχο. Ας σημειωθεί ότι το επάγγελμα του πατέρα του φιλοσόφου ήταν επαρχιακός ιατρός. Τελικά, πάντως και ο ίδιος ο Φουκώ δεν φαίνεται να γλίτωσε από τις κλινικές και τα νοσοκομεία, αφού σε ένα από αυτά κατέληξε στο τέλος. Πρέπει να πω ότι συνιστώ αυτό το έργο όχι μόνο στους φιλοσόφους και στους ιατρούς, αλλά και σε όποιον επιθυμεί να ενδυναμώσει τον στοχασμό του μελετώντας και απολαμβάνοντας τον πάντα άγρυπνο και υπέροχα εύστοχο τρόπο σκέψης και το ύφος του Φουκώ.
July 19, 2014
Much as I love love love Discipline and Punish and enjoyed Madness and Civilization, I found this excruciating and tedious. Foucault just bounces all over the place, trying to tie together various observations about space, seeing, family, empiricism and medical reforms with no clear goal or overall project. I loved the strong, accessible style of discipline and punish, but Birth of the Clinic has a really weak, meandering quality to it, maybe because it's one of Foucault's earlier works. Which is not to say that Foucault doesn't make some smart observations in it, he does, but they seem isolated and never really fall into whatever the broader project of this work is meant to be.
March 10, 2008
Like Foucault, it all begins with Descartes, and how Enlightenment casts out and "others" the mentally ill. Unfortunately, I discovered that the French edition is more complete, and most English translations are abridged, particularly in the second chapter which really digs into Decartes' Cogito and the effects of "cogito ergo sum" on madmen.
November 14, 2015
I'm sure this is an excellent history of the medical gaze in the late eighteenth century, but I found myself too deep in the weeds to actually understand Foucault's theoretical work in his endless explications of various doctor's theories of disease and the reorganization of medical administration in the wake of the French Revolution. For Foucault completists only.
April 19, 2011
This is one of the most formative books I ever read.
April 9, 2021
Це книга про різницю медичних уявлень XVIII і медичних уявлень ХІХ ст. У XVIII ст. панує патологічна медицина із нозологічною таблицею в основі, а у ХІХ ст. - постає кланако-патологічний погляд лікаря. Змінюється уявлення про смерть, хворобу, тіло, здоров'я. І ці всі зміни у медицини постають у період і під впливом політичного зламу - Французької революції.
Вобщем, я знайшла, окрім загальної надзвичайно цікавої ідеї, іще пару класних тез для себе для розмірковування (про уявлення про епідемії, природній перебіг хвороби, простоту хвороб простих людей - тобто селян, що наближені до природи). І ще трохи віднайшла точки для розуміння такої ось цікавої тези, що давно не дає мені спокою:
"Характер болезней этого года зависел от состояния погоды: господствующие зимою катарральные, ревматические, воспалительные и другие болезни, сопряженные с особым развитием пластического свойства крови, при наступлении тепла, заменились желчно-желудочными недугами, а со второй половины лета приняли свойство желудочно-мокротное, которое и сохранили до зимы. Характер болезней зависел, впрочем, не исключительно от состояния атмосферы: он очевидно находился под влиянием местных условий. Так, местности низменные, подвергавшиеся (с. 267) наводнениям, изобилировали преимущественно лихорадками, в других местах у рабочего класса, проводившего, после тяжких дневных работ, ночи в холодном воздухе, желудочно-мокротные болезни соединялись с простудами и обращались в поносы простые и кровавые. Скудость продовольствия и другие лишения в народе придавали болезням нервическое свойство, которое простые горячки обращало в тифозные."
Ну а так, в цілому, я розумію, що для якихось розлогих міркувань мені ще дуже бракує матеріалу.
Вобщем, я знайшла, окрім загальної надзвичайно цікавої ідеї, іще пару класних тез для себе для розмірковування (про уявлення про епідемії, природній перебіг хвороби, простоту хвороб простих людей - тобто селян, що наближені до природи). І ще трохи віднайшла точки для розуміння такої ось цікавої тези, що давно не дає мені спокою:
"Характер болезней этого года зависел от состояния погоды: господствующие зимою катарральные, ревматические, воспалительные и другие болезни, сопряженные с особым развитием пластического свойства крови, при наступлении тепла, заменились желчно-желудочными недугами, а со второй половины лета приняли свойство желудочно-мокротное, которое и сохранили до зимы. Характер болезней зависел, впрочем, не исключительно от состояния атмосферы: он очевидно находился под влиянием местных условий. Так, местности низменные, подвергавшиеся (с. 267) наводнениям, изобилировали преимущественно лихорадками, в других местах у рабочего класса, проводившего, после тяжких дневных работ, ночи в холодном воздухе, желудочно-мокротные болезни соединялись с простудами и обращались в поносы простые и кровавые. Скудость продовольствия и другие лишения в народе придавали болезням нервическое свойство, которое простые горячки обращало в тифозные."
Ну а так, в цілому, я розумію, що для якихось розлогих міркувань мені ще дуже бракує матеріалу.
October 15, 2025
"Человек умирает не потому, что болеет, а болеет потому, что может умереть." - тут я поняла, что больше ничего не пойму.
Мне Фуко нравится как поп-образ философии: мне нравится его биография, его шалости в небезызвестных банях, его философские мысли (те, что понимаю). Полноформатные философские трактаты Фуко мне не нравятся. Я слишком глуповата, видимо, для полноценного постмодернизма.
Единственное, что мне понравилось в этой работе - цитаты других фолософов, к сожалению.
Мне Фуко нравится как поп-образ философии: мне нравится его биография, его шалости в небезызвестных банях, его философские мысли (те, что понимаю). Полноформатные философские трактаты Фуко мне не нравятся. Я слишком глуповата, видимо, для полноценного постмодернизма.
Единственное, что мне понравилось в этой работе - цитаты других фолософов, к сожалению.
January 12, 2026
المحور الأساسي في الكتاب هو ما يسميه فوكو "النظرة السريرية": تلك اللحظة التاريخية التي انتقل فيها الطب من الإصغاء إلى المريض، إلى فحص الجسد بوصفه موضوعًا صامتًا. المريض، الذي كان سابقًا يروي ألمه، صار مجرد حامل لعلامات تُقرأ، وأعراض تُفسَّر، وأعضاء تُفكَّك بصريًا. هذا التحوّل يبدو لأول وهلة تقدمًا علميًا طبيعيًا، لكن فوكو ينجح في إظهار وجهه الآخر: وجه السلطة. فالمعرفة هنا لا تكتفي بالفهم، بل تُعيد ترتيب العلاقة بين الطبيب والمريض، بين من يرى ومن يُرى، بين من يملك اللغة ومن يُجرَّد منها.
ما يثير القلق في الكتاب ليس نقد الطب بحد ذاته، بل كشف كيف أن الإنسان نفسه تغيّر موقعه داخل الخطاب الطبي. الجسد لم يعد امتدادًا للذات، بل أصبح مساحة للقراءة والتحليل، وكأن الذات أُقصيت لصالح العين الطبية. هذا ما جعلني أقرأ الكتاب بشعور مزدوج: إعجاب بذكاء التحليل، وانزعاج أخلاقي من نتائجه. فوكو لا يتهم الأطباء، ولا يدين الطب كعلم، لكنه يضع يده على لحظة مفصلية صار فيها الإنسان يُختزل إلى "حالة".
الأسلوب ليس سهلًا. الكتاب كثيف، لغته دقيقة، وأحيانًا مرهقة. فوكو لا يشرح الفكرة مرة واحدة ثم ينتقل، بل يعود إليها من زوايا مختلفة، تاريخية ومفاهيمية، مما يجعل بعض الفصول تبدو وكأنها تدور حول نفسها. ومع ذلك، هذا التكرار ليس حشوًا بقدر ما هو إصرار على تفكيك الفكرة من الداخل، ومنع القارئ من الاطمئنان السريع إلى استنتاج بسيط.
أكثر ما شدني هو أن فوكو لا يقدّم خلاصات جاهزة. لا يقول إن الطب شر أو خير، ولا يدعو إلى العودة إلى الماضي، بل يطرح سؤالًا أخطر: كيف تصبح المعرفة سلطة دون أن تعلن عن نفسها كذلك؟ بعد قراءة الكتاب، من الصعب النظر إلى المستشفى، أو ملف المريض، أو لغة التشخيص بنفس البراءة السابقة. تبدأ بملاحظة كيف تُصاغ الكلمات، وكيف تُرتَّب الأجساد في الفضاء، وكيف يُدار الصمت داخل غرف الفحص.
في بعض المواضع، شعرت أن فوكو يحمّل التحليل أكثر مما يحتمل، وأن القارئ غير المتخصص قد يضيع بين المفاهيم والتفريعات التاريخية. لكن في المقابل، هذا الثقل هو ما يعطي الكتاب وزنه الحقيقي؛ فهو لا يُقرأ بسرعة، ولا يُستهلك، بل يُقاوَم، ويُعاد التفكير فيه بعد كل فصل.
___________________
ما يجعل "ولادة الطب السريري" أكثر عمقًا هو أنه لا يقف وحيدًا داخل مشروع فوكو، بل يبدو كحلقة تأسيسية لما سيطوره لاحقًا بوضوح أكبر. هنا نرى البذور الأولى لما سيصبح لاحقًا تحليلًا شاملًا لعلاقة المعرفة بالسلطة. فـ"النظرة السريرية" التي يفككها في هذا الكتاب تمهّد مباشرة لـ"النظرة الانضباطية" في "المراقبة والعقاب"، حيث يتحول الجسد مرة أخرى إلى موضوع للرصد والتنظيم، لا هذه المرة باسم الشفاء، بل باسم النظام. كذلك، فإن إقصاء صوت المريض لصالح الخطاب العلمي يلتقي مع ما سيشتغل عليه فوكو في "تاريخ الجنسانية"، حيث لا تُقمع الذات فقط، بل يُعاد تعريفها وتشكيلها عبر الخطاب.
بهذا المعنى، يمكن قراءة "ولادة الطب السريري" كنقطة البداية التي توضّح كيف انتقلت السلطة الحديثة من القمع المباشر إلى ممارسة أكثر نعومة وخطورة: سلطة ترى، تُسمي، تُصنّف، ثم تدّعي الحياد. الكتاب إذًا لا يشرح الطب فقط، بل يفتح الباب لفهم فوكو بأكمله.
ما يثير القلق في الكتاب ليس نقد الطب بحد ذاته، بل كشف كيف أن الإنسان نفسه تغيّر موقعه داخل الخطاب الطبي. الجسد لم يعد امتدادًا للذات، بل أصبح مساحة للقراءة والتحليل، وكأن الذات أُقصيت لصالح العين الطبية. هذا ما جعلني أقرأ الكتاب بشعور مزدوج: إعجاب بذكاء التحليل، وانزعاج أخلاقي من نتائجه. فوكو لا يتهم الأطباء، ولا يدين الطب كعلم، لكنه يضع يده على لحظة مفصلية صار فيها الإنسان يُختزل إلى "حالة".
الأسلوب ليس سهلًا. الكتاب كثيف، لغته دقيقة، وأحيانًا مرهقة. فوكو لا يشرح الفكرة مرة واحدة ثم ينتقل، بل يعود إليها من زوايا مختلفة، تاريخية ومفاهيمية، مما يجعل بعض الفصول تبدو وكأنها تدور حول نفسها. ومع ذلك، هذا التكرار ليس حشوًا بقدر ما هو إصرار على تفكيك الفكرة من الداخل، ومنع القارئ من الاطمئنان السريع إلى استنتاج بسيط.
أكثر ما شدني هو أن فوكو لا يقدّم خلاصات جاهزة. لا يقول إن الطب شر أو خير، ولا يدعو إلى العودة إلى الماضي، بل يطرح سؤالًا أخطر: كيف تصبح المعرفة سلطة دون أن تعلن عن نفسها كذلك؟ بعد قراءة الكتاب، من الصعب النظر إلى المستشفى، أو ملف المريض، أو لغة التشخيص بنفس البراءة السابقة. تبدأ بملاحظة كيف تُصاغ الكلمات، وكيف تُرتَّب الأجساد في الفضاء، وكيف يُدار الصمت داخل غرف الفحص.
في بعض المواضع، شعرت أن فوكو يحمّل التحليل أكثر مما يحتمل، وأن القارئ غير المتخصص قد يضيع بين المفاهيم والتفريعات التاريخية. لكن في المقابل، هذا الثقل هو ما يعطي الكتاب وزنه الحقيقي؛ فهو لا يُقرأ بسرعة، ولا يُستهلك، بل يُقاوَم، ويُعاد التفكير فيه بعد كل فصل.
___________________
ما يجعل "ولادة الطب السريري" أكثر عمقًا هو أنه لا يقف وحيدًا داخل مشروع فوكو، بل يبدو كحلقة تأسيسية لما سيطوره لاحقًا بوضوح أكبر. هنا نرى البذور الأولى لما سيصبح لاحقًا تحليلًا شاملًا لعلاقة المعرفة بالسلطة. فـ"النظرة السريرية" التي يفككها في هذا الكتاب تمهّد مباشرة لـ"النظرة الانضباطية" في "المراقبة والعقاب"، حيث يتحول الجسد مرة أخرى إلى موضوع للرصد والتنظيم، لا هذه المرة باسم الشفاء، بل باسم النظام. كذلك، فإن إقصاء صوت المريض لصالح الخطاب العلمي يلتقي مع ما سيشتغل عليه فوكو في "تاريخ الجنسانية"، حيث لا تُقمع الذات فقط، بل يُعاد تعريفها وتشكيلها عبر الخطاب.
بهذا المعنى، يمكن قراءة "ولادة الطب السريري" كنقطة البداية التي توضّح كيف انتقلت السلطة الحديثة من القمع المباشر إلى ممارسة أكثر نعومة وخطورة: سلطة ترى، تُسمي، تُصنّف، ثم تدّعي الحياد. الكتاب إذًا لا يشرح الطب فقط، بل يفتح الباب لفهم فوكو بأكمله.
July 26, 2023
ဖူကိုးရဲ့ translation oeuvre ကို ပထမဆုံး ဖတ်ခြင်းပါ။ ပြင်သစ် တော်လှန်ရေး မတိုင်မီ၊တော်လှန်ရေးကာလ၊တော်လှန်ရေး အပြီး (၁၉)ရာစု အစပိုင်း အတွင်းမှာ ထူးထူး ခြားခြား တိုးတက်ဖြစ်ထွန်းလာတဲ့ ပြင်သစ် ပြည်အတွင်းက ဆေးပညာသမိုင်းကြောင်း ကို တင်ပြသွားတာဖြစ်တယ်။ ဖူကိုး ရဲ့ ထုံးစံအတိုင်း epistemic shift ဖြစ်မှု medical science ရဲ့ contingency ဖြစ်မှု အဆက်အစပ် ပြတ်တောက်မှု တွေကို ဖတ်ရမယ်။ Pathological anatomyရဲ့ တိုးတက်ဖြစ်ထွန်းမှုက ရောဂါတွေအပေါ် ထားရှိတဲ့ သမားတော်ကြီး တွေရဲ့ အမြင်ကို ပြောင်းလဲစေခဲ့တယ်။ အစပိုင်းအခန်းတွေမှာ ဖတ်ရတာ နည်းနည်း ပျင်းဖို့ ကောင်းပေမယ့် နောက်ပိုင်းအခန်းတွေက ပိုပြီး စိတ်ဝင်စားစရာ ကောင်းတယ်။
January 28, 2023
I don't know what to do with this man. He starts off with a few brilliant insights and brand new perspectives. But then he becomes completely incoherent. Not difficult per se, but manipulative, incorporating bullshit. Unable to pull the thread together. It's like you want these key ideas, but suffering through his french style of proudly bullshitting the reader just feels bad.
By his own admission: “In France, you gotta have ten percent incomprehensibility, otherwise people won’t think it’s deep–they won’t think you’re a profound thinker.”
Probably closer to 30% though.
By his own admission: “In France, you gotta have ten percent incomprehensibility, otherwise people won’t think it’s deep–they won’t think you’re a profound thinker.”
Probably closer to 30% though.
February 17, 2015
Un poco complejo, pero interesante... Digamos, intermitente. Se remite a una época específica en Francia. Complicado para los que no manejan términos básicos de medicina. Bastante filosofía, algo de política, reformas, etc.
Incluye capítulos muy buenos: "Antigüedad de la clínica", "Ver, saber", "Abrid algunos cadáveres".
Incluye capítulos muy buenos: "Antigüedad de la clínica", "Ver, saber", "Abrid algunos cadáveres".
considering
March 18, 2016Este libro trata sobre el espacio, el lenguaje y la muerte; sobre el acto de ver, sobre la mirada.
Foucault para Principiantes Pág.62
Foucault para Principiantes Pág.62
Want to read
October 24, 2008medicine is a huge part of our culture, and i think it's important we learn about the role it plays in our lives, and how it came about
June 6, 2012
Uno de los libros más útiles que he leído en toda mi vida académica.
December 17, 2019
Wat een prachtig boek, zoveel wijsheid! Het vergt echt een boel inspanning om het te begrijpen maar het is het meer dan waard. Foucault gebruikt het halve boek om de tegenstelling te schetsen tussen hoe de geneeskunde was en hoe de geneeskunde nu is. Dat is nog best een lastig onderscheid, maar dat het zo moeilijk te begrijpen is, toont ook hoe normaal de huidige manier van denken is. Stap voor stap ontleedt en reconstrueert Foucault de klinische blik, de vanzelfsprekendheid waarmee je als arts je patiënt tegemoet treedt. Dat is ontzettend waardevol, want de blinde vlekken worden zo ook duidelijk. En kritische reflectie op het hoe en waarom kan ook nooit kwaad. Dit boek is een absolute aanrader voor iedereen die zich wel eens afvraagt waarom we de dingen in de kliniek op een bepaalde manier doen.
Ik miste wel de laatste vertaalslag naar de hedendaagse geneeskunde, de geneeskunde van de microbiologie, genetica, farmacologie. We eindigen op een punt waar de geneeskunde de chemie nog afwees - wat veranderde er eigenlijk zodat de geneeskunde echt een soort van verlengstuk van de biologie werd?
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) .
En dat essay van prof Zwart mag wat mij betreft geschrapt worden uit het boek. Hoewel de beschouwing over Foucault heel nuttig is (ze hadden het beter vooraan kunnen plaatsen) zitten er zoveel grove fouten in zijn samenvatting van De Geboorte dat ik me afvraag of de rest wel klopt. Het verhaal over dat de pt het beste ziek kan zijn in zijn huiselijke omgeving is een momentopname in Foucaults schets van de geneeskunde - daarna ontstond de kliniek pas! Het is absoluut geen waardeoordeel. Verder lijkt Zwart compleet gemist te hebben dat de klinische blik volgens Foucault niet iets verhevens/opzichzelf staands is, maar juist wordt gemaakt (door discours, maatschappelijke veranderingen, de fysieke ruimte, door kennis) en dat die blik in zichzelf ook 'maakt' (vergelijken, beoordelen, enz). Het lijkt er op dat Zwart het boek maar half gelezen heeft (hij citeert ook alleen uit de eerste paar pagina's). En dan die flauwe nonsequitur over genomics - even een leuk plugje van eigen onderzoek maar totaal niet (klinisch) relevant - het getuigt niet van enige kennis van hoe de dingen in de praktijk gaan.
Ik miste wel de laatste vertaalslag naar de hedendaagse geneeskunde, de geneeskunde van de microbiologie, genetica, farmacologie. We eindigen op een punt waar de geneeskunde de chemie nog afwees - wat veranderde er eigenlijk zodat de geneeskunde echt een soort van verlengstuk van de biologie werd?
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) .
En dat essay van prof Zwart mag wat mij betreft geschrapt worden uit het boek. Hoewel de beschouwing over Foucault heel nuttig is (ze hadden het beter vooraan kunnen plaatsen) zitten er zoveel grove fouten in zijn samenvatting van De Geboorte dat ik me afvraag of de rest wel klopt. Het verhaal over dat de pt het beste ziek kan zijn in zijn huiselijke omgeving is een momentopname in Foucaults schets van de geneeskunde - daarna ontstond de kliniek pas! Het is absoluut geen waardeoordeel. Verder lijkt Zwart compleet gemist te hebben dat de klinische blik volgens Foucault niet iets verhevens/opzichzelf staands is, maar juist wordt gemaakt (door discours, maatschappelijke veranderingen, de fysieke ruimte, door kennis) en dat die blik in zichzelf ook 'maakt' (vergelijken, beoordelen, enz). Het lijkt er op dat Zwart het boek maar half gelezen heeft (hij citeert ook alleen uit de eerste paar pagina's). En dan die flauwe nonsequitur over genomics - even een leuk plugje van eigen onderzoek maar totaal niet (klinisch) relevant - het getuigt niet van enige kennis van hoe de dingen in de praktijk gaan.
April 10, 2017
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.
Jadi, bagaimana ilmu perubatan boleh terkait dengan faktor kuasa? Kata penulis, pada Zaman Pertengahan yang dipenuhi dengan latar peperangan, pesakit terdedah kepada ketakutan (apoplexy & hectic fever). Pada abad ke-16 & 17 pula merupakan fasa rehat bagi sesebuah negara dan ketika ini penyakit berkaitan perasaan, nafsu dan ego yang melanda (veneral disease & congestion of viscera & blood). Beralih ke abad ke-18, sindrom untuk memuaskan perasaan ini berpindah kepada bentuk imaginasi. Masyarakat makin ramai turun ke teater, membaca novel, gemar berbual-bual kosong, berjaga malam dan tidur pada waktu pagi (hysteria, hypochondria, nervous disease).
Bangsa yang hidup tanpa peperangan dan keganasan tidak akan mengalami perkara-perkara di atas. Begitu juga bangsa yang kaya. Sebaliknya, rakyat marhaen pula akan menjadi mangsa despotik kuasawan. Mereka dihimpit dengan cukai yang menyebabkan mereka mengemis, kemiskinan yang hanya menguntungkan golongan atasan dan penginapan yang tidak kondusif (malahan gelandangan) yang hanya memaksa mereka untuk tidak mendirikan keluarga atau hidup dalam rupa bentuk yang sangat mengerikan!
Antara penekanan lain yang cukup memukau ialah mengenai jalinan teori dan praktikal ilmu perubatan. Teaching Hospital (atau klinik yang disebut oleh penulis) bertindak sebagai tempat membumikan analisis-analisis dan teori-teori perubatan. Ia ibarat menghidupkan semula kefalsafahan perubatan klasik. Seni sebenar untuk mengubati pesakit adalah melalui amali dan kunci kepada ilmu perubatan sendiri ialah apabila seseorang individu itu menguasai selok-belok ilmu ini serta sentuhan teknologi perubatan yang wujud padanya. Bukan sekadar mengetahui keabstrakan teori-teorinya semata-mata.
Perspektif indah lain yang dicetuskan oleh penulis ialah kaedah untuk meminimumkan tersebarnya penyakit; iaitu dengan memberikan pendidikan dan pendedahan ilmu perubatan (umum) kepada masyarakat. Penulis juga turut menggariskan tokoh-tokoh yang mampu mengahwinkan falsafah dan perubatan seperti Bichat, Jackson dan Freud (yang terpamer dalam budaya masyarakat Eropah). Hal ini wujud kerana pemikiran perubatan dan falsafah itu sendiri pada waktu itu telah tertanam sebati dalam diri mereka.
Jadi, bagaimana ilmu perubatan boleh terkait dengan faktor kuasa? Kata penulis, pada Zaman Pertengahan yang dipenuhi dengan latar peperangan, pesakit terdedah kepada ketakutan (apoplexy & hectic fever). Pada abad ke-16 & 17 pula merupakan fasa rehat bagi sesebuah negara dan ketika ini penyakit berkaitan perasaan, nafsu dan ego yang melanda (veneral disease & congestion of viscera & blood). Beralih ke abad ke-18, sindrom untuk memuaskan perasaan ini berpindah kepada bentuk imaginasi. Masyarakat makin ramai turun ke teater, membaca novel, gemar berbual-bual kosong, berjaga malam dan tidur pada waktu pagi (hysteria, hypochondria, nervous disease).
Bangsa yang hidup tanpa peperangan dan keganasan tidak akan mengalami perkara-perkara di atas. Begitu juga bangsa yang kaya. Sebaliknya, rakyat marhaen pula akan menjadi mangsa despotik kuasawan. Mereka dihimpit dengan cukai yang menyebabkan mereka mengemis, kemiskinan yang hanya menguntungkan golongan atasan dan penginapan yang tidak kondusif (malahan gelandangan) yang hanya memaksa mereka untuk tidak mendirikan keluarga atau hidup dalam rupa bentuk yang sangat mengerikan!
Antara penekanan lain yang cukup memukau ialah mengenai jalinan teori dan praktikal ilmu perubatan. Teaching Hospital (atau klinik yang disebut oleh penulis) bertindak sebagai tempat membumikan analisis-analisis dan teori-teori perubatan. Ia ibarat menghidupkan semula kefalsafahan perubatan klasik. Seni sebenar untuk mengubati pesakit adalah melalui amali dan kunci kepada ilmu perubatan sendiri ialah apabila seseorang individu itu menguasai selok-belok ilmu ini serta sentuhan teknologi perubatan yang wujud padanya. Bukan sekadar mengetahui keabstrakan teori-teorinya semata-mata.
Perspektif indah lain yang dicetuskan oleh penulis ialah kaedah untuk meminimumkan tersebarnya penyakit; iaitu dengan memberikan pendidikan dan pendedahan ilmu perubatan (umum) kepada masyarakat. Penulis juga turut menggariskan tokoh-tokoh yang mampu mengahwinkan falsafah dan perubatan seperti Bichat, Jackson dan Freud (yang terpamer dalam budaya masyarakat Eropah). Hal ini wujud kerana pemikiran perubatan dan falsafah itu sendiri pada waktu itu telah tertanam sebati dalam diri mereka.
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