The Birth of the Clinic: An Archaeology of Medical Perception

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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) . The Birth of the Clinic: An Archaeology of Medical Perception ( Naissance de la clinique: une archéologie du regard médical, 1963), by Michel Foucault, presents the development of la clinique, the teaching hospital, as a medical institution, identifies and describes the concept of Le regard médical ("the medical gaze"), and the epistemic re-organisation of the research structures of medicine in the production of medical knowledge, at the end of the eighteenth century. Although originally limited to the academic discourses of post-modernism and post-structuralism, the medical gaze term is used in graduate medicine and social work. [1] The medical gaze [ edit ] 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. We must place ourselves, and remain once and for all, at the level of the fundamental spatialization and verbalization of the pathological, where the loquacious gaze with which the doctor observes the poisonous heart of things is born and communes with itself” (xii-xiii).

In that light, the empiricism of the 18th and 19th centuries was not a dispassionate act of looking, noting, and reporting the disease presented before the doctor's eyes. The relationship between doctor and patient (subject and object) is not about the one who knows and the one who tells, because doctor–patient interactions are not "mindless phenomenologies" that existed before their consultation (medical discourse) as patient and doctor. [6] Clinical medicine came to exist as part of the intellectual structure that defines and organises medicine as "the domain of its experience and the structure of its rationality" as a field of knowledge. [7] The conclusion, wherein he writes about how death rose to be one of the defining points of knowledge, is worth the read alone. Thus, the medical—classificatory—gaze during this period was confined to signs and symptoms such that “paradoxically, in relation to that which he is suffering from, the patient is only an external fact; the medical reading must take him into account only to place him in parentheses” (p. 8). As a result, judgments about a patient’s condition could draw only from similarities and differences among sets of signs and symptoms laid out in pre-determined patterns—this sign goes here, that symptom goes there. Time and space have no role; never first this, then that, or here this, there that. The Shifting GazeDisease 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.' This medical experience is therefore akin even to a lyrical experience that his language sought, from Hölderlin to Rilke. This experience, which began in the eighteenth century, and from which we have not yet escaped, is bound up with a return to the forms of finitude, of which death is no doubt the most menacing, but also the fullest. Hölderlin’s Empedocles, reaching, by voluntary steps, the very edge of Etna, is the death of the last mediator between mortals and Olympus, the end of the infinite on earth, the flame returning to its native fire, leaving as its sole remaining trace that which had precisely to be abolished by his death: the beautiful, enclosed form of individuality; after Empedocles, the world is placed under the sign of finitude, in that irreconcilable, intermediate state in which reigns the Law, the harsh law of limit; the destiny of individuality will be to appear always in the objectivity that manifests and conceals it, that denies it and yet forms its basis: ‘here, too, the subjective and the objective exchange faces.’ But we are concerned here not simply with medicine and the way in which, in a few years, the particular knowledge of the individual patient was structured. For clinical experience to become possible as a form of knowledge, a reorganization of the hospital field, a new definition of the status of the patient in society, and the establishment of a certain relationship between public assistance and medical experience, between help and knowledge, became necessary; the patient has to be enveloped in a collective, homogeneous space. It was also necessary to open up language to a whole new domain: that of a perpetual and objectively based correlation of the visible and the expressible. An absolutely new use of scientific discourse was then defined: a use involving fidelity and unconditional subservience to the coloured content of experience—to say what one sees; but also a use involving the foundation and constitution of experience—showing by saying what one sees.” (p.196)

The Birth Company are proud of the high-quality service provided to their patrons and welcome a re-inspection by the CQC. Patient attributes and environmental factors became relevant considerations in discerning diseases. Furthermore, political changes stemming from the French Revolution ceded power over health matters to the new government, which it promptly transferred to the doctors. Society would now have a point of view on what constitutes health, a view the gaze could not escape. This gaze focused on health as it concerned a “benefit to the state.” Not until later yet in the nineteenth-century would the gaze shift towards deviations from established norms of health, when, in other words, the gaze was redirected from what Foucault calls the social space to the pathological space. This particular shift for him marked a transformation of classificatory medicine to clinical medicine. You'll continue to have mild, less painful contractions that are close together. The contractions help move the placenta into the birth canal. You'll be asked to push gently one more time to deliver the placenta. You might be given medication before or after the placenta is delivered to encourage uterine contractions and minimize bleeding. 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.

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.) What you can do: Push! Your health care provider will ask you to bear down during each contraction or tell you when to push. Or you might be asked to push when you feel the urge to do so.

During early labor, your cervix dilates and effaces. You'll likely feel mild, irregular contractions.What you can do: Look to your labor partner and health care team for encouragement and support. Try breathing and relaxation techniques to relieve your discomfort. Use what you learned in childbirth class or ask your health care team for suggestions. Cunningham FG, et al. Normal labor. In: Williams Obstetrics. 25th ed. McGraw-Hill; 2018. https://www.accessmedicine.com. Accessed Oct. 28, 2021. A member of your health care team may massage your abdomen. This may help the uterus contract to decrease bleeding.