The Birth of the Clinic: An Archaeology of Medical Perception

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The Birth of the Clinic: An Archaeology of Medical Perception

3.94 of 5 stars 3.94 · rating details · 843 ratings · 40 reviews

In the eighteenth century, medicine underwent a mutation. For the first time, medical knowledge took on a precision that had formerly belonged only to mathematics. The body became something that could be mapped. Disease became subject to new rules of classification. And doctors begin to describe phenomena that for centuries had remained below the threshold of the visible a...more

Paperback, 240 pages

Published March 29th 1994 by Vintage (first published 1963)

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Jul 02, 2009 Conor rated it 4 of 5 stars

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...more

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Aug 11, 2011 Oliver L. rated it 4 of 5 stars

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...more

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Oct 28, 2012 Aurochz rated it 4 of 5 stars

Shelves: philosophy, post-structuralism-and-modernism, history, linguistics

Foucault brings his same genealogical approach to short histories that he brought to other subjects to the field of medicine.

I find his critiques in this too be on par with his critiques in his other major works, but I don't find them as interesting or as unique. His idea that humanity was conceived as being rational in mind and body through a conception of health is interesting, but again not as interesting as Panopticism or a deconstruction of madness. It also seems all too close to Derrida's...more

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May 25, 2012 Trevor rated it 4 of 5 stars · review of another edition

Shelves: history, philosophy, social-theory, science

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 th...more 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.
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May 05, 2011 Thandiwe rated it 5 of 5 stars · review of another edition

I have a very complicated relationship with this man. He is both my inspiration and subject of intense scrutiny. Foucault is the author that I love to hate and cannot escape. Despite all of the criticism, Foucault is an extremely important philosopher and even if you do not agree with his theoretical position, particularly his concept of decentralized power, his discussion of institutional power and knowledge production is insurmountable.

I have read most of Foucault's major works and the Birth...more

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May 30, 2009 Bradley rated it 5 of 5 stars

Foucault was predominantly immersed in the late 18th century, or early Modernism (The Enlightenment) when he wrote this book. How did the schematic behind the perfect prison (the Panopticon) become used in the logic of the University, the Clinic, etc. How do populations become disciplined, manipulated, transformed into healthy, productive, docile bodies? Is it a coincidence that the advent of so-called "Modern" medicine occurred at a time when Western Culture was rapidly Capitalizing? The popula...more

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Oct 05, 2012 Jeremy added it

Shelves: philosophy, sociological

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 i...more

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Jul 13, 2011 Timothy rated it 4 of 5 stars

Shelves: philosophy-theory

My knowledge of the history of medical theory is practically non-existent, and I'm embarrassed to say that I know next to nothing about the French Revolution, so large sections of this book didn't really register with me. It seems like Foucault is using a slightly more direct style than is his wont, but this effect is largely eliminated by the obscurity of his historical references. As with much of his writing, I felt that I understood the beginning and end of the narrative arc pretty well witho...more

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Jun 08, 2011 Kyle rated it 4 of 5 stars

I've accepted that most things are rarely clear after reading Michel Foucault--its fine. Foucault is super ambitious and sharp in this one. Medical perception is a hard one to transform, let alone from a historical standpoint and beginning in the 18th century period (i.e. French Revolution and on). Similar to History of Sexuality, the 18th century is a pivotal time for changing European social and cultural attitudes. These changing social and cultural attitudes lend themselves to power relations...more I've accepted that most things are rarely clear after reading Michel Foucault--its fine. Foucault is super ambitious and sharp in this one. Medical perception is a hard one to transform, let alone from a historical standpoint and beginning in the 18th century period (i.e. French Revolution and on). Similar to History of Sexuality, the 18th century is a pivotal time for changing European social and cultural attitudes. These changing social and cultural attitudes lend themselves to power relations that inform the workings of social/cultural institutions. Since Foucault is interested in archaeology of medical perception, he can look at the origins of health, sickness, life and death, by contemplating the medical institutions that play a large part in shaping them. How does he do this? He looks at the medical and clinical gaze and how their dimensions evolved since the French Revolution. Foucault makes it known to readers that he is not attempting to endorse one medical or clinical practice and philosophy over another, instead this work "is among others, an attempt to apply a method in the confused, under-structured, and ill-structured domain of the history of ideas" (195). Might I add that no other philosopher has explored medical perception through the history of ideas? Regardless, this has been quite the endeavor. Of course, Foucault’s quote comes from the conclusion (I’m just being lazy here), but along the way Foucault is always articulating what he is doing. Most importantly, the issues he raises are interesting and conveyed in a curious, thought-provoking manner.

I’ll leave you with just a few more points:

1). Similar to other Foucauldian works, Birth of the Clinic is not a “page-turner.” One doesn’t drill through it fully understanding the ideas and achieving a more sobered sense of reality. It just doesn’t happen!

2). Foucault’s philosophies have no center or totalizing whole. So, enter the text wherever you wish. You’re invited and encouraged to be less linear here.

3.) A good portion of Birth of the Clinic is Foucault setting up, clarifying his methodology to readers. All this careful discernment leads nowhere. Foucault isn’t striving to make his philosophies definitive or absolute; instead he wants to disentangle centuries of medical perceptions (i.e. how medical professions have viewed disease and the body over time). Since he does this by way of the history of ideas, he manages to preserve the complexity and disorder of the ideas.
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Sep 27, 2012 Hadrian rated it 4 of 5 stars

Shelves: french, history, medicine, nonfiction, philosophy

(Source: http://www.flickr.com/photos/patrick-...)

Beneath the outstretched arms of the statue, Christus Consolatur, at the illustrious Johns Hopkins Hospital in Baltimore, there is a simple inscription: “Come unto me all ye that are weary and heavy laden and I will give you rest.” This simple phrase reflects the hopes and aspirations of many who turn to the medical profession.

Foucault here attempts an 'archaeology' of the medical field - he reconstructs a history of ideas of how medicine was perceived - through a study of French medicine in the late 18th and early 19th century, and brushes away the sediment which obscure the origins of the field. He discards the old narratives as myths and offers his own metanarrative.

Several main points about his analysis stuck with me. First, his history of the clinique, which is translated here as 'clinic' but might instead mean something more like 'teaching hospital'. He uses the phrase 'birth' of the clinic because it did not gradually form, it suddenly instantly became a new institution.

Second, his episteme history of medicine, comparing past analysis of how physicians looked at the body, the soul, humors, parts of the body vs. the whole, and so forth. He cites Morgagni, the founder of anatomical pathology, and Bichat, who differentiates tissues from organs. His history of pathology also expands into experimentation and prodding of the dead or dying, with the dissection of corpses.

Third, because he is Foucault, after all, he ties this into power dynamics. Outbreaks of illness as a sign of poor governmentality or God's displeasure. The role of physicians, after the 19th century, began to take over that of churchmen and pre-modern physicians, offering physical healing whereas the church could offer only spiritual healing instead of blessings and prayers, or arbitrary procedures which are at best a placebo.

Most interesting to me was his description of the 'medical gaze' in Chapter 6. Separating the physical symptoms of the illness from the person, and comparing it with an ideal terminology-'textbook' version of said disease. This is more of an analysis of the physical symptoms, even to the extent of disregarding the person.

For example. Imagine you are at the dentist. I know it's uncomfortable, but please try. They place the curved pick in your mouth and ask if you have been flossing. You mumble in the affirmative. They nod, not really listening, and poke around with a gloved hand, finding buildup on your gums, and a little infection, as the trickle of blood flows after each prod. You have been discovered as a liar.

Hence this dynamic of observation - which seemed like an outlandish idea when it was published, but one that seems all too relevant now. At Hopkins now, the medical school does attempt a focus on the 'bedside manner' now, the process of trying to communicate between doctor and patient, although granted it is hard to do. The difficulty of trying to find an objective discovery, and creating a less difficult power relationship.

A very interesting book. Foucault is wordy, but he crams a lot of ideas into those words.(less)

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Jun 16, 2010 Spoust1 rated it 3 of 5 stars

Shelves: foucault-and-gender-studies

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 mo...more 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?(less)

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Nov 26, 2010 Greg rated it 3 of 5 stars Recommends it for: anyone in the medical field who enjoys out-of-the-box thinking

Been working on this on and off for four years. I read it for a couple reasons. One, because there seems to me to be a glut of writings and rantings about "postmodernism" bogeymen, but I do not sense there is much reading of the primary sources themselves - Foucault, Derrida, Lyotard, et al. Second, this book exposes the structures of knowledge used in medical practice, and because my own life has been invaded by cancer, I desire to be able to get "outside" the typical story provided by the medi...more

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Sep 17, 2012 Mpz rated it 5 of 5 stars

A challenging read but one of those books that changes the way you think. I think this book helps anyone understand why our healthcare system is both as successful and dysfunctional as it is. I think this is a real challenge for the profession of nursing as we seem to be bent on making all the same mistakes that medicine has.

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Oct 06, 2012 Janine rated it 3 of 5 stars

This book is not interesting but enlightening. If you can get through it (which is tough and requires a clear alert mind and coffee) then it gives you a good understanding of how medicine has changed and developed. I wish Foucault made this more interesting because I am interested in how it developed but this was dry and boring.

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Aug 23, 2012 Julie rated it 3 of 5 stars

I knew this book would be like tearing trees apart with your bare hands and it does not disappoint. The whole notion of health hinges on the loss of doctors in the continental wars that raged in Europe pre-Revolution, that left France a land of quackery served on a side plate with a self trained country doctor sandwiches. Standards had to be put in place, and the clinic was born to address this quandary over the health space, where was it? who was authorized to be in it? and what could be done t...more

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Jan 31, 2010 Joe added it

Shelves: philosophy

Read as part of my new and surely healthy obsession with sickness and medicalization. Would like to reread thiswhile rereading Tory Dent's HIV, Mon Amour.

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Feb 21, 2012 LeeAnna rated it 3 of 5 stars

Shelves: 2012-books

This book is a philosophical look at the history of medicine. Some parts, mainly the heavily medical areas, were difficult for me to read, but overall it was very interesting book.

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Dec 28, 2012 Cheska rated it 2 of 5 stars

*pakilagay ang mura dito* graaaabe sakit sa bangs lalo. haha ilang beses mo basahin di pa din gets. XDD

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Nov 16, 2012 Michael rated it 3 of 5 stars

A really daunting read due to his reliance on philosophical sentence structure and philosophical or archaic terminology. Overall, as a physician, it is remarkable to explore the requisite naïveté and inexperience from which modern clinical medicine was birthed. The advent of touching patients, exploring for causation, examining tissue, and positivism as a replacement of what essentially sounds like witchcraft is especially estimable. Foucault is clearly brilliant. I may explore, either in revie...more

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Apr 16, 2011 Shannon rated it 4 of 5 stars

In the end I got into it. Pretty good, just really dense. Interesting subject matter though, and useful for my dissertation project stuff.

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Sep 06, 2010 Tyler rated it 1 of 5 stars

Great, if you are interested in the suppressive powers of of the viewer.

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Jun 06, 2012 Ángela rated it 5 of 5 stars · review of another edition

Uno de los libros más útiles que he leído en toda mi vida académica.

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Apr 19, 2011 John Wojewoda rated it 5 of 5 stars

Shelves: this-is-a-mind-blowing-book-a-must

This is one of the most formative books I ever read.

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Jan 03, 2011 Omari Fontenelle rated it 5 of 5 stars

to be added at a future date

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Sep 22, 2009 Dan rated it 3 of 5 stars

Shelves: cultural-study

This book is more about the history of knowledge than the history of clinics. Specifically, Foucault, a historian of knowledge (which latter is sometimes termed “episteme” in his work) analyzes the changes in the way medical and clinical knowledge was organized in the modern era (beginning with the Enlightenment). He discusses texts of the period to show how theorists and clinicians of the day interpreted disease and its relation to symptoms and to causes.

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May 19, 2013 Icten keskin added it

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Feb 12, 2012 Erica rated it 3 of 5 stars

Just not as searingly magnificent as Discipline and Punish. Great stuff about "the gaze," the Enlightenment structure of experience, disease, pregnancy. But just not one of his best, in my mind.

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Sep 05, 2007 Richard K. W. Hsu rated it 5 of 5 stars

Shelves: euro-theory

This book is phenomenal for Foucault's in-depth discussion on the entanglement of language and death from a sometimes biased observation of medical history. Highly recommend this book to those who are interested in the formation of modernity, which I think highly involved with the transformation of death that brings totally distinguished structure of perception from early modern period.

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Mar 10, 2008 James rated it 4 of 5 stars

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.

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Nov 20, 2008 Prash marked it as abandoned · review of another edition

reading this has been surreal. could understand not a single sentence in the preface. haven't read anything by him before. is there some help? been putting the book to some use though. getting my friends to read some paragraphs from the book at random. the looks of bemusement, incomprehension, bewilderment, etc. amuse both parties.

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About Michel Foucault

Michel Foucault was a French philosopher, social theorist and historian of ideas. He held a chair at the Collège de France with the title "History of Systems of Thought," and lectured at the University at Buffalo and the University of California, Berkeley.

Foucault is best known for his critical studies of social institutions, most notably psychiatry, medicine, the human sciences and the prison sys...more

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Books by Michel Foucault

Discipline and Punish: The Birth of the Prison

The History of Sexuality 1: An Introduction

Madness and Civilization: A History of Insanity in the Age of Reason

The Order of Things: An Archaeology of the Human Sciences

The Archaeology of Knowledge & The Discourse on Language

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“Death left its old tragic heaven and became the lyrical core of man: his invisible truth, his visible secret.” — 17 people liked it

“The first task of the doctor is ... political: the struggle against disease must begin with a war against bad government." Man will be totally and definitively cured only if he is first liberated...” — 14 people liked it

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