Gazing at Death

The Birth of the Clinic is a description of the changes in the language of medicine, particularly French medicine, between 1794 and 1820. It is therefore in the first place a work of history, concerned with a specific problem during a specific period. But it is also an experiment in a new way of writing the history of science, a testing ground for a radically redefined historical epistemology and methodology. Hence the double appeal of this book, which will be read not only by those who are interested in this seminal period of medical history but also by those who are dissatisfied with the traditional procedures of intellectual history and would like to see historians of ideas re-think their objectives and their methods.

The Birth of the Clinic, published in France in 1963, came after Foucault’s Histoire de la Folie (Madness and Civilization, 1961) and preceded his Les Mots et les Choses (The Order of Things, 1966). Together these works make up a trilogy in which the author is successively a historian of psychiatry and psychopathology, of medicine, of natural history, of economics, and of grammar. This ambitious enterprise has not only yielded positive results of great value, it has also led to an important theoretical advance. Foucault’s latest book, L’Archéologie du Savoir (The Archaeology of Knowledge), may be seen as the methodological postscript to his trilogy on the history of science: in this work he sums up his position, clarifying his aims, freely criticizing certain aspects of his work, and proposing new goals for future research.

We cannot fully understand The Birth of the Clinic unless we are aware of its position in this series and take note of Foucault’s subsequent declarations, in which he puts distance between himself and his preoccupations at the time when he wrote this book. In particular we need to know that the expression “regard médical” (medical perception), which figures in this book’s subtitle and reflects much of Foucault’s argument, now no longer seems to him “very well chosen,” since it seems to “refer to the unifying or synthesizing function of a subject,” i.e., of a thinker or a thinking mind. And there are indeed passages in The Birth of the Clinic which are genuine phenomenological analyses, where a subject (the doctor, the scientist, “medical perception” itself) is seen in the act of constituting the objects of its thoughts.

Since he wrote these pages Michel Foucault has completely transferred his emphasis to what he calls the “order of discourse,” i.e., to discovering the laws that tacitly govern the intellectual discourse of a given period. He now emphasizes the “dispersion of the subject,” i.e., the ways by which all thinking, no matter how individual or “creative” it may seem, is unconsciously but systematically constrained by the rules or codes that are embedded in the discourse of the times. He would reject any recourse to psychological subjectivity of any sort, and he would prefer to leave out …

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