Medical Humanities Lexicon: Clinical Gaze

Today's entry in the Medical Humanities Lexicon is the "clinical gaze."  While the concept is articulated in a number of sources, it is generally most associated with Michel Foucault in his tour de force, The Birth of the Clinic: An Archaeology of Medical Perception.

Understandably, the mere mention of a 'postmodern' French intellectual has a tendency to send people running.  But Foucault, as near as I can tell, is generally taken quite seriously among humanities scholars of medicine, even if neither his ideas nor his style are without critics.  In any case, The Birth of the Clinic is extremely important in thinking about health, illness, and the culture of biomedicine from a medical humanities perspective.

In the book, Foucault traces the birth of the clinic.  It may or may not be surprising that what the term "clinic" typically refers to today was not always the mode in which healers operated.  This point underscores Taylor's emphasis on the need for avoiding thinking about modern culture ahistorically.  The clinic developed over time, and Foucault demonstrates this.  Though it is not universally accepted, most historians of medicine and/or science agree with Foucault that the incipient "clinic" developed around 1800, centered in Paris.

What was it that developed? Foucault often refers to it as an anatomo-clinical method, but it coheres with the evolution of the investigating Eye/I that in many ways characterizes modernity.  What is it that the Eye/I observes? An older conception of healing posited predispositionist causes of disease, in which a multitude of predisposing factors were necessary (but often insufficient) for certain diseases to manifest.  This older tradition tended to require physicians to get to know their patient intimately as a subject, because many predisposing causes were contained in the patient's personality and habits (e.g., intemperance, income status, moral behavior).

The clinical gaze, however, focuses its attention much more on the object of disease than on the subject that suffers.  This is not to posit a false dichotomy; it is possible of course to both focus on the object of disease and be empathic with the patient.  The point is to understand the focus of the gaze shifts early in the 19th century.  This shift would gather momentum unevenly throughout the 19th century and into the 20th, when clinical method truly began to take on a structure familiar to our eyes.

At first, the objects of disease focused primarily on the pathology of anatomical structures, and dissection enjoyed something of a revival, if ever it really flagged (rather than simply going on surreptitiously).  Such was the emphasis on isomorphisms that strident opposition to vivisection is observable in the U.S. even prior to the Civil War.

The rise of bacteriology in the second half of the 19th century undoubtedly fueled the synthesis of the clinical gaze.  The proliferation of laboratories is of course both a cause and an effect of a number of different factors, but there is no question that it strengthens the suitability of the roving clinical Eye.  This Eye focuses on the visible objects of disease (such as bacteria) as a way of understanding the isomorphism that is the "seat of disease," to use Bichat's term.

What are the implications of the clinical gaze for the medical humanities? First, the clinical gaze tends to create or entrench distance between the healer and the patient, because the healer is now using a clinical Eye to observe the patient's symptoms and search for causes.  The clinical gaze literally objectifies, which in part characterizes scientific method in the therapeutic dyad.  How do this patient's symptoms/pathologies cohere with the 'objective' principles of healing? In turn, the clinical gaze provides a construct for thinking about why a chief complaint among patients is that physicians do not listen to them.

Second, the subtitle of Foucault's book is important: an archaeology of medical perception.  What Foucault set out to do is to unearth the beginnings of the distinctively allopathic model of therapy and medicine.  Thinking about one's own encounters with health care providers through this lenses can illuminate much -- both positive and negative -- about one's own "clinical" experience.

Third, the dominance of the clinical gaze may carry troubling implications for those diseases and impairments which are invisible to the roving clinical Eye.  They may be delegitimized, diminished, or dismissed because of their failure to present visible pathologies that seem connected to the patient's symptoms.

Fourth, the dominance of the clinical gaze has had devastating effects on disabled persons.  Because the clinical gaze objectifies, disabled persons are much more likely to be seen as deviants from the norm in a society in which the gaze is predominant.  In part what many disability scholars and advocates stress about the social model of disability is that it can produce a different way of perceiving of the subject, not as the sum of their dysfunctions and isomorphisms, but as a different being whose social capacity is in large part determined by social conditions rather than pathological morphology.

I could go on ad nausem here, but this entry has been long enough.  Suffice it to say that whatever one's position on postmodern French intellectuals, any one wishing to think about the medical humanities should be acquainted with the notion of the clinical gaze.

References

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Michel Foucault, The Birth of the Clinic: An Archaeology of Medical Perception ( ).

David B. Morris, "An Invisible History of Pain: Early 19th-Century Britain and America," J. Clin. Pain. 14, no. 3 (1998): 191-196.

Tony Walter, "Body Worlds: Clinical Detachment and Anatomical Awe," Sociology of Health & Illness 26, no. 4 (2004): 464-488.

Chris Philo, "The Birth of the Clinic: An Unknown Work of Medical Geography," Area 32, no. 1 (2000): 11-19.

Kirsti Malterud, "The (Gendered) Construction of Diagnosis Interpretation of Medical Signs in Women Patients," Theoretical Medicine & Bioethics 20, no. 3 (1999): 275-286.

John C. Long, "Foucault's Clinic," Journal of Medical Humanities 13, no. 3 (1992): 119-138.

Joanna Latimer et al., "Rebirthing the Clinic: The Interaction of Clinical Judgment and Genetic Technology in the Production of Medical Science," Science, Technology & Human Values 31, no. 5 (2006): 599-630.

Comments

[Ryan]

'I could go on ad nausem here' please do. As as someone with a disability, I feel like I am having some sort of philosophical revelation. I have not been able to articulate this form of objectification until reading about the clinical gaze. have there been major studies re: disibility and the clinical gaze?

[Daniel S. Goldberg]

Ryan,

Philosophical revelation, indeed. A very large portion of my work, and virtually all of it related to my work in the history of medicine, centers on the clinical gaze, which I think is actually understated in terms of significance.

In answer to your specific question, oh my word, yes. Try this Scholar Google search, just for starters:

http://tinyurl.com/2uxw458

Thanks for reading.