Re: Michel Foucault--The Birth of the Clinic

看板EngTalk (全英文聊天)作者fizeau (Gratias ad Opus)時間18年前 (2008/01/11 02:23)推噓0(0推 0噓 0→)

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In the rational space of disease, doctors and patients do not occupy a place as of right; they are tolerated as disturbances that can hardly be avoided: the paradoxical role of medicine consists, above all, in neutralizing them, in maintaining the maximum difference between them, so that, in the void that appears between them, the ideal configuration of the disease becomes a concrete, free form, totalized at last in a motionless, simultaneous picture, lacking both density and secrecy, where recognition opens of itself onto the order of essences. Classificatory thought gives itself an essential sace, which it proceeds to efface at each moment. Disease exists only in that space, since that space constitutes it as nature; and yet it always appears rather out of phase in relation to that space, because it is manifested in a real patient, beneath the observing eye of a forearmed doctor. The fine two- dimensional space of the portrait is both the origin and the final re- sult: that which makes possible, at the outset, a rational, well-founded body of medical knowledge, and that towards which it must constantly proceed through that which conceals it. One of the tasks of medicine, therefore, is to rejoin its own condition, but by a path in which it must efface each of its steps, because it attains its aim in a gradual neutralization of itself. The condition of its truth is the necessity that blurs its outlines. Hence the strange character of the medical gaze; it is caught up in an endless reciprocity. It is directed upon that which is visible in the disease--but on the basis of the patient, who hides this visible element even as he shows it; consequently, in order to know, he must recognize, while already being in possession of the knowledge that will lend support to his recognition. And, as it moves forward, this gaze is really retreating, since it reaches the truth of the disease only by allowing it to win the struggle and to fulfill, in all its phenomena, its true nature. Disease, which can be mapped out on the picture, becomes apparent in the body. There it meets a space with a quite different configuration: the concrete space of perception. Its laws define the visible forms assumed by disease in a sick organism: the way in which disease is distributed in the organism, manifests its presence there, progresses by altering solids, movements, or functions, causes lesions that become visible under autopsy, triggers off, at one point or another, the interplay of symptoms, causes reactions, and thus moves towards a fatal, and for it favourable, outcome. We are dealing here with those complex, derived figures by means of which the essence of the disease, with its structure of a picture, is articulated upon the thick, dense volume of the organism and becomes embodied within it. How can the flat, homogeneous, homological space of classes become visible in a geographical system of masses differentiated by their volume and dis- tance? How can a disease, defined by its place in a family, be characterized by its seat in an organism? This is the problem that might be called the secondary spatialization of the pathological. For classificatory medicine, presence in an organ is never absolutely nece- ssary to define a disease: this disease may travel from one point of local- ization to another, reach other bodily surfaces, while remaining identical in nature. The space of the body and the space of the disease possess enough latitude to slide away from one another. The same, single spasmodic malady may move from the lower part of the abdomen, where it may cause dyspepsia, visceral congestion, interruption of the menstrual or haemorrhoidal flow, towards the chest, with breathlessness, palpitations, the feeling of a lump in the throat, coughing, and finally reach the head, causing epileptic con- vulsions, syncopes, or sleepiness [15]. These movements, which are accom- panied by symptomatic changes, may occur in time in a single individual; they may also be found by examining a series of individuals with different link points: in its visceral form, spasm is encountered, above all, in lymphatic subjects, while in its cerebral form it is encountered more among sanguine temperaments. But in any case, the essential pathological configuration is not altered. The organs are the concrete supports of the disease; they never constitute its indispensable conditions. The system of points that defines the relation of the disease to the organism is neither constant nor necessary. They do not possess a common, previously defined space. In this corporal space in which it circulates freely, disease undergoes meta- stases and metamorhoses. Nothing confines it to a articular course. A nose- bleed may become haemotysis (spitting of blood) or cerebral haemorrhage; the only thing that must remain is the specific form of blood discharge. This is why the medicine of spaces has, throughout its history, been linked to the doctrine of sympathies--each notion being compelled to reinforce the other for the correct balance of the system. Sympathetic communication through the organism is sometimes carried out by a locally assignable relay (the diaphragm for spasms, the stomach for the discharge of humour); sometimes by a whole system of diffusion that radiates through the body (the nervous system for pains and convulsions, the vascular system for inflammations); in other cases, by means of a simple functional correspondence (a suppression of the excretions is communicated from the intestines to the kidneys, and from these to the skin); lastly, by means of an adjustment of the nervous system from one region to another (lumbar pains in the hydrocele). But the anatomical redistribution of the disease, whether through correspondence, diffusion, or relay, does not alter its essential structure; sympathy ope- rates the interplay between the space of localization and the space of configuration; it defines their reciprocal freedom and the boundaries of that freedom. Or, rather, threshold, not boundary. For beyond the sympathetic transference of the structural homology that it authorizes, a relation may be set up between one disease and another that is a relation of causality, but not of kinship. By virtue of its own creative force, one pathological form may engender another that is very far removed in the nosological picture. Hence the complications; hence the mixed forms; hence certain regular, or at least frequent, successions, as that between mania and paralysis. Haslam knew of delirious patients whose 'speech is disturbed, whose mouths are twisted, whose arms and legs are deprived of voluntary movement, whose memory is weakened', and who, generally speaking, 'have no awareness of their position' [16]. Overlaping of the symptoms or simultaneity of their extreme forms are not enough to constitute a single disease; the distance between verbal excita- tion and motor paralysis in the table of morbid kinships prevents a chrono- logical proximity from deciding on a unity. Hence the idea of a causality that moves by virtue of a slight time-lag; sometimes the onset of mania appears first, sometimes the motor signs introduce the whole set of symptoms. 'The paralytic affections are a much more frequent cause of madness than is thought; and they are also a very common effect of mania.' No symathetic translation can cross this gap between the species; and the solidarity of the symptoms in the organism are not enough to constitute a unity that clashes with the essences. There is, therefore, an inter-nosological causality, whose role is the contrary of sympathy: sympathy preserves the fundamental form by ranging over time and space; causality dissociates the simultaneities and intersections in order to maintain the essential purities. -- ※ 發信站: 批踢踢實業坊(ptt.cc) ◆ From: 122.120.96.100