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 05:24)推噓0(0推 0噓 0→)

留言0則, 0人參與討論串10/17 (看更多)

'Every morning a certain Aesculapius has fifty or sixty patients in his waiting room; he listens to the complaints of each, arranges them into four lines, prescribes a bleeding for the first, a purge for the second, a clyster for the third, and a change of air for the fourth [24]. This is not medicine; the same is true of hospital ractice, which kills the capacity for observation and stifles the talents of the observer by the sheer number of things to observe. Medical perception must be directed neither to series nor to groups; it must be structured as a look through 'a magnifying glass, which, when applied to different parts of an object, makes one notice other parts that one would not otherwise perceive' [25], thus initiating the endless task of understanding the individual. At this point, one is brought back to the theme of the portrait referred to above, but this time treated in reverse. The patient is the rediscovered portrait of the disease; he is the disease itself, with shadow and relief, modulations , nuances, depth; and when describing the disease th doctor must strive to restore this living density: 'One must render the patient's own infirmities , his own pains, his own gestures, his own posture, his own terms, and his own complaints' [26]. Through the play of primary spatialization, the medicine of species situated the disease in an area of homologies in which the individual could receive no positive status; in secondary spatialization, on the other hand, it re- quired an acute perception of the individual, freed from collective medical structures, free of any group gaze and of hospital experience itself. Doctor and patient are caught up in an ever-greater proximity, bound together, the doctor by an ever-more attentive, more insistent, more penetrating gaze, the patient by all the silent, irreplaceable qualities that, in him, betray-- that is, reveal and conceal--the clearly ordered forms of the disease. Bet- ween the nosological characters and terminal features to be read on the pa- tient's face, the qualities have roamed freely over th body. The medical gaze need hardly dwell on this body for long, at least in its densities and functioning. Let us call tertiary spatialization all the gestures by which, in a given society, a disease is circumscribed, medically invested, isolated, divided up into closed, privileged regions, or distributed throughout cure centres, arranged in the most favorable way. Tertiary is not intended to imply a de- rivative, less essential structure than the preceding ones; it brings into play a system of options that reveals the way in which a group, in order to protect itself, practises exclusions, establishes the forms of assistance, and reacts to poverty and to the fear of death. But to a greater extent than the other forms of spatialization, it is the locus of various dialectics: heterogeneous figures, time lags, political struggles, demands and utopias, economic constraints, social confrontations. In it, a whole corpus of medical practices and institutions confronts the primary and secondary spatializations with forms of a social space whose genesis, structure, and laws are of a different nature. And yet, or, rather, for this very reason, it is the point of origin of the most radical questionings. It so happened that it was on the basis of this tertiary spatialization that the whole of medical experience was overturned and defined for its most concrete perceptions, new dimensions, and a new foundation. In the medicine of secies, disease has, as a birthright, forms and seasons that are alien to the space of societies. There is a 'savage' nature of dis- ease that is both its true nature and its most obedient course: alone, free of intervention, without medical artifice, it reveals the ordered, almost vegetal nervure of its essence. But the more complex the social space in which it is situated becomes, the more denatured it becomes. Before the ad- vent of civilization, people had only the simplest, most necessary diseases. Peasants and workers still remain close to the basic nosological table; the simplicity of their lives allows it to show through in its reasonable order: they have none of those variable, complex, intermingled nervous ills, but down-to-earth aoplexies, or uncomplicated attacks of mania [27]. As one improves one's conditions of life, and as the social network tightens its grip around individuals, 'health seems to diminish by degrees'; diseases become diversified, and combine with one another; 'their number is already great in the superior order of the bourgeois;...it is as great as possible in people of quality' [28]. Like civilization, the hospital is an artificial locus in which the trans- planted disease runs the risk of losing its essential identity. It comes up against a form of complication that doctors call prison or hospital fever: muscular asthenia, dry or coated tongue, livid face, sticky sin, diarrhoea, pale urine, difficulty in breathing, death on the eighth or eleventh day, or on the thirteenth ar the latest [29]. More generally, contact with other dis- eases, in this unkempt garden where the species cross-breed, alters the proper nature of the disease and makes it more difficult to decipher; and how in this necessary proximity can one 'correct the malign effluvium that exudes from the bodies of the sick, from gangrenous limbs, decayed bones, contagious ulcers, and putrid fevers'? [30] And, in any case, can one efface the unfor- tunate impression that the sight of these places, which for many are nothing more than 'temples of death', will have on a sick man or woman, removed from the familiar surroundings of his home and family? This loneliness in a crowd, this despair disturb, with the healthy reactions of the organism, the natural course of the disease; it would require a very skilful hospital doctor 'to avoid the danger of the false experience that seems to result from the arti- ficial diseases to which he devotes himself in the hospitals. In fact, no hospital disease is a pure disease' [31]. -- ※ 發信站: 批踢踢實業坊(ptt.cc) ◆ From: 122.120.96.100