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 (2008/01/26 12:49)推噓0(0推 0噓 0→)

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The years preceding and immediately following the Revolution saw the birth of two great myths with opposing themems and polarities: the myth of a na- tionalized medical profession, organized like the clergy, and invested, at the level of man's bodily health, with powers similar to those exercised by the clergy over men's souls; and the myth of a total disappearance of disease in an untroubled, dispassionate society restored to its original state of health. But we must not be misled by the manifest contradiction of the two themes: each of these oneiric figures expresses, as if in black and white, the same picture of medical experience. The two dreams are iso- morphic: the first expressing in a very positive way the strict, militant, dogmatic medicalization of society, by way of a quasi-religious conversion, and the establishment of a therapeutic clergy; the second expressing the same medicalization, but in a triumphant, negative way, that is to say, the volatilization of disease in a corrected, organized, and ceaselessly supervised environment, in which medicine itself would finally disappear , together with its object and its raison d'etre. Sabarot de l'Averniere, a prolific author of projects in the early years of the Revolution, saw priests and doctors as the natural heirs of the Church's two most visible missions--the consolation of souls and the alleviation of pain. So the wealth of the Church, which has been diverted from its original use by the higher clergy, must be confiscated and returned to the nation, which alone knows its own spiritual and material needs. The revenues would be divided equally between the parish clergy and the doctors. Are not doctors the priests of the body? 'The soul cannot be considered separately from animate bodies, and if the ministers of the Altars are venerated, and receive from the state a reasonable living, those who tend your health should also receive a salary sufficient to feed themselves and to succour you. They are the tutelary genii of the integrity of your faculties and sensations' [30]. The doctor would no longer have to demand a fee from his patient; the treatment of the sick would be free and obligatory--a service that the nation would provide as one of its sacred tasks; the doctor would be no more than the instrument of that service [31]. At the end of his studies, the new doctor would occupy not the post of his choice, but the one that was assigned to him according to the needs and vacancies, throughout the country; when he had gained in experience, he could apply for a more responsible, better-paid job. He would have to give an account to his superiors of his activities and would be held responsible for his mistakes. Having become a public, disinte- rested, supervised activity, medicine could improve indefinitely; in the alleviation of physical misery, it would be close to the old spiritual vocation of the Church, of which it would be a sort of lay carbon copy. To the army of priests watching over the salvation of souls would correspond that of the doctors who concern themselves with the health of bodies. The other myth proceeds from a historical reflexion carried to its conclusion. Linked as they are with the conditions of existence and with the way of life of individuals, diseases vary from one period and one place to another. In the Middle Ages, at a time of war and famine, the sick were subject to fear and exhaustion (apoplexy, hectic fever); but in the sixteenth and seventeenth centuries, a period of relaxation of the feeling for one's country and of the obligations that such a feeling involves, egotism returned, and lust and gluttony became more widespread (venereal diseases, congestion of the viscera and of the blood); in the eighteenth century, the search for pleasure was carried over into the imagination: one went to the theatre, read novels, and grew excited in vain conversations; one stayed up at night and slept during the day (hysteria, hypochondria, nervous diseases) [32]. A nation that lived without war, without violent passions, without idleness would know none of these ills, nor, above all, would a nation that did nor know the tyranny of wealth over poverty, nor given to abuses. The rich? 'Living in the midst of ease, surrounded by the pleasures of life, their irascible pride, their bitter spleen, their abuses, and the excesses to which their contempt of all princi- ples leads them makes them prey to infirmities of every kind; soon...their faces are furrowed, their hair turns white, and diseases harvest them before their time) [33]. Meanwhile, the poor, subjected to the despotism of the rich and of their kings, know only taxes that reduce them to penury, scarcity that benefits only the profiteers, and unhealthy housing that forces them 'either to refrain from raising families or to procreate weak, miserable creatures' [34]. The first task of the doctor is therefore 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: 'Who, then, should denounce tyrants to mankind if not the doctors, who make man their sole study, and who, each day, in the homes of poor and rich, among ordinary citizens and among the highest in the land, in cottage and mansion, con- template the human miseries that have no other origin but tyranny and slavery? ' [35]. If medicine could be politically more effective, it would no longer be indispensable medically. And in a society that was free at last, in which inequalities were reduced, and in which concord reigned, the doctor would have no more than a temporary role: that of giving legislator and citizen advice as to the regulation of his heart and body. There would no longer be any need for academics and hospitals: By training citizens in frugality by means of simple dietary laws, by showing young eople above all the pleasures that may be derived from even a hard life, by making them appreciate the strictest discipline in the army and navy, how many ills would be prevented, how much expense avoided, and what new abilities would reveal themselves...for the greatest, most difficult enter- prises. And gradually, in this young city entirely dedicated to the happiness of possessing health, the face of the doctor would fade, leaving a faint trace in men's memories of a time of kings and wealth, in which they were impove- rished, sick slaves. All this was so much day-dreaming; the dream of a festive city, inhabited by an open-air mankind, in which youth would be naked and age know no winter, the familiar symbol of ancient arcadias, to which has been added the more recent theme of a nature encompassing the earliest forms of truth--all these values were soon to fade [36]. And yet they played an important role: by linking medicine with the destinies of states, they revealed in it a positive significance. Instead of remaining what it was, 'the dry, sorry analysis of millions of infirmities', the dubious negation of the negative, it was given the splendid task of establishing in men's lives the positive role of health, virtue, and happiness; it fell to medicine to punctuate work with festivals, to exalt calm emotions, to watch over what was read in books and seen in theatres, to see that marriages were made not out of self-interest or because of a passing infatuation, but were based on the only lasting condition of happiness, namely, their benefit to the state [37]. Medicine must no longer be confined to a body of techniques for curing ills and of the knowledge that they require; it will also embrace a knowledge of healthy man, that is, a study of non-sick man and a definition of the model man. In the ordering of human existence it assumes a normative posture, which autho- rizes it not only to distribute advice as to healthy life, but also to dictate the standards for physical and moral relations of the individual and of the society in whch he lives. It takes its place in that borderline, but for modern man paramount, area where a certain organic, unruffled, sensory happiness communicates by right with the order of a nation, the vigour of its armies, the fertility of its people, and the patient advance of its labours. The dreamer Lanthenas gave medicine a definition that was brief but heavy with history: 'At last, medicine will be what it must be, the knowledge of natural and social man' [38]. It is important to determine how and in what manner the various forms of medical knowledge pertained to the positive notions of 'health' and 'normality '. Generally speaking, it might be said that up to the end of the eighteenth century medicine related much more to health than to normality; it did not begin by analyzing a 'regular' functioning of the organism and go on to seek where it had deviated, what it was disturbed by, and how it could be brought back into normal working order; it referred, rather, to qualities of vigour , suppleness, and fluidity, which were lost in illness and which it was the task of medicine to restore. To this extent, medical practice could accord an important place to regimen and diet, in short, to a whole rule of life and nutrition that the subject imposed upon himself. This privileged relation between medicine and health involved the possibility of being one's own phy- sician. Nineteenth century medicine, on the other hand, was regulated more in accordance with normality than with health; it formed its concepts and prescribed its interventions in relation to a standard of functioning and organic structure, and physiological knowledge--once marginal and purely theoretical knowledge for the doctor--was to become established (Claude Bernard bears witness to this) at the very centre of all medical reflexion. Further- more, the prestige of the sciences of life in the nineteenth century, their role as model, especially in the human sciences, is linked originally not with the comprehensive, transferable character of biological concepts, but , rather, with the fact that these concepts were arranged in a space whose profound structure responded to the healthy/morbid opposition. When one spoke of the life of groups and societies, of the life of the race, or even of the 'psychological life', one did not think first of the internal structure of the organized being, but of the medical bipolarity of the normal and the pathological. Consciousness lives because it can be altered, maimed, diverted from its course, paralyzed; societies live because there are sick, declining societies and healthy, expanding ones; the race is a living being that one can see degenerating; and civilizations, whose deaths have so often been remarked on, are also, therefore, living beings. If the science of man appeared as an extension of the science of life, it is because it was medically, as well as biologically, based: by transference, importation, and, often, metaphor, the science of man no doubt used concepts formed by biologists; but the very subjects that it devoted itself to (man, his behaviour, his individual and social realizations) therefore opened up a field that was divided up according to the principles of the normal and the pathological. Hence the unique charac- ter of the science of man, which cannot be detached from the negative aspects in which it first appeared, but which is also linked with the positive role that it implicitly occupies as norm. [1]Th. Sydenham, 'Observationes medicae', Opera medica (Geneva, 1736, I, p. 32) [2]Ibid., p. 27 [3]Le Brun, Traite historique sur les maladies epidemiques (Paris, 1776, p. 1) [4]Lepecq de la Cloture, Collection d'observations sur les maladies et constitutions epidemiques (Rouen, 1778, p. xiv) [5]Razoux, Tableau nosologique et meteorologique (Basel, 1787, p. 22) [6]Menuret, Essai sur l'histoire medico-topographique de Paris (Paris, 1788, p. 139) [7]Banan and Turben,Memoires sur les epidemies du Languedoc (Paris, 1786, p. 3) [8]Le Brun, op. cit., p. 66, n. 1 [9]Menuret, op. cit., p. 139 [10]Le Brun, op. cit., pp. 2-3 [11]Anon., Description des epidemies qui ont regne depuis quelques annees sur la generalite de Paris (Paris, 1783, pp. 35-7) [12]Le Brun, op. cit., pp. 127-32 [13]Anon., op. cit., pp. 14-17 [14]Le Brun, op. cit., p. 124 [15]Ibid., p. 126 [16]Cf. Precis historique de l'etablissement de la Societe royale de Medecine (Undated. The anonymous author is Boussu) [17]Retz, Expose succint a l'Assemblee Nationale (Paris, 1791, pp.5-6) [18]Cf. Vacher de la Feuterie, Motif de la reclamation de la Faculte de Medecine de Paris contre l'etablissement de la Societe royale de Medecine (Place and date of publication unknown) [19]Quoted in Retz, op cit. [20]Hautesierck, Recueil d'observations de medecine des hopitaux militaires (Paris, 1766, vol. 1, pp. xxiv-xxvii) [21]Menuret, op cit., p.139 [22]Cantin, Projet de reforme adresse a l'Assemblee Nationale (Paris, 1790) [23]Mathieu Geraud, Projet de decret a rendre sur l'organisation civile des medecins (Paris, 1791, nos. 78-9) [24]Razoux, op. cit [25]Quoted in ibid., p. 14 [26]Mathieu Geraud, op. cit., p. 65 [27]Cf. N.-L. Lespagnol, Projet d'etablir trois medecins par district pour le soulagement des gens de la campagne (Charleville, 1790). Royer, Bienfaisance medicale et projet financier (Provins, Year IX) [28]J.-B. Demangeon, Des moyens de perfectionner la medecine (Paris, Year VII , pp. 5-9); cf. Audin Rouviere, Essai sur la topographie physique et medicale de Paris (Paris, Year II) [29]Bacher, De la medecine consideree politiquement (Paris, Year XI, p. 38) [30]Sabarot de L'Averniere, Vue de Legislation medicale adressee aux Etats generaux (1789, p.3) [31]In Menuret, Essai sur le moyen de former de bons medecins (Paris, 1791) , one finds the idea of financing medicine from church revenues, but only when it is a question of treating the poor [32]Maret, Memoire ou on cherche a determiner quelle influence les moeurs ont sur la sante (Amiens, 1771) [33]Lanthenas, De l'influence de la liberte sur la sante (Paris, 1792, p. 8) [34]Ibid., p. 4 [35]Ibid., p. 8 [36]On 2 June 1793, Lanthenas, who was a Girondist, was put on the proscribed list, then crossed off, Marat having described him as 'weak-headed'. Cf. Mathiez, La Revolution francaise (Paris, 1945, vol II, p. 221) [37]Cf. Ganne, De l'homme physique et moral, ou recherches sur les moyens de rendre l'homme plus sage (Strasbourg, 1791) [38]Lanthenas, op. cit., p. 18 -- ※ 發信站: 批踢踢實業坊(ptt.cc) ◆ From: 118.168.188.22