gaze in medical perception

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gaze in medical perception Michel Foucault's book La Naissance de la Clinique, first published in France in 1963, reached an English-speaking audience in 1973. The opening sentence read: ‘This book is about space, about language, and about death; it is about the act of seeing, the gaze.’ This was the first reference to a new concept underpinning much subsequent understanding of Western clinical practice and the body. Ironically, for a term that has achieved such widespread recognition as a key component of Foucault's analysis of Western medicine, it was the choice of his translator, A. M. Sheridan Smith. Indeed, in a translator's note he referred to the problem of translating the French noun, le regard. As Foucault made clear in his opening sentence, he was not referring to a passive visual process, but to something more active, an ‘act of seeing’. Accordingly Sheridan Smith felt that the term, ‘the gaze’, though unusual, was a useful way of registering the breadth of Foucault's concept, and this is the word used throughout the book except in the subtitle (An Archaeology of Medical Perception), which was a ‘concession’ to the unprepared reader by Sheridan Smith.

Foucault went on to describe an eighteenth-century report of a medical treatment that was said to have resulted in a patient discarding her insides in her urine. He then compared this strange account to a nineteenth-century description of the meningeal layers of the brain. Between these two ways of describing the clinical world, Foucault argued, lay a transformation in ‘…the relationship between the visible and the invisible’, a process in which knowledge and clinical practice were radically changed as medicine began to ‘see’ by means of this novel gaze into the depths of the body.

In earlier models of illness, disease was mobile, a sum of the trail of symptoms that marked its passage through the inside and outside of the body. In contrast, the new pathological medicine construed illness as a specific anatomical lesion located in the analyzable three-dimensional structure of the body. The gaze was the literal ability to see through the density of the corporal tissues to the hidden lesion that was bringing about the patient's distress. The gaze therefore encompassed both a system of knowledge that equated illness to the underlying pathological lesion and a new method of clinical practice. The post-mortem that could finally reveal the truth of the pathological lesion, the techniques of the clinical examination that enabled the three-dimensional volume of the body to be explored, and the neutral space of the hospital in which these practices could occur, all were both consequences and manifestations of the new clinical gaze. Thus, perception and cognition, seeing and knowing, were brought together within an overall framework of clinical practice.

The new clinical gaze underpinned the development of medicine in Western countries throughout the nineteenth and twentieth centuries' as increasingly sophisticated searches were devised to penetrate and ‘read’ the patient's body. And yet, despite this intensification of the gaze into the body, it was also accompanied by a widening of its field to other objects during the latter half of the twentieth century as medicine increasingly explored the patient's mind and social context. This extension represents further evidence that the gaze is an active process: the gaze does not simply see what is there but constructs the conditions of possibility, to use a Foucauldian term, for the emergence of certain (medical) objects that in their turn are brought to the senses. The notion of the gaze therefore stands opposed to a conventional account of medical progress that would claim that two centuries ago a means was found of sweeping away the veils of ignorance and revealing things as they really were. Modern Western medicine is only one version — historically and culturally located — of how illness and the body relate together: according to Foucault, this order of the solid visible body was only one way ‘in all likelihood neither the first nor the most fundamental in which one spatializes disease. There have been and will be, other distributions of illness.’

David Armstrong