§59. Clinical Experience

Michel Foucault wrote of the “birth of the clinic,” referring to the emer­gence of the modern teaching hospital in the wake of a reorganization of medicine during the French Revolution, a generation or so before Bernard.

To patriotic contemporaries the reorganization seemed progressive, lib­erating the physician to practice Condillac’s analytical gaze. Doctors look at patients in a new way, which they interpret as a breakthrough in objec­tivity for a perception previously confused by imagination and authority. To blame stagnation in medicine on vacuous theorizing is empiricism’s oldest trope, and Locke was still arguing that way. The Revolutionary doctors in­terpret their contribution to the political change of the time as a triumph of empiricism, the liberation of medical experience from authority and sterile orthodoxy.

Foucault thinks something more interesting happened in medicine at this time. The modern (post-Revolutionary) clinic is more than a place to prac­tice the ancient arts of observation and diagnosis. It is the place for a new kind of vision directed to a new kind of patient with a new kind of body, and a change “in the fundamental structure of experience.” Such language sounds paradoxical if we think experience is a pure and timeless given. But if we remember a lesson of empiricism, which is that experience is a mnemic syn­thesis of sensations recalled and repeated, then a change in “the fundamental structure of experience” is no more mysterious than differences in what is memorable in perception, which may of course change with time.⁸⁹

The birth of the clinic is the moment when medical experience, or what is institutionally memorable in a doctor’s perception, is directed down a new channel.

Foucault describes the advent of this new clinic as regime-change at the level of medical savoir, which he distinguishes from accumulated connaissances. “It is not a matter of the same game, somewhat improved, but of a quite different game.” Experience is conditioned not just generally and indifferently by the evolution and neurology that people everywhere share.

Experience is also conditioned by what divides us, especially place and time. These differences condition the discursive rules and regimes of perception that enable people to see and say the same things. The idea is not that experi­ence is conditioned by language; rather, it is subject to conditions like those of language, knowledge being structured like a language.⁹¹

Seeing is always seeing-what, and the “what” is a concept, hence condi­tioned by a rule of application which for Foucault, contradicting Kant, is in every case historically contingent, even ephemeral. The appeal to experi­ence offers no relief from contingency and historical difference. Foucault’s refusal to lead the series of contingencies to a reasonable end ruins Kant’s transcendental aspiration for empirical objectivity. However, if you think of experience as Aristotle and Galen did, as much memory, then Foucault’s demonstration of its historical contingency is interesting, but not paradox­ical or even unexpected. There is no universal regime of memorable percep­tion, and who would have expected one?

Foucault’s claim that experience depends on unconscious historical syntax seems deterministic. Even if his hypothetical rules of discursive formation exist, which was more asserted than demonstrated, they seem as amenable to creative torsion as they are exacting of unconscious conformity. No discur­sive formation organized Galileo’s telescopic observations. He tried to adjust what he saw to available syntax, but let the experience stress and afflict it, successfully rebelling against any regime of perception that may have existed at his time. Everywhere that experiments are creative, the syntax of know­ledge is afflicted. In Bernard’s time syntax said plants were not animals, but his experiments made the rule seem impudent.