something about "The Birth of the Clinic" by Michel Foucault

In The Birth of the Clinic, Michel Foucault mines late 18th and early 19th century changes in medical practice (this, significantly, is around the time of the American and French Revolutions, following on the heels of the Enlightenment). These changes shaped modern medicine.

The discourse on human rights inspired by these revolutions led to an overall concern with society and health; and the move toward egalitarianism pushed physicians (and teaching physicians) out of the the aristocracy and reassigned them to general society.

The new imaginings of hard science dictated that we let truths reveal themselves to us. In The Birth of the Clinic, Foucault feels out what he calls the medical gaze--a way of seeing in which the physician allows the disease to reveal its own truth. The human body gives off signs, and the physician uses his knowledge and observations of the body to translate the reality of the disease.

The physician talks to the patient, observes him, examines him, orders tests and whatnot. Mysticism is abandoned for a discussion of the body; the physician relies less on bookish medical wisdom and instead reads the body. The physician's eye sees in space symptoms and physical signs.

The physician’s observations affect the gaze; the gaze affects the physician. Doctors systematically describe diseases using medical jargon. The physician's power is now his experience rather than his status. The gaze has scientific credibility. And we've successfully achieved truth in spite of the doctor's status, not because of it. (So we think.)

Together at any cost

The New York Times interest piece "Navigating Love and Autism" (1) establishes romantic relationships as a normalizing force and (2) documents an effort to normalize autistic people. The story begins with college-aged Kirsten dating a young man who offers her some much needed coaching in the social graces. She chafes under his direction and is soon drawn to another young man, Jack, who shows no interest in such social conventions. Comforted by the lack of expectations each felt from the other, Jack and Kirsten strike up a relationship. Soon, though, she realizes she needs more affection and understanding than her new beau can give. He has Asperger syndrome, and, turns out, she sort of does, too. They push on together, usually either arguing or just keeping one another company. She starts learning to cope and eventually he lets her get a kitten.

We're supposed to assume that being in a troubled relationship is preferable to being alone, and that this couple is to be congratulated even though their partnership is fraught with difficulties. From the article:

The months that followed Jack and Kirsten’s first night together show how daunting it can be for the mindblind to achieve the kind of mutual understanding that so often eludes even nonautistic couples.

The story continues: After establishing a presence on an advice web site for Autistic people, Jack and Kirsten are somehow invited to speak publicly about relationships. Kirsten is quoted as saying  “Parents always ask, ‘Who would like to marry my kid? They’re so weird.' But, like, another weird person, that’s who." The people who approached them for advice feel anxiety about their own relationship prospects.

The message: They may not be happy but at least these autistic people can try to be normal by having a relationship.

Since the earliest diagnoses, the prevailing wisdom has said that people with Aspergers were mostly unable to have meaningful personal relationships. So, now, the general narrative spawning this article and Jack and Kirsten's efforts is supposed to be that "the overarching quest of many (new adults) in this first generation to be identified with Asperger syndrome is the same as many of their nonautistic peers: to find someone to love who will love them back." Before establishing this narrative we might first check whether we share a common definition of love and value the same things in relationships. What we consider a traditional relationship may not be the shoe that fits Kirsten or Jack.

Where does this "quest" come from? Why the anxiety about being alone?

Notes:

• I heard Asperger syndrome won't appear in the next Diagnostic and Statistical Manual of Mental Disorders (this would be volume five). Instead the diagnosis will fall under the general Autism spectrum.

• The best part of the article comes when the question is put to Jack: Did you ever fear being alone? He answers, “I have no doubt if I wasn’t dating Kirsten I would have a very hard time acquiring a girlfriend that was worthwhile.”

Their death, their salvation

The CNN piece "A safe place to drink, or just giving up?" depicts wethouse residents while asking, "Are wet houses a way to keep late-stage alcoholics safe, or do they just give up on a treatable disease?"

When considering the former answer, the author suggests that residents are being kept from the streets and the streets are being kept from the potentially destructive residents. When considering the latter answer, the article reveals that a resident interviewed in the piece subsequently died, and that death there is common. Additionally, quotes supporting each answer are collected from two professionals in the health and treatment industry.

The article's question isn't answered explicitly, but the primary conclusion was made long before its words were committed to paper: That these residents are symbols of tragedy and shame whose salvation comes from health professionals.

The residents depicted in the article feel tremendous guilt for the personal and public costs of their living. The article discusses each man's loneliness and poverty, and it summarizes the tax savings wethouses can bring by avoiding hospitalization and incarceration.

In all, the article (1) emphasizes the self-shaming felt by those of fail to embody the esteemed value and ideology of self-reliance, and (2) re-establishes modern medicine and psychology as the valid and dominant sources of that ideology, and as leaders in prescribing correct ways of living.


Article discussed: http://www.cnn.com/2011/HEALTH/05/11/minneapolis.wethouse.alcoholics/