Testimony to Muzil: Hervé Guibert, Michel Foucault, and the “Medical Gaze” examines the fictional/autobiographical AIDS writings of the French writer Hervé Guibert. Locating Guibert's writings alongside the work of his friend Michel Foucault, the article explores how they echo Foucault's evolving notions of the “medical gaze.” The article also explores how Guilbert's narrators and Guibert himself resist and challenge the medical gaze; a gaze which particularly in the era of AIDS has subjected, objectified, (...) and even sometimes punished the body of the gay man. It is argued that these resistances to the gaze offer a literary extension to Foucault's later work on power and resistance strategies. (shrink)

In conjunction with the growing feminist literature on pregnancy and visualization, this paper uses Foucault’s The Birth of the Clinic to demonstrate how the effort to make the interior of the pregnant body visible in medical discourse was a crucial part of the development of the modern medical gaze. In doing so I develop two concurrent arguments. First, I argue that the pathological corpse of the Clinic can conceptually serve as a double for the pregnant body as (...) it emerged in modern medicine in the 20th century. At the same time I use the insights of the Clinic to illustrate changes in pregnancy from early modernity to the 20th century. In early modernity, the pregnant body was understood in terms of generation, as a tree that bears fruit; by the 19th century, the pregnant body was a machine that reproduced the species. This transition can be seen in the overlap of pathology and pregnancy in early modernity, an overlap that continued throughout the 19 century and is inadvertently reinforced through the practice of ultrasound. (shrink)

ArgumentIn this paper I examine the mass medical inspections of immigrants to the United States from the 1890s through the 1920s. I show how, framed as it was not only by nativism and eugenics but also by national industrial imperatives and priorities, scientific medicine served dual purposes. On the one hand, the medical exam was a tool for managing cultural and biological threats to the nation. There were regional variations in medical inspections that reflected the politics of (...) race. On the other hand, the medical exam played an important role in the process of building an unskilled, highly mobile labor force. The industrial demands of the nation provided a rationale for drawing and absorbing millions of European immigrants into the labor force. It was thus a distinct product of the political economy of immigration. It was this second function that characterized the exam for the majority of immigrants entering the nation. (shrink)

Perceptions are often merely regarded as the basic elements of knowledge. They have, however, a complex structure of their own and are far from being elementary. My paper will analyze two basic patterns of perception and some of the resulting medical implications. Most basically, all object perception is characterized by a mixture of knowledge and ignorance (Husserl). Perception essentially perceives with inner and outer horizons, brought about by the kinesthetic activity of the perceiving subject (Sartre). This first layer of (...) perceptual reality, the world of open perceptions, is the inescapable background for every rationality, every value, every existence (Merleau-Ponty). On an epistemological level a characteristic change of perceptual patterns in medicine was introduced by pathological anatomy (Foucault). The reference of medical perception to the dead body created the new possibility of absolute perception, allowing for more precise medical interventions, but at the same time coming into conflict with the open structures of ordinary, non-scientific perception patterns in everyday life. On the basis of these distinctions, an analysis of the different perceptual patterns in medicine becomes possible. Such an analysis would be the task of a sub-field in medical philosophy that could be called medical aesthetics having as its goal an art of perception understood as a technique of adequately applying different perceptual patterns in medical practice. (shrink)

The article illustrates the main features of the concept of medicalization, starting from its theoretical roots. Although it is the process of extending the medical gaze on human conditions, it appears that medicalization cannot be strictly connected to medical imperialism anymore. Other "engines" of medicalization are influential: consumers, biotechnology and managed care. The growth of research and theoretical reflections on medicalization has led to the proposal of other parallel concepts like pharmaceuticalization, genetization and biomedicalization. These new theoretical (...) tools could be useful in the analysis of human enhancement. Human enhancement can be considered as the use of biomedical technology to improve performance on a human being who is not in need of a cure: a practice that is increasingly spreading in what might be defined as a "bionic society". (shrink)

Medicine, as Byron Good argues, reconstitutes thehuman body of our daily experience as a medical body,unfamiliar outside medicine. This reconstitution can be seen intwo ways: as a salutary reminder of the extent to which thereality even of the human body is constructed; and as anarena for what Stephen Toulmin distinguishes as theintersection of natural science and history, in which many ofphilosophy''s traditional questionsare given concrete and urgent form.This paper begins by examining a number of dualities between themedical body and (...) the body familiar in daily experience. Toulmin''s epistemological analysis of clinical medicine ascombining both universal and existential knowledge is thenconsidered. Their expression, in terms of attention,respectively, to natural science and to personal history, isexplored through the epistemological contrasts between themedical body and the familiar body, noting the traditionalphilosophical questions which they in turn illustrate. (shrink)

This volume addresses the interdependencies between visual technologies and epistemology with regard to our perception of the medical body. It explores the relationships between the imagination, the body, and concrete forms of visual representations: Ranging from the Renaissance paradigm of anatomy, to Foucault's "birth of the clinic" and the institutionalised construction of a "medical gaze"; from "visual" archives of madness, psychiatric art collections, the politicisation and economisation of the body, to the post-human in mass media representations. Contributions (...) to this volume investigate medical bodies as historical, technological, and political constructs, constituted where knowledge formation and visual cultures intersect. Contributors are: Axel Fliethmann, Michael Hau, Birgit Lang, Carolyn Lau, Heikki Lempa, Stefanie Lenk, Joanna Madloch, Barry Murnane, Jill Redner, Claudia Stein, Elizabeth Stephens, Corinna Wagner, and Christiane Weller. (shrink)

Scientific medicine carries within it an inherent contradiction. On the one hand, given its general scientific inquiry into health and disease, their conditions, etiologies, and treatments, it makes a claim for universality. To justify this claim, at different times and in different places, scientific medicine has prioritized techniques such as the medical gaze and autopsies to assure its diagnoses; it has applied numerical methods in order to have a better grasp of diseases and their possible treatments; it has (...) used laboratory analyses in order to understand life at its molecular level; and more recently it has introduced Randomized Clinical Trials in order to generalize clinical treatments. On the other hand, contrary to its universalistic claims, scientific medicine sets up and reifies boundaries. It creates distinctions between the healthy and the sick and defines categories, such as gender and race, that have deep political and social meanings. (shrink)

Slovenian philosopher Miran Bozovic's An Utterly Dark Spot examines the elusive status of the body in early modern European philosophy by examining its various encounters with the gaze. Its range is impressive, moving from the Greek philosophers and theorists of the body (Aristotle, Plato, Hippocratic medical writers) to early modern thinkers (Spinoza, Leibniz, Malebranche, Descartes, Bentham) to modern figures including Jon Elster, Lacan, Althusser, Alfred Hitchcock, Stephen J. Gould, and others. Bozovic provides startling glimpses into various foreign mentalities (...) haunted by problems of divinity, immortality, creation, nature, and desire, provoking insights that invert familiar assumptions about the relationship between mind and body. The perspective is Lacanian, but Bozovic explores the idiosyncrasies of his material (e.g., the bodies of the Scythians, the transvestites transformed and disguised for the gaze of God; or Adam's body, which remained unseen as long as it was the only one in existence) with an attention to detail that is exceptional among Lacanian theorists. The approach makes for engaging reading, as Bozovic stages imagined encounters between leading thinkers, allowing them to converse about subjects that each explored, but in a different time and place. While its focus is on a particular problem in the history of philosophy, An Utterly Dark Spot will appeal to those interested in cultural studies, semiotics, theology, the history of religion, and political philosophy as well. Miran Bozovic is Associate Professor of Philosophy at the University of Ljubljana, Slovenia. He is the author of Der grosse Andere: Gotteskonzepte in der Philosophie der Neuzeit (Vienna: Verlag Turia & Kant, 1993) and editor of The Panopticon Writings by Jeremy Bentham (London: Verso, 1995). (shrink)

This article discusses the moment in which normative ideas about aging and reproductive embodiment became conceptually linked in the mid-nineteenthcentury medicalization of menopause. The reading centers on the first English book-length publication on menopause, written by E. J. Tilt in 1857, and Foucault’s concept of the medical gaze. I analyze mechanisms of observing, conceptualizing, and treating the body in relation to time and discuss their function in affirming and reworking social norms of age and gender. In doing so, (...) I highlight the political work implicit in contesting conceptualizations of female reproductive bodies, their age-specific pathologies, and directives of surveillance employed in discourses surrounding women’s reproductive health. (shrink)

Medicine maintains a distinction between the medical symptom -- the patient''ssubjective experience and expression, and the privileged medical sign -- the objective findings observable by the doctor. Although the distinction is not consistently applied, it becomes clearly visible in the undefined, medically unexplained disorders of women patients. Potential impacts of genderized interaction on the interpretation of medical signs are addressed by re-reading the diagnostic process as a matter of social construction, where diagnosis results from human interpretation within (...) a sociopolitical context. The discussion is illustrated by a case story and empirical evidence of the gendering in the doctor-patient relationship. The theoretical analysis is supported by semiotic perspectives of bodily signs, feminist theory on experience, and Foucault''sideas about medical perception and gaze, and concludes that a medical diagnosis is seldom a biological fact, but the outcome of a process where biological, cultural and social elements are interwoven. Further deconstruction of the chain of signs from a feminist perspective, assigning validity to the voice of the woman patient, might broaden the understanding of women''shealth, illness and disease. (shrink)

ObjectiveA sickness history from General Practice will be unfolded with regard to its implicit lived meanings. This experiential matrix will be analyzed with regard to its medico-theoretical aspects.MethodThe analysis is grounded in a phenomenology of the body. The patient Katherine Kaplan lends a particular portrait to the dynamics that are enacted in the interface between socially silenced domestic violence and the theoretical assumptions of human health as these inform the clinical practice of health care.ResultsBy applying an understanding of sickness that (...) transcends the mind-body split, a concealed and complex logic emerges. This logic is embedded in a nexus of the impact of childhood abuse experience and the medical disinterest in subjective experiences and their impact on selfhood and health. Its core is twofold: the violation of embodiment resulting from intra-familial abuse and existential threat, and the embodiment of violation resulting from social rules and the theoretically blinded medical gaze.ConclusionA considerable medical investment, apparently conducted in a correct and consistent manner as to diagnostic and therapeutic measures, results in the complete incapacitation of a young physician. (shrink)

Bioethical concerns about the potential for abuse in medical aid in dying (MAID) have focused primarily on the risk of coercion (Battin et al. 2007; Foley and Hendin 2002). Accordingly, the require...

Guiding our response in this essay is our view that current efforts to demarcate the role of the clinical ethicist risk reducing its complex network of authorizations to sites of power and payment. In turn, the role becomes susceptible to various ideologies—individualisms, proceduralisms, secularisms—that further divide the body from the web of significances that matter to that body, where only she, the patient, is located. The security of policy, standards, and employment will pull against and eventually sever the authorization secured (...) by authentic moral inquiry. Instead of asking “What do I need to know?”, the question animating the drive to standardize will be “What is the policy or standard?” The claims of the authors in this issue of HEC Forum confirm these suspicions. (shrink)

This article presents an archaeological inquiry into the early histories of Quality of Life measures, and takes this as an occasion to rethink the concept of the ‘medical model of disability’. Focusing on three instruments that set the ground for the emergence of QoL measures, namely, the Karnofsky Performance Scale, and the classification of functional capacity as a diagnostic criterion for heart diseases and as a supplementary aid to therapeutic criteria in rheumatoid arthritis – I discuss how medicine, throughout (...) the emergence of QoL, began to expand its gaze beyond the confines of the body to what that body does in daily life. Building upon Armstrong et al.’s notion of ‘distal symptoms’ and Wahlberg’s idea of ‘knowledge of living’, I propose the notion of disabilitization to encapsulate this expansion of the clinical gaze, through which medicine has come to articulate diseases and their treatments in new ways, and in so doing, has inadvertently created disability as a new kind of knowledge category in itself – a category that is defined not through its reduction to mere pathology, but through its dispersal into everyday life. I present this concept not as a periodization, but as a provocative discontinuity with the totalizing history assumed within the medical model of disability, and in so doing, ask what, in fact, holds ‘the medical model’ together, and whether there might be other ways of understanding medicine’s complex relationship to disability than what the concept of the medical model allows us to envisage. (shrink)

The following pages sketch the outlines of “a Canaanite reading” of the health system. Beginning with the Black person—African, Afro-diasporic, Aboriginal, and Torres Strait Islander—who is seen by a health professional, the functions and effects of the racializing gaze are examined. I wrestle with Al Saji’s understanding of “colonial disregard,” Whittaker’s insights into the extractive disposition of settler institutions vis-à-vis Indigenous peoples, and Saidiya Hartman and Fred Moten’s struggle with the spectacular. This leads me to conclude that the situation (...) of the Black within the health system is a tragic one. The prescription for the path out of this tragedy that I settle on, responding to Okiji’s opening call, is found in Vernon Ah Kee’s “Unwritten” series. (shrink)

The interior of the body is an alien landscape, the frontiers of which we are continually expanding. Technological developments have allowed us to see more and more of what lies beneath the skin. Starting with the violently erotic public spectacle of dissection in amphitheatres, through X-ray and endoscopy, to other current and future technologies that work towards the yet to be realized ideal (or myth) of a truly non-invasive but microscopically detailed depiction of the human body. This opening up of (...) the human interior to our gaze is not exclusively a medical phenomenon. It is an exploration that has been shared by scientists, artists and entertainers, variously reappropriating imagery and technologies of seeing. Each new invasive technology brings with it the somewhat naïve belief that it can excavate the essence of the subject, their passions, motivations and faults, their ‘souls’ for lack of a better word. Yet while an X-ray can certainly not tell us anything of the subject’s personality, as we delve deeper we discover more about our chemical and electrical natures, encouraging the perception that our consciousness is the ‘sum of our parts’. However, as technologies have become more sophisticated, there has been an increasing tendency to present the body in segments, detached from their surrounding structures. A certain objectification and distancing that occurs when we view the flesh laid open. How do we engage with these views culturally, and how do they influence how we view others and ourselves? In this article I grapple with notions of a mutating body that we are actively in the process of changing in the context of my own and others’ visual practice, with particular emphasis on making the mediated nature of these images visible. I will engage in a celebratory but critical discussion of others’ and mine. (shrink)

This is the first book to unpack the legal and ethical issues surrounding unauthorised intimate examinations during labour. The book uses feminist, socio-legal and philosophical tools to explore the issues of power, vulnerability and autonomy. The collection challenges the perception that the law adequately addresses different manifestations of unauthorised medical touch through the lens of women's experiences of unauthorised vaginal examinations during labour. The book unearths several broader themes that are of huge significance to lawyers and healthcare professionals such (...) as the legal status of women and their bodies. The book raises questions about women's experiences during childbirth in hospital settings. It explores the status of women's bodies during labour and childbirth where too easily they become objectified, and it raises important issues around consent. The book highlights links to the law on sexual offences and women's loss of power under the medical gaze. The book includes contributions from leading feminist philosophers, medical professionals, and academics in medicine and law, and offers pioneering analysis relevant to lawyers and healthcare professionals with an interest in medical law and ethics; feminist theory; criminal law; tort law; and human rights law. (shrink)

This article aims to explore Kazuo Ishiguro’s Never Let Me Go within the Foucauldian theoretical framework in order to analyse the manifold biopolitical issues, namely cloning, by stretching the discourse to a speculative, dystopian posthuman scenario wherein the dominant, privileged, affluent human society replenishes them by incorporating bio-matter from the clones. The article also proposes to unfold the myriad ways the institutions, namely Hailsham and recovery centres in the novel, exercise power and execute power relations with the clones. It describes (...) the way these institutions turn out to be what Foucault calls the regimes of truth and how the clones choose to remain docile to the institutional power, and consequently, they turn out to be rich sites for both medical gaze and disciplinary gaze. Nevertheless, the article also details the procedures by which the bizarre truth of organ donation of the clones is buried under the technical discourse of good work. (shrink)

This essay review discusses criticall the book the universal excemption of Slavoj Zizek. Just after finishing my two recent books: Tracing Spikes in Fear and Narcissism in Western Democracies Since 9/11 and The Challenges of Democracy in the War on Terror. While in the first work I traced back the limitations of Psychoanalysis as well as its complicities to legitimate the advance and expansion of capitalism, the latter focused on the role of torture –as a lesser evil- of contemporary government (...) in their war on terror. One of my arguments sounded polemically as though not only terrorism is the organization of labor by other means but psychoanalysis organized a specific ethics, which extracting its nature from ancient Greek philosophy, ascribed to the theory of scarcity which is the touchstone of capitalism. Secondly but most important, Occident carefully developed a doctrine of security, which the part may be sacrificed at the moment the body is in danger. Let me put the medical metaphor of cancer. While the medical gaze is programmed to look and eradicate the pathology, the illness, cancer derives from an anomaly of cell growth. Once some organs are affected, the medical gaze does not hesitate in extirpating the affected organ. The same allegory can be applied to the war on terror and the serious risks of ghettoization the Muslim community daily faces. (shrink)

The terms ‘menopause’ and ‘mid‐life women’ have become the subjects of both the medical gaze and a billion‐dollar industry built by pharmaceutical companies to manage the ‘problems’ of menopause. Menopause is a discursive construction, a label that has become endowed with a large number of taken‐for‐granted assumptions about physical and psychological symptoms, self‐image and health status. These assumptions are based on the medical interests, social preoccupations, research and subsequent drug‐marketing strategies conducted in western societies. Thai society is (...) structured around a different philosophy, which has created different meanings for the mid‐life woman. This paper explores the Western discourses of menopause and the colonizing effect when the assumptions underpinning these are imposed on Thai women. (shrink)

The themes of this issue—which include the meaning of our health and disease concepts, the so-called “medical gaze” and its embedded power relations, and the epistemic value of mixing therapy with research—are introduced by reflecting on a case about an infant girl whose head is observed to be somewhat flat.

With the increased acceptance of complementary and alternative medicine (CAM) within society, new research reflects deeper folk health histories beyond formal medical spaces. The contested relationships between formal and informal medicine have deep provenance and as scientific medicine began to professionalise in the 19th century, lay health knowledges were simultaneously absorbed and disempowered (Porter 1997). In particular, the ‘medical gaze’ and the responses of informal medicine to this gaze were framed around themes of power, regulation, authenticity (...) and narrative reputation. These responses were emplaced and mobile; enacted within multiple settings by multiple agents and structures over time. The work is drawn from secondary material from Ireland, which identify more indigenous narratives of health and act as potential sources for medical humanities. While assumptions have been made as to the place of folk-medicine being essentially rural, evidence will be presented which shows a more complex network of health beliefs and practices. The narratives of informal practice and folk-medicine drawn from evidence from Ireland point to more fluid and hybrid relations with formal medicine and suggest that the complementary nature of the two models reflected wider cultural debates and models of belief (Del Casino Jnr., Health & Place 10:59-73, 2004). (shrink)

This article analyzes how the medical gaze made possible by MRI operates in radiological laboratories. It argues that although computer-assisted medical imaging technologies such as MRI shift radiological analysis to the realm of cyborg visuality, radiological analysis continues to depend on visualization produced by other technologies and diagnostic inputs. In the radiological laboratory, MRI is used to produce diverse sets of images of the internal parts of the body to zero in and visually extract the pathology. Visual (...) extraction of pathology becomes possible, however, because of the visual training of the radiologists in understanding and interpreting anatomic details of the whole body. These two levels of viewing constitute the bifocal vision of the radiologists. To make these levels of viewing work complementarily, the body, as it is presented in the body atlases, is made notational. (shrink)

This essay argues that Berger and Mohr’s A Fortunate Man (1967) – comprising social observation and photographs of the rural practitioner, Dr. Sassall and his patients – enacts an embodied, intersubjective empathy called “pain-work.” The book enacts “pain-work” through two strategies. Firstly, by conflating three ways of seeing – Berger’s observation, Mohr’s photography, and Sassall’s medical gaze – it shows that the clinical encounter embodies objective vision through intersubjective pain. Secondly, it employs the concepts of recognition and witnessing (...) to show how the subjectivity of the physician is distributed in his community. Thus, Berger and Mohr witness Sassall’s witnessing of his patients; even as Sassall and his patients are constituted intersubjectively, so too are Berger, Mohr, and Sassall. (shrink)

Frequent observation: sexualities, self‐surveillance, confession and the construction of the active patient Following Foucault’s analyses of the development of the disciplinary power of the medical gaze, this paper describes the themes that are relocating the ‘active patient’ as the central object of health scrutiny by professionals. A key element in these discourses has been the deployment of power through disciplinary knowledge and techniques of social control through ritual forms of confession, thereby positing the patient/client as the subject of (...) self‐surveillance. The individual is also engaged their own sexuality, performativity and ‘truths’ of sexual experience. These Foucauldian insights have constructed the notion of surveillance medicine, whereby with the assistance of professional technologies, not only the patient’s body but also the ‘self’ can be probed through incitement to confess. However, the actor is not docile; resistances to disciplinary techniques are evident and within the professional practices of the clinic, there is resistance to the power of the erotic. The paper draws on recent research on the social construction of male sexualities in the fields of genitourinary practice, and explores how the ceremonial practices of the clinic engage with the rise of surveillance medicine and the medicalisation of everyday life. The individual actor is exhorted to engage in increased sexual and medical self‐surveillance and to be recruited in the project of becoming an ‘active patient’. It concludes with an examination of some of the implications this surveillance of self may have for practitioners in terms of power and the professional lens through which the sexualised, symbolic body is viewed. (shrink)

‘Plastinates’ (i.e. corpses conserved through plastics) are lab created artifacts which since the nineties have been the subject of a cultural field experiment via an anatomical exhibition. Similarly to brain-dead or digitalized bodies, they constitute an ambiguous form of post-mortem existence. The article inquires after the ways in which the ontological status of these entities is constituted through the practices of body donors, anatomists and visitors. Plastinates owe their ambiguity to an oscillation between two different frames of perception. Their meaning (...) is determined by the extent to which an anatomy exhibition can impose a ‘medical gaze’ over a non-professional way of perception, which would stubbornly associate bodies with persons. This association depends on two qualities of plastinates, which refer back to the donor: on the one hand, they draw the observer into a communicational relationship, since the body is the archetypal medium of the self-representation of persons. On the other hand, the plastinated body, considered as ‘bequest’, acquires a biographical dimension: though the exhibition tries to appropriate the individual body anatomically, as an exemplar of a timeless, abstract idea of the human, the visitor’s mundane perspective reintegrates the exhibit into history. Plastinates are the embodied expression of the last will of those people whom the public meets in the exhibition. (shrink)

Testimony to Muzil: Hervé Guibert, Michel Foucault, and the “Medical Gaze” examines the fictional/autobiographical AIDS writings of the French writer Hervé Guibert. Locating Guibert's writings alongside the work of his friend Michel Foucault, the article explores how they echo Foucault's evolving notions of the “medical gaze.” The article also explores how Guilbert's narrators and Guibert himself resist and challenge the medical gaze; a gaze which particularly in the era of AIDS has subjected, objectified, (...) and even sometimes punished the body of the gay man. It is argued that these resistances to the gaze offer a literary extension to Foucault's later work on power and resistance strategies. (shrink)

This essay brings together critical perspectives from the discrete traditions of artists’ books and the medical humanities to examine artists’ books by three contemporary artists – Penny Alexander, Martha A. Hall and Amanda Watson-Will – that treat experiences of illness and wellbeing. Through its focus on a multimodal and multisensory art form that has allegiances with, but is not reduced to, narrative, the essay adds to recent calls to rethink key assumptions of illness narrative study and to challenge utilitarian (...) approaches. In particular, it draws attention to the aesthetic and imaginative elements of illness communication by exploring how artists’ books represent lived experiences in a distinctively palpable way and offer an “intimate authority” that extends beyond narrative legitimacy or a form of struggle against the medical gaze. By interrogating narrative’s dominance in medical humanities research, the essay further expands awareness of illness experiences that resist conventional forms of representation (such as chronic illness), and of alternative reflective practices within healthcare education that encourage engagement with both mind and body. (shrink)

In Naissance de la clinique, Michel Foucault develops a theory of the socialization of perception called “archaeology of the medical gaze.” According to this model, the everyday gaze is conditioned by a perceptual code that determines both the features worthy of attention and the meaning to be attributed to them, called “regimes of visibility.” The aim of this article is to describe the interests and difficulties of such a project. I will show that Foucault does not develop (...) any real theory of perception, which weakens his model in two ways: first, at the theoretical level, it leaves aside the question of the transformation of the perceptual code that has been brought to light; second, at the empirical level, it is unable to account for contemporary ethnographies of medical practice. (shrink)

In this paper I draw on the French philosopher Michel Foucault for a viewpoint on aspects of EBM. This means that I develop his idea of the spaces occupied by disease. I give much of the paper to only one of these spaces, the space of perception of disease, in order to major on the medical gaze, one of Foucault’s best-known contributions to the philosophy of medicine. As I explain what I mean by each of the spaces of (...) disease, I configure EBM into this space. The conscientious, explicit, and judicious use of current best evidence in making decisions about the care of individual patients. Evidence-based clinical practice requires integration of individual clinical expertise and patient preferences with the best available external clinical evidence from systematic research and consideration of available resources. EBM can be considered a subcategory of evidence-based healthcare, which also includes other branches of health-care practice such as evidence-based nursing or evidence-based physiotherapy. EBM subcategories include evidence-based surgery and evidence-based cardiology (Guyatt et al. 2008 , 783). (shrink)

This paper argues that the graphic adaptation of Dennis Lehane’s Shutter Island utilizes the medium to evoke an affective participation and investment from the reader. It explores the ways the graphic novel overcomes problematic representations of mental illness in the popular film version. Drawing on graphic fiction theory, I contend that readers’ engagement in and construction of the story between panels, in the “gutters,” allows them to participate in the protagonist’s persecutory delusion. Additionally, I draw on Foucault’s conceptualizations of the (...) medical gaze and historical figurations of madness connected to water in order to demonstrate the mechanism by which the reader is placed in a dual subject position, becoming both observer and observed. In this capacity, I suggest that graphic fiction provides a unique experience to engender empathy for psychiatric illness. (shrink)

A Foucauldian assessment of the common presumption that genetic information is potent and thus oppressive demonstrates that the concern may be misplaced. Foucault's concept of “technologies of self” reveals that genetic power originates not only from the potency of genetic information but from the penchant of individuals to victimize themselves in the name of optimal health, enhanced intelligence, perfect babies, or would-be immortality. Rather than seeking liberation from the power of the new genetics, Foucault's reinterpretation of the ancient understanding of (...) concern for the self offers the possibility to avoid control by the scientific discourse. His ethical response calls for resistance rather than opposition and places responsibility for resistance in the hands of the subject. Characteristically, he avoids a generalizable form of morality but clarifies that resistance includes acknowledging the human appetite for perfection and subordinating science to ethical and aesthetic matters. (shrink)

Gazing into the Depths of the Soul: Hypnotism in Documentary and Instructional Film (1920–1936). Although part of the medical fold since the 1870s, hypnosis was long relegated to the margins, recognised and used by only a relatively small group of medical professionals. In the decades around 1900 hypnotic techniques were monopolised as a form of medical treatment through a long and in no way linear process. Hypnosis of laymen was vehemently opposed, however, denounced as being far too (...) dangerous. And yet, medical participation in the aura of spectacular intervention into the human psyche garnered support. The medium of both documentary and instructional film served an important function in this regard, conveying popular interest in acknowledging hypnosis as a scientific method. On the basis of four medically accredited films on hypnosis from 1920 to 1936, this paper attempts to investigate how medical experts and these genres, as part of their effort to claim hypnosis from the realm of public spectacle and parapsychological experimentation, worked to stabilise hypnosis as a purified form of medical and psychiatric practice. (shrink)

Government, media, and medical accounts of Emma Goldman converged to create her public presence in the U.S. as a "dangerous individual." The prevailing discourses constituted Goldman as violent, utilizing her alleged menace to distract attention from far more egregious violence against labor by state and corporate forces. Goldman responded by denying, confronting, and redirecting the alarmed gaze toward greater risks left underarticulated in hegemonic accounts. Goldman's bold confrontations with authorities constituted a kind of anarchist parrhesia, fearless speech, a (...) relentless truth-telling practice that risked her own security in pursuit of her "beautiful ideal." The labor of remembering America's history of class violence hones our attention to the complex discursive processes by which some historical facts come to count in prevailing narratives, while others fade into obscurity. (shrink)

This article examines how digital epidemiology and eHealth coalesce into a powerful health surveillance system that fundamentally changes present notions of body and health. In the age of Big Data and Quantified Self, the conceptual and practical distinctions between individual and population body, personal and public health, surveillance and health care are diminishing. Expanding on Armstrong’s concept of “surveillance medicine” to “quantified self medicine” and drawing on my own research on the symbolic power of statistical constructs in medical encounters, (...) this article explores the impact of digital health surveillance on people’s perceptions, actions and subjectivities. It discusses the epistemic confusions and paradoxes produced by a health care system that increasingly treats patients as risk profiles and prompts them to do the same, namely to perceive and manage themselves as a bundle of health and security risks. Since these risks are necessarily constructed in reference to epidemiological data that postulate a statistical gaze, they also construct or make-up disembodied “individuals on alert”. (shrink)

The enlarging domain of psychiatric intervention is frequently associated with the undue medicalization of unusual experiences. In such a climate, it becomes of utmost importance to carefully choose appropriate candidates for the psychiatric gaze. This suggests a need to draw a distinction between religious experiences (with psychotic form) and pathological psychotic experiences. As Jackson and Fulford (1997) maintain, “spiritual experiences, whether welcome or unwelcome, and whether or not they are psychotic in form, have nothing (directly) to do with medicine. (...) It would be quite wrong, then, to “treat” spiritual psychotic experiences with neuroleptic drugs, just as it is quite wrong to “treat” political .. (shrink)

Those are the words of Pope John Paul II, speaking in March 2004 to an international congress held in Rome. The conference was on "Life-sustaining Treatments and Vegetative State: Scientific Advances and Ethical Dilemmas," and it was organized by the World Federation of Catholic Medical Associations and the Pontifical Academy for Life. The pope was able to cut through all the ethical dilemmas. Although he acknowledged that a patient in a persistent vegetative state, or PVS, "shows no evident sign (...) of selfawareness or of awareness of the environment, and seems unable to interact with others or to react to specific stimuli," he said that they should be kept alive indefinitely. Such patients, he insisted, "retain their human dignity in all its fullness" and "the loving gaze of God the Father continues to fall upon them." For this reason, he said, it is obligatory to continue to provide them with food and water, even if this can only be done through a tube. The pope added that to withdraw the tube, knowing that it will lead to the death of the patient, is "euthanasia by omission.". (shrink)

One of the dominant behavioral markers of visual-expert search strategy, Holistic Visual Processing (HVP), suggests that experts process information from a larger region of space in conjunction with a more focused gaze pattern in order to improve search speed and accuracy. To date, extant literature suggests that visual search expertise is domain specific, including HVP and its associated behaviors. The current study is the first to use eye tracking to directly measure the HVP strategies of two expert groups, radiologists (...) and architects, in comparison to one another and a novice control. In doing so, we replicated and extended this prior research: visual expertise is domain specific. However, our eye tracking data indicate that contrary to this prior work, HVP strategies are transferable across domains. Yet, despite the transfer of HVP strategies, there is neither reduced search time nor greater accuracy in visual search outside of an expert’s domain. Therefore, our data suggest that HVP behaviors are a particular form of visual search mechanism that, outside of an expert’s native search-ecology, are not necessarily conducive to more general visual search success. It is in addition to explicit knowledge of an expert’s domain, how to search, and where to search, that HVP strategies are their most effective for visual search success. (shrink)

Foucault's genealogies and archeologies provide occasions in which one may come to know the powers, accidents, and influences that have structured a particular knowledge or discipline. The Birth of the Clinic shows the development of modern medicine in a process by which rational inference and emphasis on the history of a disease are replaced by pathological anatomy. In modern anatomy, the corpse, not reason, became the “space” of modern medical knowledge. In this “space” developed a confederation of dead body, (...) knowledge, trained and noninferential gaze, organic unity, and the increased importance of bodily space instead of physical time. The discussion shows how Foucault's genealogy of modern medicine is influenced by and overcomes the knowledge that it describes. In this context, his genealogy is also shown to be self-overcoming and to raise important questions for medical ethics when ethical thought is conceived within the structures of knowledge that have been exposed by the genealogy. (shrink)

Bioethicists currently working in the United Kingdom demonstrate—as indeed do the very best of their colleagues internationally—an eagerness to engage in two extremely different but complementary approaches to their subject. First, they readily become involved in discussions of concrete bioethical issues that are of great concern to the medical profession, legislators, and the wider U.K. public. Second, perhaps because they recognize the importance of the “first-order” questions that exercise the public imagination, they show themselves commendably willing to turn their (...) critical gaze onto the very methods and frameworks they use to address those questions. The first approach we can properly call “bioethical,” whereas we might term the second approach “metabioethical.”. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Lynn Huffer's Mad For Foucault:An Analysis of Historical Eros?Laura HengeholdMad for Foucault is a remarkably beautiful book balanced on the edges between the personal, the impersonal, and the public and reflected through Foucault's own struggles to establish those divides. Huffer's goal in Mad for Foucault is to draw scholarly attention to the emotional and ethical content of Foucault's writing, as well as to assess the risks of queer theory's (...) dependence on dialectics and psychoanalytic theory. Reading History of Sexuality I in light of History of Madness, she argues, renders the ethical aspects of Foucault's early project clear and reveals the continuity with his later work on ethics, putting the central concerns of queer theory in a different light. But this continuity is only visible through attention to the lyrical force resulting from tensions between these edges, which also separate genders and epochs, as if Las Meninas were to draw the viewer's gaze toward a fractured mirror rather than a sovereign one.The elements of History of Sexuality I that have been most important for the queer theorists Huffer engages are Foucault's attempt to date the shifts from a perception of sinful acts to a perception of homosexual personality types, and his warning that reifying such personality types as "identities" in hopes of liberation from heterosexist oppression continues to support the social mechanisms that identify personal truth with sexuality. Some (associated with Judith Butler) have tried to develop an account of agency that owes less to the exclusions of traditional moral and psychological theories but risks establishing its own hierarchies of psychic "health." Others (Lee Edelman is exemplary) [End Page 226] have also argued that the affects associated with these acts and identities, and possibly the ethical attitudes arising from these affects, are historical effects that must be bracketed in the name of resisting biopower (Huffer 2010, 94-95).Both groups, Huffer argues, have merely performed a dialectical reversal within the order of sexualities inherited from the nineteenth century, without appreciating Foucault's effort to cast the very terms of that order into question—above all, in History of Madness (Huffer 2010, 113-16). What is more disturbing, both sides have enlisted psychoanalysis on their behalf, although Foucault remained skeptical of psychoanalysis. In History of Madness (2006a), Foucault's skepticism was justified in the name of the affective attachments of queer life and his deeply felt fascination for the traces of a sexual hybridity almost erased from European history. For Huffer, the real question posed by both History of Sexuality I and History of Madness is not, as queer theorists might believe, "why sexuality became a moral issue" (and how might it cease to be one) but who was buried when the nineteenth-century medicalization of sexuality replaced erotic experience with explanations of sexual abnormalities (2010, 229). She reads Foucault's work as a meditation on the ethical tragedy presented by the scattered ashes of even "infamous men."Although there are many themes I could address, I will let my comments be guided by Huffer's reading of the explicit and implicit critique of psychoanalysis found in Foucault's work, and its relation to Foucault's ambivalent Kantianism (2010, 127-33, 134). This critique comes from several directions. First, throughout all his works, including Archeology of Knowledge, Foucault criticizes interpretive approaches to the historical record and to human speech. Practices such as "commentary" reduce the variety of events that can be perceived in the historical field and turn some into the content or meaning of others, which are thereby privileged metaphysically as "more real." Second, Foucault criticizes power relations forcing some to confess and to interpret the products of their own confession in terms of the meanings religious or medical authorities insist on finding there. From the seventeenth century through the present, such authorities have identified work and family-oriented behavior as "reasonable" and have forced those whose behavior does not fit those terms to understand themselves as deviations from that norm (Huffer 2010, 105, 107-108).Third, according to Huffer, Foucault subjects belief in the psyche as scientific object and focus of work on the self to historical analysis... (shrink)

In lieu of an abstract, here is a brief excerpt of the content:A Theory of International Bioethics: Multiculturalism, Postmodernism, and the Bankruptcy of Fundamentalism 1Robert Baker (bio)AbstractThis first of two articles analyzing the justifiability of international bioethical codes and of cross-cultural moral judgments reviews “moral fundamentalism,” the theory that cross-cultural moral judgments and international bioethical codes are justified by certain “basic” or “fundamental” moral principles that are universally accepted in all cultures and eras. Initially propounded by the judges at the (...) 1947 Nuremberg Tribunal, moral fundamentalism has become the received justification of international bioethics, and of cross-temporal and cross-cultural moral judgments. Yet today we are said to live in a multicultural and postmodern world. This article assesses the challenges that multiculturalism and postmodernism pose to fundamentalism and concludes that these challenges render the position philosophically untenable, thereby undermining the received conception of the foundations of international bioethics. The second article, which follows, offers an alternative model—a model of negotiated moral order—as a viable justification for international bioethics and for transcultural and transtemporal moral judgments.Man in the Twentieth Century can not be circumscribed by the standards of any single culture.American Anthropological Association (1948) in a statement officially denouncing the 1948 United Nation’s Declaration of Human Rights.Recently... so-called “liberal” medicine has revived the old rights of a clinic understood in terms of a special contract, a tacit pact made between one man and another. This patient gaze has even been attributed the power of assuming [a role in clinical decision making].Miracles are not so easy to come by....Michel Foucault (1975, p. 5) [End Page 201]An Overview of the AnalysisInternational bioethics originated in the trauma of the Holocaust, specifically, in the 1946–1947 Nuremberg “Doctors Trial” when a tribunal of three American judges convicted Nazi medical researchers of “crimes against humanity.” In justifying their judgment, the Nuremberg Tribunal cited 10 principles for morally permissible research, which, they claimed, were based on “fundamental” principles that civilized societies “all agree” upon and accept as the foundations of their “moral, ethical, and legal” norms. Foremost among the principles was one stating that morally permissible human experiments require the informed voluntary consent of the subject. The Nuremberg judgment soon became associated with the ideal of human rights declared in the 1948 United Nations Charter. These two ideas—fundamental principles of morality and human rights—have been linked in all major formulations of international bioethics promulgated in the past 50 years, including the Council of Europe’s 1997 Convention for the Protection of Human Rights and Dignity of the Human Being with Regard to the Application of Biology and Biomedicine (Council of Europe 1997; Dommel and Alexander 1997). In this paper, I explore the received justification for international bioethics—the idea that it is grounded in fundamental principles accepted in all societies—tracing it from its initial, almost off-hand, promulgation by the Nuremberg Tribunal, through its more thoughtful development by such bioethicists as Ruth Macklin, to its more complex use by the President’s Advisory Committee on Human Radiation Experiments.After a brief review of the evolution of the received justification, I discuss the viability of this justification in the face of the critique implicit in two important intellectual movements: multiculturalism and postmodernism. In the international context, multiculturalism asserts the claim that there are no common moral principles shared by all cultures. Postmodernism asserts a similar claim against all universal standards, moral and nonmoral. In the 1990s, bioethicists have attempted to respond to these claims in various ways. These responses are documented, analyzed, and then shown to be “bankrupt,” in the sense that they undercut the most important objective of moral fundamentalism: the justification of transcultural moral judgments, such as the condemnation of the Nazi doctors.A second article, which follows the present one in the same issue of the Kennedy Institute of Ethics Journal, revisits the contractarian tradition [End Page 202] of Hobbes and Locke, as it has been reinterpreted by David Gauthier (1986), John Rawls (1971, 1993), and Robert Nozick (1974), to develop the idea of negotiated moral order as the basis of international bioethics. When conceptualized as a negotiated moral order, international bioethics can accept the genuine insights... (shrink)