The Medical Gaze: Michel Foucault’s Description of a Revolution in Medical Thinking
A short introduction to the enduring concept
Michel Foucault is well known to researchers and readers in several fields, especially sociology, anthropology, history, and philosophy. Many of his ideas also have to do with another field, modern medicine, though most doctors, nurses, and other healthcare practitioners — at least in my home country, India — have hardly heard about him. To be sure, one can very well understand the theories and practice of medicine without ever reading even the F of Foucault. So he is not a requirement that way. But he is definitely essential if one needs to understand the philosophy of medicine.
Foucault’s most commonly known idea in medicine, the “medical gaze” or the “clinical gaze,” is one that pertains to medical perception, or the style of thinking in medicine. He introduced it in 1963 in the book Naissance de la Clinique which later was translated into English as The Birth of the Clinic: An Archaeology of Medical Perception. Foucault argued that there occurred a revolutionary shift in how medical practitioners conceptualized the human body and disease beginning around the late 1700s (though arguably the shift began much earlier). To understand this shift in thinking, it will be helpful to get a basic idea of how we thought about illness and disease in the past.
The human body as composed of “humors”
Wherever human societies lived in the past, there always existed what can be called a healing tradition, often dynamic and adapting to new ideas and discoveries. Every such tradition had its own concepts and beliefs about what the human body was, how it worked, and how disease developed, though there also were similarities in how different societies thought about disease. For example, an influence of evil spirits or an imbalance in the body’s “vital elements” were ideas common to multiple cultures and traditions throughout the world.
Imagine a physician in the 1300s looking at a patient who is coughing uncontrollably. What would be going on in their mind? Just to take a sampling of disease causes enumerated in the book The Roots of Ayurveda (author Dominik Wujastyk), these are some causes that a random physician in South Asia from that period might have thought about:
- the ill person has been consuming an inappropriate diet, or a diet out of sync with the weather around;
- there is an abnormal collection in the chest of one of the body’s vital elements/humors;
- the ill person heard extremely bad news or saw something horrible;
- the ill person accidentally consumed something poisonous or was deliberately fed a harmful substance.
It is important to note that this was what the texts said, but not necessarily what always happened in reality. But a clear message to take home from this list of disease causes — which is not very different from lists elsewhere in the world — is that in the past medical thinkers, writers, and practitioners rarely, if ever, considered disease to be localized. That is, medical thought did not have anything to say about the lungs in the case of a coughing patient, or about the kidney or the bladder for a patient with urinary issues. Physicians simply did not think at the level of organs or tissues. For the purposes of disease causation and treatment, the human body was considered to be a single interconnected whole, and to be in a constant give and take with its surrounding environment. All the above causes were thought to eventually alter the balance of humors, or vital elements, in the body, and lead to a diseased state.
The human body as organs and tissues
What would a modern physician today think when they come across an ill person coughing uncontrollably? They might remember the whitish-yellowish lung tissue they saw during an autopsy or in a pathology specimen, or the cavities they saw on a chest X-ray. They might also recall all the names of the different bacteria and viruses which can potentially infect lungs.
This localized, frequently reductionist way of thinking about disease and ill health is what Foucault called the medical gaze. That is, on simply hearing the patient talk about their problems, the mental gaze of the physician bypasses the patient, penetrates the patient’s body, and begins evaluating the possibilities of abnormalities in tissues and organs inside. Besides, this gaze is less individual and more institutional, in that it immediately recruits for the doctor the collective existing knowledge in medical thinking learned in medical institutions, as against the accumulative knowledge of a single doctor gathered painstakingly through interactions with individual patients.
On a historical scale, the medical gaze is a recent development in human thinking. Earlier, we never thought of the body as a working collection of discrete tissues and organs each having its own independent pathology and disease. Earlier, the gaze of the physician began at the body-whole and ended in the heavens, traversing such elements as food, family, community, and climate in between. Today, on the other hand, the medical gaze begins invariably at the tissue level, and often at the level of the gene.
The “social gaze”
The medical gaze contributed immensely to medical research and knowledge-making since the early 1800s. At the same time, it also led to modern medical practice becoming less and less concerned about the patient as a person, although to their credit medical educators in most countries quickly took note of that and have constantly made attempts to bring humanistic perspectives to medical education in different ways.
Lastly, apart from considering the patient as a person and an individual whole, it is important also to consider them as an inseparable part of society and the society’s structures and institutions. Structural inequalities and systemic oppression, for example, are hugely important causes of disease and ill health, but often do not cross the gaze of many practitioners. To quote the famous lines by Rudolph Virchow:
“Medicine is a social science and politics is nothing else but medicine on a large scale. Medicine as a social science, as the science of human beings, has the obligation to point out problems and to attempt their theoretical solution; the politician, the practical anthropologist, must find the means for their actual solution.”
