The Silent World of Medicine

Yet modern scientific medicine owes its success to silence of a sort, a disbelief in words that Lain Entralgo traces to two tenets of the Hippocratic school of medicine. First, the latter rejected the use of words as a therapeutic tool; medicinal remedies were preferred to exorcism, which relied on the curative power of "fine words used in the manner of charms" (Lain Entralgo, p. 47). In addition, Hippocratic physicians trusted the patient's symptoms to reveal the causes of disease and dismissed the patient's own words about the source of his or her condition as unreliable opinion.

THE CLINICAL GAZE. Michel Foucault (1973), in his discussion of the antecedents of modern medicine, discovers a similar kind of silence in the "clinical gaze," a reorganization of medical perception that took place in the eighteenth century. Disease ceased to be perceived as an alien force inserted into the body and subject to the words of exorcism; instead, disease was the body itself, become diseased. Healing became the task of deciphering corporal space, a work of seeing instead of speaking. The model physician is Hippocrates, who applied himself only to observation, despising all preconceived systems that might bias the observer. This clinical gaze flourishes only in the relative silence of theories, imaginings, and whatever serves as an obstacle to the sensible immediate. In addition, when physicians question the patient, they question only what they can see—the body become diseased—and only in the language proposed by the body. All other languages, including that spoken by the patient, must fall silent before the absolute silence of observation. Within this double silence, Foucault says, things seen can be heard at last, and heard solely by the virtue of the fact that they are seen. It is in this sense that "the clinical gaze has the paradoxical ability to hear a language as soon as it perceives a spectacle" (p. 108).

The conversation that emerges from this double silence is an interior dialogue that the observer has with him- or herself, not a dialogue with the object of gaze. In the context of the physician-patient encounter, the language describing what the physician has seen gives structure to the encounter, not any language the patient might speak. The profundity of this silence derives from its absoluteness: Not only must the patient keep quiet about theories and imaginings that might relate to his or her illness, absolutely nothing the patient says can have any significance for the physician because no language can exist that has priority over the language of observation. This muting of the patient's own voice gives rise to what Foucault calls "the great myth of a pure Gaze that would be pure Language: a speaking eye" (p. 114). What it sees, it gathers and organizes; and as it sees, and sees more clearly, it speaks and teaches. The speaking eye becomes "the servant of things and the master of truth"

THE LANGUAGE OF CURING. Secretiveness, or what Foucault terms "esotericism," arises from this model for the physician-patient relationship because, as Foucault observes, one sees the visible (the true) only because one knows the language.

Unlike Moliere's physicians, who spoke Latin merely in order not to be understood, Foucault's clinicians speak openly about that which anyone can see but only they can understand, because through the language of clinical description they have the means to see and hear at the same time, having access to a language that masters the visible. At this point, the earlier epistemological silence (Foucault's "double silence") that results from a constriction of perception changes into the silence of which Jay Katz speaks, a silence made even more baffling and profound by having as its vehicle a multitude of words that make every pretense of being understandable.

In effect, this model of medical perception insists that healing cannot be spoken or even thought of apart from the language of curing, that is, scientifically accurate diagnosis and treatment. This clinical perception and its promise of truth tend to overshadow all other claims to truth, reducing the promise to help those who suffer illness to the promise to be scientifically competent. Attempting to expand that visual horizon—particularly in the direction of the perspective of the patient—risks introducing an unacceptable noise into the silence of the medical clinic, an unwelcome and meaningless distraction from the work of curing.

Anxiety and Depression 101

Anxiety and Depression 101

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