Foucault’s Notion of Discourse in Medical Practices

Keywords

Foucault; Discourse; Medical Discourse; Power; Gaze.

Introduction

Discourse as a concept is multidimensional and is broadly observed, it has various definitions, Lupton defines discourse ‘a group of ideas or patterned way of thinking which can be identified in textual and verbal communications, and can also be located in wider social structures’ [1] the methodology of discourse provides understanding of the working of bodies of knowledge in their definite situated settings. One of the important approaches of discursive analyses are found in Foucault’s works, which provides a vehicles for understanding discursive methodology and offers a complete analysis of discourse from the discipline of clinics. Discourse discussion generates vital claims with respect to the effects of a discourse on the domination and authorization of clutches of people in a specific situation without the privileges of generality. The theoretical origin for discursive investigation is based on various historical developments in the social theory and philosophy of science. As a methodology to analyze organized bodies of knowledge, and for Foucault discourse analysis shares in several western traditions.

In analysis of language discourse denotes speech patterns and the practice of language, suitable statements and dialects within a community. It is a method of analysis about people who live in isolated areas where they share similar speech agreements. Philosophers and sociologists inclined to use the concept ‘discourse’ to explain the conversation and the interaction within the group of people who share common ideas. The term ‘discourse’ derived from the Latin ‘discursus’, “means running to and from” and is usually referred to “written or spoken communication.” [2] Above all there are rules for proper governing of languages, as Foucault puts “whenever, between objects, types of statement, concepts, or thematic choices, one can define regularity (an order, correlations, positions and functionings, transformations),we will say...that we are dealing with a discursive formation.”[3] He makes it clear that it is by discourse that we are created, and power and knowledge interactions take place.

Discourse creates world, by molding our vision about world, drawing together chains of relations that gives proper understanding and then establishing the way we behave towards other people, objects and the world. Discourse creates our everyday life in the world; we construct our social world through compound interactions between upbringing, experience and education. By the discourse social beings are binded together by the chains of language and it plays an important role in social formation of reality. Discourse creates not the world only in which we live but also forms of knowledge and truth. For Foucault knowledge is not only communicated by language, all forms of knowledge are planned through structures, associations and interconnections that are constructed on language. Knowledge is also communicated by discourse not only about the planned importance of language, but about the speakers of discourse. One can get the information and relationship with the other people of the speaker by the discourse. In medical discourse doctors position of power have the authority to speak. Foucault was himself interested in analyzing the methods of discourse that everyone has not the right or it requires specific power or location to gain that authority.

Medical Discourse

Discourse plays an essential role in medicine; discourse is about curing, healing, expressions of sufferings or therapy and relevant language principles. Analyzing discourse and medicine simultaneously takes us to encounter culture as broadly established. As historical practical methods of medical discourse performs important task in cultural production. Effective involvement in those practices of interaction of physician and patient remains the main focus of analysis. The relationships between actual medical concerns motivate the meeting between practitioner and patient, and the success of assimilation to each other. Doctors trust on the medical status and socio cultural power to give guidance to patients verbally and non-verbally through the stages ending with diagnosis and treatment strategy. This is possible by the discourse in which both patient and physician actively looking for a goal to achieve the individual objectives. The practitioner can linguistically investigate the medical background of patient, trusting by questioning, to get a detailed medial history.

The different acts of signs, speech, postures and so on combinely produce meaning in medical communication. Patients make their body parts visible to doctors, even the doctor gazes the laboratory reports. During the medical examination patient found themselves as clinical objects, gazing seems disrespected by the way they make their subjectivity as a source of clinical examination, representing their pain and its location. Through the coordination of medical fellows by the use of gesture and talks, the team members use the signs and symbols to communication with the fellows how to handle the apparatus and deal with the situation. Their talks can cause and harmonize physical activities, as the team members says patient how to move or lay down. As the senior doctors use spoken signs and gestures while teaching medical students and to guide in the ongoing activities and the current problems of the body. This shows the power of doctors begins by spoken talks in which doctors provokes and confirms evidences and gives directions to patient, though the patient gives information and try’s to respond according to doctors moves.

In certain ways patient-doctor communication is clearly or subtly a meaning that works bitterly to idealness. Doctor involvement in the health of a person in certain ways is analyzed when people compliant about their sickness or they stop working. And doctor declares that patient is disabled and is unable to do his job or in other ways patients gets relief from social responsibilities and feels himself free, it becomes doctor’s duty to declare when the patient is fit to return his job. These instances show the power of profession to define the health of a people and its relation with social practices. Discourse as a social concept is generated and continued by the power of profession and the modes of communication. Same is the case with doctors who have the power to decide one person ill whether he may not compliant and to decide another healthy weather he complaints his illness. In every society creation of discourse is selected, controlled, redistributed and organized according to confident procedures. But Foucault’s says what is thought and said is discourse but is also about the freedom of speech with what authority, all these relation constitute subjectivity and power practices. “Practices that systematically form the objects of which they speak. In addition, discourses are not about objects; they do not identify objects, they constitute them and in the practice of doing so conceal their own invention” [4].

Foucauldian Idea of Discourse

There is nothing to describe discourse as autonomous, but the truth is that it is always related with other layers, institutions, practices, political relations and other social dealings. I will try to relate these domains of discourse in Foucault’s critical discourse analysis mainly focus on medical domain. Analysis of critical discourse is largely rooted in the notion of social construction of language. As it is practiced in various disciplines to analyze how language is shared with the phenomena of social construction. But one may recognize Foucault’s highly beneficial analysis of past history of the hospitals; the madness, criminal law and penal system have attained great attention and respect. Foucault’s main concern was to expose apparently natural categories as concepts, articulated by discourse and arguments to emphasize the radical possibility of what causally seems normal. The outlines of language that discourse investigation gazes are the specific sets of rules that manage the style of language.These rules are very significant that they cannot tumble over other aspects of our life that may be our artwork we create, drawing pictures and constructing buildings and even our social institutions we live in. In Birth of the Clinics Foucault highlights the changes in medical discourse effects the whole networkof medical institutions, similarly transformations in legal discourse has direct impact on our judicial system and criminal punishment. By this way discourses affects our everyday lives and cannot be even isolated from particular genre. Discourse for Foucault is an object and an instrument of power. Foucault puts it “...Discourse transmits and produces power; it reinforces it, but also undermines it and exposes it, renders it fragile and makes it possible to thwart it” [5].

In the order of things Foucault talks about the way discourse is controlled by institutions in a way to protect some of its dangers. He discussed the process of rejection which performs on discourse to curb what we say, and what can be considered as knowledge. The first process is exclusion or prohibition of taboos. The various other subjects that were difficult to discuss in societies both of west and east are death and sex where considered unethical or immoral. Foucault puts it “in every society the production of discourse is at once controlled, selected, organised and redistributed by a certain number of procedures whose role is to ward off its powers and dangers, to gain mastery over its chance events, to evade its ponderous, formidable materiality” [6] discourse is power, it supports power and can work against it and therefore, society efforts to control it by prohibiting discussions on certain topics. Through discourse individual gets degrees of cultural, social and political power. Such as when the doctor talks about mental and physical illnesses, this gives them power to recommend sequences of patterns or actions of behavior, and in same way in our society’s religious authorities apply tremendous power as they have the authority to speak about divine.

Throughout his works Foucault has analyzed the history of professional social control. By the study of human sciences he has transported the relations between knowledge and power. For Foucault professions such as law, medicine, psychology and social work have progressed and have controlled our everyday life. Foucault argued that many technologies of surveillance have developed to attain professional power in hospitals, mental institutions and clinics, schools, criminology etc. He has treated history as an object of power and knowledge that need to be interpreted in the language. His method of discourse was aimed to change the way of thinking about disease and death. In 18th century Foucault found a method of reading the disease by nosology structure.“The restraint of clinical discourse reflects the non-verbal conditions on the basis of which it can speak: the common structure that carves up and articulates what is seen and what is said.” [6] Foucault links transformation of medical discourse to institutions, hospitals and political practices. In order to explain history and to make clear its relation with natural objects and the different historical practices of medicine that are related to present structure and to bought truth together in medicine in time.

Michel Foucault interpreted medical discourse during 18th century medical practice and traced the changes in the way of looking towards disease and death. Foucault’s approach was towards the development of disease, medicine and the theories throughout the creation of clinical gaze in 19th century. Foucault says “A discourse on the individual is once more possible, or, rather, necessary, because it is the only way in which the gaze can avoid renouncing itself, effacing itself in the figures of experience, in which it would be disarmed.” As the words and letters are related to discourse and their values and mechanism can be studied correctly for their proper use. In the same way observation belongs to science and should be conveyed properly. The way pathological principal appear and their importance and relation give rise to a variety of diseases.

In mid-17th century the Medicalized and institutionalized medically ill people, idea was born. Those mentally ill people were taken away from family and kept in silence rather than being cured but being tolerated as being different. Same underlined philosophy Foucault talked in his next book the birth of clinics and it also talks about naming and seeing diseases in eighteen century and for Foucault clinic is a discursive practice. Clinic for him is site of the production of knowledge or the examination of apparatus take place. He targeted here medicine broadly, that medicine has become more dehumanized with time, off course he accepted that, at present we have better medicine and drugs, but he believed that in contemporary period medical doctor are born as they would look to the patient as medical gaze, dehumanizing patient to look at the patient just as the set of organs not as a person. What was being once considered in medical gaze was the functioning of the organ like liver, kidney and so on but not as a person.

For Foucault this clinical way of thinking is the authority of truth, a way of expression and perception that enables speeches about disease. This clinical discourse is set of procedures and rules within a system that creates a link between knowledge and health. But this inquiry is limited and specific when restricted to certified medical institutions, and the approved physicians have essential knowledge of medical dogmas. The clinic for Foucault is the place for the practice of medicine and is also a discursive training, an etymology of health and disease. But the main concern in this paper is to analyze Foucault’s clinical practices in light of medical discourse. To understand the discourse practices between the physician and the patient and how with the passage of time they have changed. And the language plays an important role in medical discourse.

Conclusion

To conclude medical discourses have contributed to wider analysis of ideologies that allow some communicators and mark others as pre-modern. Traditionally physicians have adopted as dominated power within the medical discourse, as they alone have the authority to diagnose. However in present time there have also been deviations in access to power in consultations by the increasing authorization of patients. But Foucault’s approach could be analyzed as reactive to social challenges or modifications in the existing conditions and also seems highly suitable in the context of contemporary challenges in current medical practices and in medical education. Foucault’s intention of discourse not refers to speaking and interaction between people; however it is the discourse of truth or of the fields, the writings and the works on a subject, which decides as well as reproduces the reality we perceive. Second thing that can be summed up, is his thought has more relevance in modern medical profession, as it works on the internal techniques as well on external exclusion from the discourse, that decides who has the authority to speak or write in a particular position about a given subject.