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The diaphanous nature of consciousness (as experienced by its owner) is more than matched by its opaqueness to analysis and description. And yet a descriptive psychopathology which did not include this concept would be difficult to imagine. Thus, during the nineteenth century, many ‘mental symptoms’ were defined in terms of introspective data from consciousness (e.g. hallucinations, depersonalization, dejd vu, etc.). The subjectivity of the madman became a private theatre where phantasms played dramas to which the psychiatrist had no direct access. All he could do was get the privileged seer to describe the experiences and then believe that the patient was telling the truth. It goes without saying that such belief is based on the assumptions that consciousness exists and that the patient's descriptive capacity has been spared by the disease. But in clinical practice things are more complicated than that. Sensations, images, feelings and impulses, often odd or never experienced before, must be recognized and put into words by a person who is simultaneously bemused, confused, upset, terrified or who may actually be participating in the inner drama. Therefore, what the psychiatrist may get is a prosaic, analogical, or bizarre paraphrase. Based on training and imagination, the interviewer will try to name and classify those descriptions that sound familiar. But what about the many which do not? In current practice, and due to the control of ready-made glossaries, it is likely that such descriptions will be quietly ignored. This is a pity for these unnamed experiences are also markers of disease. In the past, when alienists felt freer to describe madness, patients were listened to: that was the manner in which current symptoms were born. [ABSTRACT FROM AUTHOR]

Only connect … In the history of Western medicine, from the school of Salerno to that of Freud, the content and structure of its four principal ingredients - its conception of the nature of man, its technical capacity to do medical research and to give treatment, its sense of religion, and the social structure of medical aid - have changed continually; but the exclusive concern of pathology with the physical side of man's being has not disappeared or changed. If one poses, for a science such as theoretical physics or organic chemistry, the problem of its relations with the political and economic structure of society, doesn't one pose a problem which is too complicated? Isn't the threshold of possible explanation placed too high? If, on the other hand, one takes a knowledge [savoir] such as psychiatry, won't the question be much easier to resolve, since psychiatry has a low epistemological profile, and since psychiatric practice is tied to a whole series of institutions, immediate economic exigencies and urgent political pressures for social regulation? Cannot the interrelation of effects of knowledge and power be more securely grasped in the case of a science as ‘doubtful’ as psychiatry? It is this same question that I wanted to pose, in The Birth of the Clinic apropos of medicine: it certainly has a much stronger scientific structure than psychiatry, but it is also very deeply involved in the social structures. [ABSTRACT FROM AUTHOR]

Introduction Ours is not the first generation to be preoccupied with modernity, nor the first to search for clues as to when ‘our’ kind of medicine began. Conventional wisdom generally locates that origin in the Revolutionary Paris of the 1790s. Thus, R. H. Shryock's chapter on early-nineteenth-century French medicine is entitled ‘The emergence of modern medicine, 1800-1850’, and the ‘clinic’ described by Michel Foucault does not simply concern the activities of Bichat and Laennec, but also the ‘conditions of possibility of medical experience in modern times’. This French hospital medicine coincided with political and social upheaval and with ‘the end of the Enlightenment’, a fact which deepens the apparent chasm separating our medicine from that of the Enlightenment and before. If our own medicine derives in some important sense from the hospitals of Revolutionary France, the medical forms, patterns, and practices of the Enlightenment can be viewed in two antithetical ways: as having created the possibility of modernity; or, by way of reaction, the ultimate victim of it. The latter has been the more common historical attitude. Thus Shryock, while applauding eighteenth-century advances in mathematics, physics, chemistry, and the social sciences, discovered a variety of social and intellectual reasons why medicine lagged behind. [ABSTRACT FROM AUTHOR]