En el presente artículo realizamos un análisis del estatus ontológico de la noción de psicopatología que se deriva de cuatro aproximaciones metodológicas a su estudio, a saber: aproximación psiquiátrica, fenomenológico-existencial, constructivista-histórica y antipsiquiátrica. Por medio de una metodología de revisión bibliográfica sistematizada y siguiendo el marco de trabajo metaframework ReSiste-CHS (Revisiones Sistematizadas en Ciencias Humanas y Sociales), sostendremos que dicha noción presenta divergencias en al menos tres puntos: (i) la relevancia de la sintomatología como característica, (ii) la existencia o inexistencia (...) del sufrimiento psíquico y (iii) la relevancia de los factores sociales en su configuración. En el apartado introductorio abordaremos las consideraciones históricas generales relacionadas con el estudio de los trastornos mentales. En el segundo apartado nos referiremos a la metodología empleada para la realización del artículo. En el tercer apartado expondremos los rasgos fundamentales de las cuatro metodologías de estudio mencionadas anteriormente, dividiendo la descripción en los siguientes puntos: orientación, etiología, clasificación, diagnóstico y tratamiento. En el cuarto apartado contrastaremos los conceptos de psicopatología que pueden ser extraídos de ellas. A modo de conclusión, propondremos una sistematización de las condiciones mínimas que debe cumplir una noción de psicopatología que sea fructífera desde un punto de vista teórico y práctico. Estas condiciones incluyen un posicionamiento crítico ante los extremos reduccionista y relativista, la consideración del sufrimiento psíquico como rasgo constitutivo y núcleo fundamental de este género de experiencia, así como una dimensión ética relacionada con su abordaje. Por último, mostraremos algunas limitaciones y futuras directrices que se derivan del trabajo realizado. (shrink)

De moderne filosofie lijdt aan muziekvergetelheid. Opvallend is echter dat filosofen, wanneer ze toch aandacht schenken aan muziek, hun aandacht bij voorkeur op één bepaald genre richten, namelijk de opera. Filosofen zoals Søren Kierkegaard en Friedrich Nietzsche lieten hun gedachten over Don Giovanni, Parsifal en Carmen gaan, terwijl omgekeerd de filosofie van Arthur Schopenhauer de opera heeft beïnvloed via Wagner. Diens werk lijkt zich op het snijpunt van het grensverkeer tussen moderne filosofie en moderne muziek te bevinden. Het was zijn (...) ambitie de menselijke existentie en de menselijke geschiedenis in één panoramisch oeuvre te vatten, vanaf het primordiale begin tot en met de dramatische finale die ophanden leek: een catastrofale apotheose die een geheel nieuwe toekomst mogelijk zou maken. Dat is althans de verhaallijn van zijn meesterwerk Der Ring des Nibelungen. Aan het slot van Götterdämmerung lijkt zich een algehele verwoesting te hebben voltrokken: ‘Everything is destroyed and there is an enigmatic kind of hovering over the scene of destruction’ (Badiou 2010, p. 106), een ambivalente stemming van hoop en destructie zette Wagner op muziek. Voor Wagner is dan ook een hoofdrol in deze studie weggelegd: voor zijn muziektheoretische geschriften (waarin hij over een ‘muziek van de toekomst’ filosofeerde), maar meer nog voor de muzikale totaalkunstwerken die hij daadwerkelijk componeerde. (shrink)

RESUMO O artigo analisa a importância das reflexões sobre medicina, a dinâmica do corpo, da doença e da saúde, tais como desenvolvidas pelo médico John Brown no século XVIII, sobre a filosofia da natureza de Novalis, contextualizando a recepção dessas reflexões do âmbito romântico-idealista da Alemanha do começo do século XIX. ABSTRACT This paper examines the relevance for Novalis’s philosophy of nature of John Brown’s reflections upon Medicine, dynamics of body, illness and health, the way they were developed by this (...) 18th century physician, by setting the context for it within romantic-idealist early 19th century Germany. (shrink)

This paper reflects on the relation between psychiatric institutions and political thought. Starting from the distinction made by G. de Clérambault between interpretation and passionate deliria, we aim at identifying two types of symbolic connotations in the demand for justice. Based on this, we formulate the following hypothesis: a description of the semiotic systems that include the two types allows for a differential analysis of the two distinct theologico-political structures to be carried out; they can come up against each other (...) or merge in historical institutions, but they still determine the power positions and the means of heterogeneous subjectivation. From these different perspectives, our hypothesis points to an ambiguity of the concept of « theologico-political ». (shrink)

The state subvention and distribution of health care not only jeopardize the financial sustainability of the state, but also restrict without a conclusive rational basis the freedom of patients to decide how much health care and of what quality is worth what price. The dominant biopolitics of European health care supports a healthcare monopoly in the hands of the state and the medical profession, which health care should be opened to the patient’s authority to deal directly for better basic health (...) care. In a world where it is impossible for all to receive equal access to the best of basic health care, one must critically examine the plausible scope of the authority of the state to limit access to better basic health care. Classical distributive justice affords a basis for re-examining the current European ideology of equality, human dignity, and solidarity that supports healthcare systems with unsustainable egalitarian concerns. (shrink)

Periodic attacks of uncertain origin, where the clinical presentationresembles epilepsy but there is no evidence of a somatic disease, arecalled Pseudo-Epilepsy or Pseudo-Epileptic Attack Disorder (PEAD). PEADmay be called a `non-disease', i.e. a disorder on the fringes ofestablished disease patterns, because it lacks a rationalpathophysiological explanation. The first aim of this article is tocriticize the idea, common in medical science, that diseases are realentities which exist separately from the patient, waiting to bediscovered by the doctor. We argue that doctor and (...) patient construct adisease, and that the construction of the disease PEAD includes manynormative evaluations. The second aim is to provide insight into thesuffering of patients with PEAD. We focus on three aspects of thepatient, identity, autonomy and responsibility. We present somecharacteristic descriptions of (pseudo-)epileptic attacks by FjodorDostoevsky, Gustave Flaubert and Thomas Mann. We argue that diagnosingPEAD reduces a meaningful life event into an insignificant, thoughintriguing, medical phenomenon, and that the patient will not benefitfrom being diagnosed as having PEAD. (shrink)

Foucault's analysis of an aesthetics of existence is presented as an instrument to practice ethical thought without the presupposition of an autonomous subject. The implications of Foucault's aesthetics of existence for ethical thought are traced to the work of Nietzsche. In Foucault's work, experiences of oneself are not a given, but are constituted in power relations and true-and-false games. In the interplay of truths and power relations, the individual constitutes a certain relationship to him- or herself. Foucault designated the relation (...) to oneself and one's existence as the main area of ethical concern and the most important field where aesthetic values are to be applied. In his aesthetics of existence, he invited the individual to problematize the relationship with the self and by using 'self-techniques' to transform it into a work of art. The relation to intimate others, shaped as friendship, is crucial to this ethical-aesthetic approach. Key Words: aesthetics of existence • ethics • Foucault • friendship • Nietzsche • subjectivity. (shrink)

This paper describes the scientific practices of the anatomists from the Société Anatomique de Paris (1803–1873) who were collecting anatomical and pathological specimens in Nineteenth-Century Paris and which led to the building of the anatomy and pathology Musée Dupuytren (1835–2016). The framework introduced by Robert Kohler to describe collecting sciences (2007) is useful as a tool to identify the set of diverse practices within pathological anatomy in nineteenth-century Paris. However, I will argue that anatomy and pathology collecting had specific features (...) compared to most collecting sciences. Two main collecting practices could be distinguished: first, “finding” anatomical specimens and second, keeping these specimens. The first kind of practices were at least rhetorically and explicitly motivated by Auguste Comte’s positive philosophy. But “finding” an anatomy or pathology specimen could not be completely compared to finding an object or making a simple observation, as dissecting as well as some experimental practices were also involved. Heterogeneous practices thus coexisted within collecting in anatomy and pathology. Epistemological as well as pragmatic tensions arose. On top of Kohler’s framework, I introduce Sabina Leonelli’s concept of “data journey” to offer a narrative of the diversity of collecting practices involved in the Société Anatomique de Paris and the Musée Dupuytren. I use the concept to analyse how this diversity of practices impacted knowledge production. (shrink)

Este artigo aborda o tratamento que Canguilhem e Foucault oferecem da medicina. Passando pelas distintas análises da clínica, da medicina em sua história e de seu aspecto social e político, observaremos desdobramentos irredutíveis em torno de uma problemática compartilhada.

To contribute to our understanding of the relationship between philosophical ideas and medical and healthcare models. A diachronic analysis is put in place in order to evaluate, from an innovative perspective, the influence over the centuries on medical and healthcare models of two philosophical concepts, particularly relevant for health: how Man perceives his identity and how he relates to Nature. Five epochs are identified—the Archaic Age, Classical Antiquity, the Middle Ages, the Modern Age, the ‘Postmodern’ Era—which can be seen, à (...) la Foucault, as ‘fragments between philosophical fractures’. From a historical background perspective, up to the early 1900s progress in medical and healthcare models has moved on a par with the evolution of philosophical debate. Following the Second World War, the Health Service started a series of reforms, provoked by anti-positivistic philosophical transformations. The three main reforms carried out however failed and the medical establishment remained anchored to a mechanical, reductionist approach, perfectly in line with the bureaucratic stance of the administrators. In this context, future scenarios are delineated and an anthropo-ecological model is proposed to re-align philosophy, medicine and health care. (shrink)

BackgroundThis article aims to contribute to a better conceptualization of pain and suffering by providing non-essential and non-naturalistic definitions of both phenomena. Contributions of classical evidence-based medicine, the humanistic turn in medicine, as well as the phenomenology and narrative theories of suffering and pain, together with certain conceptions of the person beyond them are critically discussed with such purpose.MethodsA philosophical methodology is used, based on the review of existent literature on the topic and the argumentation in favor of what are (...) found as better definitions of suffering and pain.ResultsPain can be described in neurological terms but cognitive awareness, interpretation, behavioral dispositions, as well as cultural and educational factors have a decisive influence on pain perception. Suffering is proposed to be defined as an unpleasant or even anguishing experience, severely affecting a person at a psychophysical and existential level. Pain and suffering are considered unpleasant. However, the provided definitions neither include the idea that pain and suffering can attack and even destroy the self nor the idea that they can constructively expand the self; both perspectives can b e equally useful for managing pain and suffering, but they are not defining features of the same. Including the existential dimension in the definition of suffering highlights the relevance of suffering in life and its effect on one’s own attachment to the world. An understanding of pain and suffering life experiences is proposed, meaning that they are considered aspects of a person’s life, and the self is the ever-changing sum of these experiences.ConclusionsThe provided definitions will be useful to the identification of pain and suffering, to the discussion of how to relieve them, and to a better understanding of how they are expressed and experienced. They lay the groundwork for further research in all these areas, with the twofold aim of a) avoiding epistemological mistakes and moral injustices, and b) highlighting the limitations of medicine in the treatment of suffering and pain. (shrink)

Les technologies contemporaines de l’image, telles que les ultrasons, l’endoscopie, et autres IRM et scanners, transforment l’image de notre corps. Dans cet article, cette transformation est particulièrement mise en lumière à partir d’une œuvre de Mona Hatoum intitulée “ Corps étranger ”. Cette œuvre d’art consiste en une projection vidéo d’images endoscopiques de l’intérieur du corps de l’artiste. On dit souvent qu’il est impossible de s’identifier soi-même à partir de ce type d’images dans la mesure où elles sont difficilement reconnaissables (...) comme des parties de son corps propre. Ou encore qu’elles n’appartiennent pas à l’image narcissique du corps. A l’aide d’une analyse phénoménologique et psychanalytique, l’auteur s’attache ici au contraire à montrer que de telles images fournissent une image affective de notre corps propre et qu’à travers elles il devient possible d’affronter l’étrangeté de celui-ci. (shrink)

Thinking in medicine is still dominated by the cartesian view of science of the past centuries, dividing individuals into the reasoning mind (res cogitans) and an objective body as part of all non-subjective things of the world (res extensa). This classical scientific paradigm does not take into account the influence the observer exerts on the observed phenomena. Applying this paradigm to medical research and education has consequences regarding the relationship between physicians and patients as well as between medical teachers and (...) their students. An improvement of medical education towards a broader understanding of complex illnesses with their psycho-social implications must be based on philosophical and epistemological issues. The requirements of modern medicine cannot just be met by adding more psycho-social content to somatic medical education or by changing the didactic approach without reflection on the underlying concepts and the relation of the human being to his world. (shrink)

By drawing on Jean-Luc Nancy’s philosophy of ontological relationality, this article explores what it means to be a ‘we’ in breast cancer. What are the characteristics—the extent and diversity—of couples’ relationally lived experiences of bodily changes in breast cancer? Through analyzing duo interviews with diagnosed women and their partners, four ways of sharing an embodied life are identified. (1) While ‘being different together’, partners have different, albeit connected kinds of experiences of breast cancer. (2) While ‘being there for you’, partners (...) take care of each other in mutually dependent ways. (3) While ‘being reconnected to you’, partners (re-)relate to each other through intimacy and sexuality. (4) While ‘being like you’, partners synchronize their embodied daily lives to one another, sometimes up to the point that the self cannot be distinguished from the other anymore. These ways reveal that being a ‘we’ involves complex affective, bodily encounters in which the many fault lines that both separate partners into individual selves and join them together as a unity are continuously reshaped and negotiated. Being a ‘we’ may be understood as something we have to do. Therefore, in being true to the legacy of Nancy, we argue at the end of this article for a sensible praxis of sharing a life and body, particularly in breast cancer. (shrink)

In this article, our concern is to describe how body(ies) and self are performed in women’s birth narratives through the mediation of a number of significant elements, including technical devices. We will show how, in these narratives, (1) action is distributed among a series of actants, including professionals and technology; (2) that dichotomies appear which cannot be reduced to one of body/mind, but are more adequately described in terms of ‘body-in-labour’/’embodied self’, each of them being locally performed through the mediation (...) of medical practices, knowledge and technologies, the definition of these elements and of their relations being specific to each obstetrical configuration; (3) that part of professionals’ activities is devoted to the detailed management of the articulation between the body-in-labour and the embodied self, and to monitoring their joint transformations. (shrink)

In this paper it is suggested that Canguilhem's examination of the history of the distinction between the normal and the pathological contains material of relevance to current debates about the nature of medicine, in particular concerning the status of quantitative indicators as indicators of the need for medical intervention. His arguments against the equation of health with normality are presented, together with his own suggested definition of health and the implications of this definition for physiology and medicine.

El pluralismo cultural y la diversidad social atraviesan diferentes contextos sociales en el mundo contemporaneo, ejerciendo diferentes impactos sobre las instituciones oficiales. En el contexto de los servicios de salud de una ciudad cosmopolita como Montreal, la realización de nuevos proyectos de investigación y de intervención se hace necesaria, con el fin de evaluar la manera como los diversos grupos poblacionales entran en relación con dichos servicios. A nivel investigativo, se hace indispensable la creación de colaboraciones interdisciplinarias con las cuales (...) poder examinar las situaciones clínicas, a la luz de los diferentes elementos que la componen: sociales, culturales y étnicos. En este artículo, expongo algunas reflexiones que se derivan de una investigación interdiscip-linaria entre antropólogos y médicos, cuyo tema central giro en torno de los desórdenes funcionales del intestino dentro de la población infantil. Este trabajo en antropología médica permitió documentar y analizar los discursos de las familias y de los niños alrededor de la percepción de dicho problema de salud, así como de las prácticas y soluciones que estos ponen en marcha y con las cuales buscan aliviar el dolor y lograr un estado de bienestar. Las reflexiones que comparto en este artículo tienen como centro de interés los principales referentes teóricos y metodológicos utilizados desde la disciplina antropológica, los cuales seran ilustrados con la ayuda de algunos extractos de entrevistas realizadas. Mas allá de simplemente enumerar los resultados de la investigación, muestro un ejemplo de colabora-ción fructífera entre la antropología y la pediatría, la cual abre perspectivas de investigación y de aplicación futuras en lo que atañe a las relaciones entre las familias, las comunidades y los servicios institucionales. (shrink)

O artigo se propõe a esclarecer a hesitante relação de Foucault com a teoria estruturalista da década de 1960 a partir da recondução histórica e política dessa questão ao debate intelectual que procurou, com maior ou menor sucesso, no modelo linguístico de Saussure, uma nova grade de inteligibilidade para as ciências humanas ciências humanas. A descrição das transformações que ocorreram no interior deste debate e o modo como elas levaram Foucault a repensar sua participação nele nos ajudam a esclarecer como (...) a simpatia explícita pelo estruturalismo do início dos anos 1960 cede lugar a uma recusa insistente de filiar-se a ele no final dessa década. This paper intends to elucidate the hesitating relation between Foucault and structuralist theory at the 1960s by recasting it, in a historical and political way, within the intellectual debate that tried to build, more or less successfully, a new grid of comprehensibleness to humanities from the linguistic model of Ferdinand de Saussure. The descritption of transformations that took place within this debate and the way they compelled Foucault to rethink his participation in it could help us to understand how explicit affinities towards structuralism in the beginning of the 1960s gives place to an insistent refusal of affiliation at the end of this decade. (shrink)

My purpose is to examine two of the foundations of medical ethics: the principle of autonomy and the concept of the human. I also investigate the extent to which health technology makes autonomy and humanness possible. I begin by underlining Illich's point that the same health technology designed to promote health and autonomy also is pathogenic. I proceed to analyse the Kantian concept of autonomy, a concept which is closely associated with health and which continues to determine current ethical thinking. (...) In so doing, I uncover an unexpected ontological function of health technology, a function described in Heidegger's work on technology. Based on this discovery, I suggest that calls for Kantian autonomy may often be self-defeating or even sometimes harmful. I conclude by calling for continued ethical vigilance, but also for a questioning of the hitherto virtually unquestionable concepts of ethics and humanness which may themselves play a role in our era's greatest problems. (shrink)

Two essential periods may be identified in the early stages of the history of vitamin D-resistant rickets. The first was the period during which a very well known deficiency disease, rickets, acquired a scientific status: this required the development of unifying principles to confer upon the newly developing science of pathology a doctrine without which it would have been condemned to remain a collection of unrelated facts with very little practical application. One first such unifying principle was provided by the (...) notion of hygiene; while the blanket explanations provided by this notion alone were much too general to enable rickets to achieve scientific status, it did point out the need to look for specific external causes for the disease and to examine the life-style and dietary habits of the patients. The second phase of the conceptualization of the disease was the assumption of a specific cause — that is, using concepts developed in the area of infectious diseases. This was made possible by fundamental similarities between deficiency and infectious diseases, in spite of their apparent differences. Both types of illness have some of the characteristics of what Georges Canguilhem calls the ontological representation of disease as opposed to dysharmonic representations, which primarily concern the endocrine diseases. It is precisely this shift from one to the other manner of perceiving ill health that enabled the identification of the vitamin D-resistant rickets. Conceptualization of the notion of vitamin D resistancy required that the conditions causing the disease be looked for within the organism rather than outside it; this was thus the first time that endocrine concepts were applied to studying the physiology of vitamin D.The history of resistant rickets therefore represents an interesting model for understanding the growth of biomedical knowledge. It allows the development of a number of more general ideas on the question of the relationship between biology and medicine and on the thorny problem of specificity in medical thinking. As far as this topic is concerned it can be seen that there was an ongoing exchange between medical and biological thinking during the initial period up until 1937, and that one could deny any such specificity in medical thinking during this same period. Albright, for example, used human diseases as spontaneously produced models for experimental biology. It was also more feasible for an experimental biologist to administer toxic doses than for a clinician to do so.What, then, if any, is the place of the specificity of medical thinking in this history? The fact that medicine is characterized not only by it ccognitive content78 but also by its final aim, which is to restore health, makes it necessary to take factors other than objective knowledge into consideration. This is particularly evident in two aspects of medicine, therapeutics and nosology, and in approaching the notion of pathological individuality.Therapeutic activity has a largely empirical approach. Many drugs, such as cod-liver oil, were discovered empirically. Treatment often in the past, and still now, has proceeded by trial and error, upon no established theoretical basis. At this level the relationship between biology and medicine is roughly comparable to that between science and technology79 \3- that is, it is impossible to reduce either therapeutics or technical activities to the simple application of basic science. In this sense, the application of vitamin D to vitamin-resistant rickets is quite typical. Further-more, in the case studied here, the therapeutic activity heralds a definite breaking away from the medicatrix naturae of conventional medicine dating back to ancient times, and it embodies a new concept of the organism and of disease: no longer can the diseased organism be thought of as merely having a perturbed equilibrium requiring restoration by means of a natural style of medicine. On the contrary, vitamin D resistance is an obstacle that indicates profound biological dysfunction, to be rectified only by means of an extremely aggressive and therefore dangerous therapy. The therapy thus serves to reveal the severity of the dysfunction, thereby leading inevitably to conceptual innovation. This sheds light on the theoretical innovations of which the therapeutic activity is capable.Therapeutic activity is also influenced by notions of health and illness, normal and pathological states, none of which may be determined entirely objectively. For example, the term healing as used by Albright in the case of resistant rickets that he described may be discussed in this light.Nosology, or the classification of diseases, depends largely on the description of clinical syndromes, which are themselves mainly based on subjective elements (discomfort, disability, or the extent of a patient's suffering). The advent of pathological anatomy at the beginning of the nineteenth century disrupted classification by introducing the concept of localized anatomical lesions81-and, hence, an element of material objectivity \3- into nosology. Radiological examination further complicated matters by enabling the equivalent of an autopsy on living matter. Lastly, biological examination complicated nosology by showing that biological anomalies may exist in human beings without necessarily leading to a pathological condition. Medical thinking can choose to combine all these elements to describe a disease, but can also separate them and retain only a few, or a single one, according to requirements - as did Albright.The notion of biological and pathological individuality is fundamental to the development of medical thinking. Whatever its theoretical origin, medical thinking has since ancient times incorporated the idea that each individual reacts differently to the same treatment and his own specific pathological tendencies. I mentioned earlier that in the history of vitamin D-resistant rickets the notion of rachitic tendency reflected this type of thinking. After 1937, this history progressed by successively separating new individual entities, affecting smaller and smaller groups of individuals in each case. In other words, the need to understand and to define individual illness more closely required the development of new concepts and the construction of new individual categories of disease linking these concepts to older clinical, radiological, and biochemical elements. (shrink)

This article discusses the emergence of the modern body, as portrayed by Foucault, in early 20th-century medical practice. Specifically, this article argues how the coming of the patient-centered record in the United States was a pivotal event in this emergence. We argue how the shape and functions that the record acquired during this period was fundamentally intertwined with the new shape that both the patient’s body and medical institutions acquired. We zoom in on two specific examples: the re-historizing and subjectifying (...) of the body, both afforded by new record-keeping practices. The topic addressed here is the embodying of the patient: the production of a patient with a body whose characteristics are the effect of the interrelation of the patient with a growing number of professionals and investigative instruments, and with a medical record which becomes more and more significant in these interrelations. (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 paper treats several ontological questions about certain nineteenth-century and contemporary medical and scientific conceptualizations of hereditary relation. In particular, it considers the account of mid-nineteenth century psychiatric thought given by Foucault in Psychiatric Power: Lectures at the Collège de France, 1973–1974 and Abnormal: Lectures at the Collège de France, 1974–1975 . There, Foucault argues that a fantastical conceptual prop, the ‘metabody,’ as he terms it, was implicitly supposed by that period’s psychiatric medicine as a putative ground for psychiatric pathology. (...) After presenting the heart of Foucault’s thought on the ‘metabody,’ the paper investigates the possibility that a contemporary version of a ‘metabody’ may operate today as a conceptual analog of the nineteenth-century psychiatric theory and practice that Foucault began to expose in the texts examined here. It speculates that we might identify a contemporary genetic version of a ‘metabody’ in a particular current conception of the gene as replicator, an item marked by an ambiguous temporal ontology. (shrink)

In this article, we present an analysis of bodily integrity in hand transplants from a phenomenological narrative perspective, while drawing on two contrasting case stories. We consider bodily integrity as the subjective bodily experience of wholeness which, instead of referring to actual bodily intactness, involves a positive identification with one’s physical body. Bodily mutilations, such as the loss of a hand, may severely affect one’s bodily integrity. A possible restoration of one’s experience of wholeness requires a process of re-identification. Medical (...) interventions, such as a hand transplant, may improve the possibility of a successful re-identification. However, since the experience of wholeness does not refer simply to physical intactness or impairment, the choice for medical intervention should not be based merely upon the degree of physical mutilation. It should also be based upon the degree to which a person fails in re-identifying with his or her mutilated body. We argue that a normalizing operation is only ethically justifiable if the intervention enables the person to be the body he or she has. (shrink)

This paper addresses two ways in which scarcity in health care turns up and three ways in which this dual condition of scarcity can be approached. The first approach is the economic approach, which focuses on the causes of cost-increase in health care and on developing various mechanisms of rationing and priority-setting in health care. The second approach is the justice approach, which interprets scarcity as one of the Humean ‹Circumstances of Justice.’ Whereas these approaches interpret scarcity as a given (...) fact, the third approach casts doubt on this interpretation. Rather, it interprets scarcity as a social, anthropological, and technologically induced construction of Modernity. This paper supports the theories of Hans Achterhuis, Ivan Illich, and Nicholas Xenos but also further elaborates their views with regard to health care by offering an approach to scarcity that interprets it as an economic translation of finitude. I argue that this approach, which entails a contemporary revaluation of the ancient Socratic attitude on human life and finitude, will be better able to deal with the pressing contemporary issues of setting limits on health care because it mitigates contemporary health care’s tendency toward infinity in meeting – and creating – health care needs. (shrink)

Foucault’s critique of early modern political theory aimed at displacing sovereignty as the principle of intelligibility of power. In the genealogical literature since Foucault, sovereignty has become a residual category lacking analytic specificity, largely displaced by governance, in turn equated with politics. We argue that Foucault and the Foucauldians have not understood that the flourishing of governance has presupposed a symbolic regime with a division of knowledge-power-law characteristic of the democratic sovereign. The conflation of governance with politics, together with the (...) sliding of sovereignty under governance, has left Foucauldians unable to diagnose the dangers present in varying possible sovereignty-governance configurations. (shrink)

This article discusses various ethical and philosophical aspects of heroin addiction. It arose as a result of the plan by the Amsterdam city council to supply free heroin to drug addicts. The objective of treatment of heroin addicts is ambivalent because what is in fact a socio-cultural problem is transformed into a medical problem. The characteristics of this treatment are made explicit through a philosophical analysis which sees the medical intervention as part of a strategy aimed at achieving social normalisation. (...) The reason why such a social control function is practised by physicians is discussed, as well as the reason why heroin users in particular are the object of such a process. In this paper, heroin addiction is considered primarily as a cultural problem. The consequences of this for treatment and ethics form the conclusion. (shrink)

Resumen Este artículo busca reconstruir los principios metodológicos de la “arqueología de la política” que Foucault introduce hacia el final de L’archéologie du savoir aunque nunca desarrolla de manera explícita. La exposición se organiza en tres ejes. En primer lugar, explora los puntos de cruce y las posibles diferencias entre la arqueología del saber y la arqueología de la política. En segundo lugar, examina el lugar que podrían ocupar los “programas” y las “racionalidades de gobierno” en la arqueología de la (...) política. Por último, propone a la razón de Estado, el liberalismo y el neoliberalismo como posibles campos de investigación para el desarrollo de esa arqueología. Con ello se pretende obtener una “grilla de inteligibilidad” cuyo punto de partida no sean las categorías universales habitualmente utilizadas por el análisis jurídico-político procedente de los siglos XVI y XVII, sino las prácticas de los gobernantes y los gobernados.This article proposes to reconstruct the methodological principles of the “archaeology of politics” mentioned by Foucault at the end of L’archéologie du savoir, although never explicitly continued. The text is organized in three complementary axes. First, it explores the crossing points and possible differences between the archaeology of knowledge and the archaeology of politics. Second, it investigates the place that “programs” and “government rationalities” might take in the archeology of politics. Finally, it porposes the reason of State, liberalism and neoliberalism as possible research fields for the development of said archeology. Therefore, this article seeks to obtain a “grid of intelligibility” whose basis are not the universal categories usually used by legal-political analysis from the 16th and 17th centuries, but the practices of the governing and governed. (shrink)

Based on detailed descriptions of human–machine ensembles, this article explores how humans and machines work together to see specific things and unsee others, and how they come to co-configure one another. For seeing is not an automated function; whether one is a human or a machine, vision is gradually enskilled and mutually co-constituted. The analysis intersects three different ways of human–machine seeing to shed further light on the workings of each one: an airport, where facial recognition algorithms collaborate with border (...) guards to grant passage to particular travellers and not to others; a luggage-scanning system, where potential security threats are assessed by a complex of X-rays and human intro-spection; and a hospital operating room, where human–machinic surgical robots find their way and operate on the insides of human bodies, touching only by seeing. In these examples, human and machine ways of seeing merge together, seeing in particular apparatuses of material, political, organisational, economic and fleshy components. The article analyses the practical work of human–machinic collaboration and explores how the different material and social constituents, not necessarily always working from the same agenda, come to configure what can be seen and sensed and what cannot. (shrink)

In order to understand the lived experiences of physicians in clinical practice, we interviewed eleven expert, respected clinicians using a phenomenological interpretative methodology. We identified the essence of clinical practice as engagement. Engagement accounts for the daily routine of clinical work, as well as the necessity for the clinician to sometimes trespass common boundaries or limits. Personally engaged in the clinical situation, the clinician is able to create a space/time bubble within which the clinical encounter can unfold. Engagement provides an (...) account of clinical practice as a unitary lived experience. This stands in stark contrast to the prevailing notion, referred to as a dual discourse, that describes medicine as the addition of humanism to science. Drawing on Aristotle’s notion of phronesis and Sartre’s definition of the situation, we illustrate how this novel perspective entwines clinical practice, the person of the clinician, and the clinician’s situation. (shrink)

En este artículo nos proponemos exponer, a partir de los límites conceptuales encontrados a los planteamientos arqueo-genealógicos de Michel Foucault, la posibilidad de plantear, en dos momentos –arqueo-genealógico y gubernamental–, una “ética de la insubordinación reflexiva”. Es decir, una “ética de la libertad inmanente” al débil que al decir su palabra, denuncia y al denunciar cuestiona al tirano y su mundo al habar y actuar con –y por– los otros. Esta ética de la intersubjetividad planteada como una ética de la (...) insumisión concertada, crítica y deliberada, pensamos, puede derivar de ciertas “condiciones enunciativas” encontradas en las dos últimas investigaciones concernientes al “decir veraz” o el “hablar franco” expuestos en El gobierno de sí y de los otros y El coraje de la verdad. (shrink)

We should now be able to come to some general conclusions about the main lines of Cuvier's development as a naturalist after his departure from Normandy. We have seen that Cuvier arrived in Paris aware of the importance of physiology in classification, yet without a fully worked out idea of how such an approach could organize a whole natural order. He was freshly receptive to the ideas of the new physiology developed by Xavier Bichat.Cuvier arrived in a Paris also torn (...) by many overlapping debates on the nature of classification, and in particular that between the natural and artificial systems. The very validity of the enterprise of classification was questioned in many quarters. Cuvier's achievement on his entry into the Parisian world of science was not simply to establish himself as a highly competent anatomist: far more important, he also began to use ideas from many different specialties to change completely the notion of what was involved in natural history.124 At the same time that he himself swung away from the guiding image of the field naturalist as the ideal of the specialty, he took ideas from the new physiology to answer questions about the order of the animal world, and from comparative anatomy to resurrect extinct creation — and to come to conclusions from that creation about the history of the forms of life and the manner of their succession. He showed himself able to alter the relationships between natural history and many other fields of study in a way that implied, rightly or wrongly, his own complete mastery over such a movement. Partly he was able to do this because the ideas he borrowed were not themselves logically articulated and thus could be easily adapted and refocused for many different specific purposes. The value of the heuristic possibilities inherent in the idea of life, for example, far outweighed its inability to generate full systems of classification. Cuvier also consistently refused to consider in science matters relating to the first causes of events. Freed from the consideration of first-order phenomena, he was able to use second-order explanations across a far wider field of applicability. Personal doubts about the validity of a theology that had used science in order to bolster its own claims were combined here with the strong influence of the Kantian critique of the limits of human reason.125Cuvier's characteristic mode of procedure was that of intellectual appropriation and a bold capacity for altering the relationships between different fields of knowledge, rather than, with the exception of taxonomy, the technique of expanding their subject matter. His claims to originality came, first, from this reappropriation and reorientation and, second, from the sheer scope of his work, which aimed at nothing less than the cataloging and classification of all animate objects.126 They rested also on his acute use of his assertion of a certain relationship with the past of his subject. Very often he would present this history in such a way as to obscure his own intellectual genealogy, and often too he would give differing accounts of the priority of use of an idea in order to distract attention from the questionable exactitude of his own claims to originality. Cuvier came to Paris at precisely the time when society and institutions were most profitably malleable for a newcomer; it was also a time when many scientific disciplines had reached a stage advanced in terms of their factual content, yet relatively inadequate in conceptual organization. They were ripe for takeover by large-scale organizing ideas such as the animal economy and the subordination of characteristics. Paleontology is a particularly good example of a specialty in this particular form of underdevelopment in 1795.Cuvier paid a high price for his initial success. His electic applications of large-scale organizing ideas tended to mean that little of his own work had complete coherence at all levels. Ideas, as we have seen, that proved capable of providing a complete reform of the larger groups of the animal kingdom were incapable of producing its detailed working-out in the taxonomy of smaller groups, which had to be supplied from observed analogical correlations. Further, his physiological approach to classification involved the breakdown of strict correspondence between organs and functions, which left the way open for workers such as Geoffroy St. Hilaire gradually to tilt the balance away from the study of the correlations of hierarchies of functions, and toward morphology as the basis of the order of nature. Cuvier's brilliant appropriations from physiology from the beginning, therefore, contained the seeds of conflict with Geoffroy.Cuvier's eclectic approach made it very nearly impossible for him to present a clear idea of the ways in which the life sciences could be said to be lawful. In spite of his efforts to assimilate them to the position of the physical sciences in this respect, he was forced in the end to accord only an ambiguous status as “laws” to observational correlations. From this area of failure came much of the attempt to give his own two laws — the correlation of parts and the subordination of characteristics — predictive qualities, particularly in relation to paleontological research.It is not surprising that Cuvier's title as the “legislator” of natural history should represent more a claim than a reality. How, then, was he able to emerge as the leading French naturalist of his day? First of all must be adduced the sheer scale of his undertakings. Then comes his expertise as a practical anatomist, and the range of different topics toward which he turned his interest. His collaborators cannot be given credit for his output nor, as we have seen, for slavish adherence to his ideas. Cuvier was able to successfully claim to have dominated the underdeveloped specialties, such as paleontology, and turned them into a major heuristic input into both geology and comparative anatomy; but in other fields, such as physiology, he appropriated concepts and encouraged research but made little impact on the field himself. His attempts in 1812 to head off, or neutralize and absorb the growth of morphological studies landed him in a dangerously rigid position, which despite his encouragement of the new physiological research under the Restoration made further elaboration of his own conceptual underpinnings almost impossible.Cuvier's authority in the scientific world would in any case have been great because of his substantive achievement in taxonomy, but the rest of his work had enough ambiguities and dislocations for it to need the support of his political and social power. Cuvier's detractors seized on a vital fragment of the truth when they accused him of finding the political dimension all-important: it obscured the disjunctions in his theories and at the same time gave him the authority to make new claims for the status of the observational sciences - and for their relations of power with their surrounding specialties. Cuvier's science both thrived on and was halted by the power games of intellectual appropriation, manipulation of the past to confirm the present, and continual claims for hegemony. (shrink)

Este artículo propone una exégesis de dos de los hitos conceptuales fundamentales con los que Foucault llevó adelante su investigación sobre la medicina como campo de producción de lo “humano” en la modernidad: por un lado, el delineamiento del individuo en el nacimiento de la clínica moderna y, por el otro, el surgimiento de la figura de lo “humano” a partir del proceso de medicalización como correlato de lo que el filósofo denomina la bio-historia. A tal fin, en primer lugar, (...) se analiza la producción de lo “humano” bajo la noción de “individuo” como consecuencia de la “mirada médica”, en Nacimiento de la clínica. Luego, se relaciona esa noción con la de “hombre”, que aparece como su corolario en Las palabras y las cosas, donde esta última figura cobra toda su significación como resultante de la positividad de las ciencias que se producen en tono de él. Finalmente, se realiza un examen de la producción de lo “humano” en las conferencias que Foucault pronuncia en la Universidad del Estado de Río de Janeiro, en 1974, donde la producción de lo “humano” va a aparecer ligada al paradigma de la biopolítica y, específicamente, en el caso de la medicina, de la “bio-historia”, que complementan y precisan los desarrollos previos. (shrink)

The varieties of meaning in which we use the terms illness and health requires that we develope a conceptualization allowing us to maintain a unity between the differences. In fact, the experiences of health and illness are complex ones and they need to be understood in their different levels so that the need for help of patients and their desire for health is adequately faced. At its roots, the experience of illness is that of a threat posed to the unreflective (...) credit given to life in good health. This threat has not only a biopsychosocial dimension, but a moral and sybolic one as well, and it is mainly at this level that illness represents a moral challenge. Contemporary culture seems to be at pains in suggesting a shared set of meanings enabling the patient to give an intersubjectively valid sense of illness, since the only kind of answer offered is a technical one. The symbolic dimension of the notions of health and illness call for a deeper cultural enterprise of looking for a credible sense of illness for our times. (shrink)

ArgumentThis paper considers how certain ideas elaborated by the Montpellier vitalists influenced the rise of French alienism, and how those ideas framed the changing view of passions during the eighteenth century. Various kinds of evidence attest that the passions progressively became the focus of medical attention, rather than a theme specific to moralists and philosophers. Vitalism conceived of organisms as animal economies understandable through the transformations of the various modes of their sensibility. This allowed some physicians to define a kind (...) of anthropological program, which viewed human beings as a whole, with no distinction betweenle physiqueandle moral. The passions in this context became a specific alteration of the animal economy. Such an anthropological program was the framework within which Pinel understood the various classes of madness as disease – those troubles being general disturbances of the animal economy, which presupposed a knowledge of the latter, to be addressed and cured. In this view, and departing from the vitalist writers with regard to the specificity of mental illness as such, Pinel proposed another conception of the relations between passions and madness, and elaborated a general view of their status in etiology and therapeutics; those views were taken up and systematized by Esquirol, who finally defined a new kind of continuity between passion and madness, demonstrated by the idea that some kinds of madness that he called “monomania” had as a principle a “ruling passion” that the alienist, this novel medical specialist, had to unveil and address. (shrink)

In order to fully understand Michel Foucault’s archeology of knowledge it is necessary to put it not only in the context of the discourse theories of the French school, but also in that of the linguistic theories of science. On the one hand, Foucault rejects the representational theory of scientific language. In his analysis of the discourse of the human sciences, with its complicated definition of the statement, he aims to show that we cannot limit the language of knowledge to (...) a vocabulary. On the other hand, Foucault’s approach is a serious challenge to structuralism because it is impossible to analyze the language of savoirs without taking into account the statement’s correlate. If the discourse of sciences is an artificial vocabulary created by means of the purification of the natural language, Saussure’s semiology could not compete against the conceptual dynamics of representational semiotics, and should admit that, in the cognitive usage, signs are representations. Therefore, Foucault admits that the statement has a correlate, that this correlate is not a physical object and that it functions as a historical structure of the discourse. This structure can be seen as a norm; the changing of this norm cannot be identified but in the archive and its description is always retrospective, structural and archaeological. (shrink)