The Clinical Gaze

Definition:

     When the doctor views the patient as a disease not as a person. According to Shapiro, the clinical gaze strips people of their wholeness and leaves them feeling as if who they are is defined by their illness (Shapiro).  Michel Foucault stated, “disorders became localised to a distinct point within the body, dismembered and separated from the rest” (Pryce). The clinical gaze makes the patient feel as if they are no longer a person but just a diagnosis.

      The clinical gaze developed from improvements in science and the birth of modern medicine. With the modernization of medicine came the development of extremely detailed tests. Today, doctors often rely more on test results, shown in Figures 1 and 2, than on the narrative of the patient.

Figure 1

Figure 2

History: 

     Before the 19^th century, medicine was largely speculative. Without knowledge or tools, doctors had to rely on their senses and interpret their patients’ complaints. Furst describes in From Speculation to Science that patients’ “narratives of their symptoms were a central part of the transaction between patient and doctor” (3). During these early times doctors gave patients specific diagnoses and treatments. Physicians spent much more time traveling to visit their patients personally. Families were largely involved in consultations, and held many “strong opinions about the best course to follow” (Furst 4). Some of these early health care providers were hated, as their patients often died. However, others were considered “advisers and friends who could be entrusted with family problems” (Furst 4).  During the time of humoral medicine, the clinical gaze was not apparent. It was necessary for physicians to engage their patients and attempt to understand their complaints in order to make a feasible diagnosis. 

     The clinical gaze started to develop in the 19^th century, with the innovation of modern medical instruments. For example, the stethoscope was invented in 1816, and allowed doctors to make more scientific based diagnoses using characteristic sounds of different diseases.  This symbolic tool was the first step towards a mode of medicine rooted in “pragmatically established facts” (Furst 7). As described in lecture, stethoscopes required the physician to “isolate himself in a world of sounds, inaudible to the patient” (Paul Starr 136). This encouraged physicians to interact less with the paitent and “more with the sounds from the body.” Patients could not even hear these sounds, let alone interpret them. 

     Anesthesia was developed in the second half of the 18^th century, and allowed surgeons to perform more complex surgeries for a longer amount of time. Anesthetized patients lay “in quiet repose” so the surgeon could investigate the body. While anesthesia is a hugely important aspect of modern medicine, sometimes patients do not even meet the surgeon who worked on them. Anesthesia distanced physicians from understanding their client’s personhood even more. 

     The clinical gaze started to become apparent in the second half of the 19^th century with the increase in the number of hospitals and the momentous advances in the basic sciences. Hospitals in the United States rose from “178 in 1872 to more than 4000 in 1910”, and while they certainly had benefits to patients, they increased the prevalence of the clinical gaze in physicians (Furst 18). In these institutions, doctors had more patients to see and less time to devote to understanding each patient. The reduction of time doctors spent with their clients changed their relationship by “fostering a greater emotional distance and personality” (Furst 18). The gulf also widened between doctors and patients due to science innovation in areas such as microscopic pathology and biological chemistry. Doctors became less dependent on patients’ “subjective accounts” and more reliant on scientific figures and information (Furst 18). Innovations in the sciences also created an intelligence gap between doctors and patients who often had no understanding of the origins of diseases and their treatments. 

Examples:

There are many places where the clinical gaze is seen in literature, art, and film. Below are some examples.

“You minutely described in these papers every step you took in the progress of your work; this history was mingled with accounts of domestic occurrences.  You, doubtless, recollect these papers.  Here they are. Every thing is related in them which bears reference to my accursed origin; the whole detail of that series of disgusting circumstances which produced it is set in view; the minutest description of my odious and loathsome person is given, in language which painted your own horrors, and rendered mine indelible” (Shelley 92-93)

      In Mary Shelley's Frankenstein, Dr. Frankenstein often displays the clinical gaze. He created the Creature under this viewpoint. He meticulously put the body together and took precise notes on his process; however, he did not think about the Creature as a person. The body of the Creature and his personhood were separated by Dr. Frankenstein through his use of the clinical gaze.

Creature:  “Listen to my tale… do hear me… listen to me…” (Shelley 69)

Victor:  “Begone! Relieve me from the sight of your detested form” (Shelley 70)

     The clinical gaze creates a conflict between listening and seeing. This quotation shows how the Creature, essentially equivalent to a patient, wants to be heard by Dr. Frankenstein. But because Dr. Frankenstein is using a clinical gaze he only sees the Creature's body and does not want to listen to his story. Medical advances that contribute to the clinical gaze allow doctors to look at specific test results and make a diagnosis as opposed to thoroughly listening to the patient's story to gain the information needed to make a diagnosis.

In Thomas Eakin's The Gross Clinic, a woman is seen on the left side crying. She presumably is the mother or wife of the patient and seeing someone close to you in such a vulnerable situation is very upsetting. At this time the outcomes of medical procedures were unpredictable and frequently not positive. Sometimes patients died during the surgery and even more often they died after the surgery as a result of infection. The woman’s display of despair reflects the unpredictable nature of medicine. The fact that she is easily overlooked in the painting as well as the fact that the doctors are not paying any mind to her adds to the idea that the doctors are displaying a clinical gaze directed only toward the area of the patient that is being operated on.

“...reduced to diseased brains and essentialized into chemicals rather than acknowledged as the perhaps enigmatic, but nonetheless sentient, persons they know themselves to be”
     In “The Politics and Poetics of First Person Narratives of Schizophrenia” by Sue Estroff schizophrenic patients describe how they experience the clinical gaze. The clinical gaze makes patients uncomfortable. They feel as if their doctor is only paying attention to test results, diagnoses, and treatments instead of looking at them as a person.      

Related Concepts:  

     The clinical gaze has been an overarching theme of English 268H.  One important related concept, and another theme of the course, is how illness calls for a narrative. Perhaps the best example of integration between the sciences and the humanities is the idea that recovering from a disease often requires people to accept, and tell their illness narrative. As discussed in lecture and in The Wounded Storyteller, by telling the story of their disease, people can “redraw maps, find new destinations, and redefine where they are going” (53). Illness is an interruption, and refuses to become a memory of the past. In order to reclaim the self from the disease, people have to tell their truthful story, and begin to see their body as their own again. We have seen the therapy of storytelling during the course of English 268H through guest lecturer and novelist Randi Davenport, through characters like Siegfried Sassoon, and through our individual Faces of Illness projects.                     

     The clinical gaze has eliminated the need for doctors to thoroughly listen to their patient’s illness narrative. Doctors who frequently employ the clinical gaze look past the patient, and only see the disease. The clinical gaze is counter intuitive for a patient attempting to recover their person-hood from the grasps of an illness, as it denies the legitimacy of a patient’s narrative.        

Fixing the Problem:  

     It is important to note that the clinical gaze is not completely negative. The clinical gaze allows doctors to thoroughly investigate and comprehend the person's illness on the biological level. This permits doctors to fully understand how to best treat the patient medically. However, what the clinical gaze prevents doctors from doing is viewing the patient holistically. The emotional and mental state of a patient can greatly effect their medical illness. In order to keep the clinical gaze from morphing into a completely negative thing, it is important that doctors have proper training in the humanities. If doctors have an understanding of what the clinical gaze is and what it can potentially effect, they will be able to prevent it from becoming a problem while working with their patients. It is also useful to have an interdisciplinary team working on cases. When you have people who specialize in things that are more humanistic, such as social work and psychology, collaborating with the doctors, the patient is sure to get more a well rounded evaluation and treatment process.    

  External Links and Further Reading:  

http://en.wikipedia.org/wiki/Medical_gaze  

http://www.medhumanities.org/2008/01/medical-humanit.html        

Bibliography:     

• Frank, Arthur . The Wounded Storyteller. Chicago: University of Chicago Press, 1997. 53-73. Print.  
• Furst, Lilian. Medical Progress and Social Reality. 1. New York: State University of New York Press, 2001. 1-21.Print.   
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• http://www.altairtech.com/StoreImages/Dept1/Area4/LabResultsReport.gif
•  Pryce, Dr. Anthony. "Contemporary Sociologies - Foucault, Power and Surveillance." City University London. Web. 27 Oct. 2011 
• <http://www.staff.city.ac.uk/apryce/foucault.htm>.  
•  Shapiro, Johanna. "(Re)Examining the Clinical Gaze Through the Prism of Literature." Families, Systems, & Health 20 (2002): 161-70. Print.   
• Shelley, Mary. Frankenstein. New York: Bantam Dell, 2003. Print

 

 

 

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