Epistemic Inclusion and the Silence of the Patients

In The Birth of the Clinic, Michel Foucault (1963) practiced historical epistemology, combining two scholarly crafts, history of medicine and philosophy of science. With his philosophical hammer and stethoscope, he assessed epistemic configurations: landscapes of discourse and practice. Philosophical readers are intrigued by the epistemological ruptures he discerned, the sudden upheavals in the ways in which physicians observed, treated, looked at, listened to, and wrote about their patients. Foucault was an “archaeologist”, signalling the sudden emergence and disappearance of “discursive formations”, pointing to abrupt and remarkable changes in the ways in which phenomena are described, analysed, and categorised. (Foucault 1969). For an archaeologist, all (anonymous) potsherds and coins stemming from a particular formation (or discursive layer) share a number of basic similarities: they were all produced in a similar vein. Likewise, within a particular discursive formation, all texts are basically similar. And although author names are mentioned by Foucault, the author’s identity does not really count. Foucault is interested in the basic logic at work, anonymously almost. Notwithstanding the countless discussions and debates between authors, a spontaneous unanimity can be discerned, concerning basic presuppositions that remain unquestioned. At the same time, there are striking differences between discursive formations (between layers within libraries). Historians tend to be critical about this approach. Add more detail, and the epistemic fault lines become increasingly diffuse,—the theorem of epistemic discontinuity becomes difficult to uphold.