The Eye of the Expert II: Medical Perception and the Training of Expertise

Now, having discussed some aspects of the expert observation required to interpret images of patients correctly, the next thing that comes to mind is of course how one should learn to do so. Next to “making the invisible visible”, as we have seen, film as scientific method created a debate about for whom this previous “invisible” was disclosed, and how and by whom it could be made visible.

I ended last blog with a note on patient-doctor interaction and a few notes of the use of discourse in medical practice. Yet, I suggest we take a step back and think again about Foucault’s ideas about the relation between seeing and knowing. Foucault’s expert is someone with a trained eye – so trained that he does not need to ask additional questions. Nothing can be hidden from the expert’s view.

This emphasis on observation is traced back to Hippocrates yet, as Foucault points out, modern medicine uses observation in a very different way, and attaches different meanings to it.

In an essay titled “On Scientific Observation”, historian of science (currently director of the Max Planck institute in Germany) Lorraine Daston writes:

Observation is everywhere and nowhere in the history and philosophy of science. It is ubiquitous as an essential scientific practice in all the empirical sciences, both natural and human, and even arguably in mathematics in some of its exploratory phases. It is invisible because it is generally conceived to be so basic as to merit no particular historical or philosophical attention. (Daston 2008:97)

In Daston’s opinion, observation needs to be “given” a history because of its widespread use. As a technique, she argues, observation is invisible because it is taken for granted as a valid scientific practice. The adjectives “everywhere” and “nowhere” describe the contradictory fact that albeit widely used and acknowledged, scientific observation has not been analysed properly. Everyone does it, but no-one really thinks about it. Furthermore, Daston says, the historians that have been concerned with the topic of scientific observation have done so to reinforce its view as “primitive and passive” (2008:97).

Now, whereas I doubt whether Foucault and his disciples would agree with this, as Foucault’s analysis of perception and the gaze are, I would say, far from “passive”. Doctors might have thought, as Foucault writes, that they had discovered the “purity of an unprejudiced gaze” (1973:195), what happened was the opposite. Medical perception is inscribed in changing reorganisation of disease, health and illness (ibid.). However, Daston’s essay focusses on particular aspect or “effect” of scientific observation. By invoking the concept of an ontology of scientific observation, Daston aims to analyse how expert observation creates and stabilises scientific objects (98). How do scientists “furnish” the universe with objects they can analyse by observing them?

Daston argues that for earlier philosophers, it was evident that observation uninformed by theory was impossible (98). Her focus on an ontology – almost as effect of – scientific observation enables to critically engage with perception as expert practice. How are we taught to see, and what does this entail for what is seen?

In ‘Reading the Human Brain: How the Mind Became Legible’, Nikolas Rose analyses contemporary practices of brain imaging and how these are related to the idea that the human “mind” is “readable”, understandable, unravelled. He says:

[D]espite all our doubts and our necessary scepticism, we may be seeing signs here that a new ontology is gradually emerging out of the shadows. Even if they remain confined to laboratory conditions, novel neurotechnologies embody a challenging materialism embodied and enacted in the capacity to access the contents of the human mind, whether to evaluate the presence of particular mental states or capacities, the existence of durable memory traces, or even the fleeting existence of specific thoughts and intentions. (158)

Images of brain activation and their meaning have gained a tremendous importance in neuroscience (and beyond) today. But, as Rose points out, these images “do” more than simply render visual and tangible aspects to our brains.

Following from this quote, we can argue that Daston’s analysis of how scientists “furnish the universe” is the result of a complex interaction between “seeing”, “training”, “creating”. And if we pursue this line of thought, we could say that claims about the “construction” of the human brain or mind are important not only to get more insight into the “what” this construction is about, but as much in relation to “how” and “by whom” it is created. “Constructions” or images of patients, their brains and its lesions are not merely ready-made products waiting for us to “unpack” them. What makes the “perception” of those images possible and how one learns to “see” them requires habit, as Daston points out (99).

Just as Daston, I do not write this to drain us into some determinist mysticism, saying that we cannot “know the outside world” or that what scientists study simply does not exist. But, as she argues, the practice of science crucially depends on its own ontologies, which therefore need to be taken into account when proposing such an analysis (110).

Daston, Lorraine

2008 On Scientific Observation. Isis, Volume 99 (1):97-110

Foucault, Michel

1963 La naissance de la Clinique. Paris : PUF (Quadrige).

1976 The Birth of the Clinic. Trans. A. M. Sheridan. London: Tavistock.

Rose, Nikolas

2016  Reading the Human Brain: How the Mind Became Legible. Body & Society, Volume 22 (2): 140-177