Symptoms and Signs versus Transference and Speech

“In the medical tradition of the eighteenth century, the disease was observed in terms of symptoms and signs. These were distinguished from one another as much by their semantic value as by their morphology. The symptom hence its uniquely privileged position is the form in which the disease is presented: of all that is visible, it is closest to the essential; it is the first transcription of the inaccessible nature of the disease. [...] The symptoms allow the invariable form of the disease set back somewhat, visible and invisible to show through. The sign announces: the prognostic sign, what will happen; the anamnesic sign, what has happened; the diagnostic sign, what is now taking place. Between it and the disease is a distance that it cannot cross without accentuating it, for it often appears obliquely and unexpectedly.” In this passage from The Birth of the Clinic, Michel Foucault describes one of the medical ‘codes of knowledge’ at the end of the 18th century, showing that one and the same phenomenon, namely illness, underwent an epistemological transformation and was regarded as a different object of study, following a reorganisation within the prevalent bodies of knowledge and the power they confer upon specialised observers. Foucault points out that medical science at the end of the 18th century did not distinguish itself by its primary focus on what is visible, nor by a particular conception of illness itself, but rather by a modified relationship between the patient, his or her illness and the specialist confronted with it. According to Foucault, the position of the medical doctor at the end of the 18th century differed from the one he had occupied in ancient times and during the Middle Ages, because he was now able to rely on the environment of the clinical institution, which gave him the power to make new decisions. Within this context, illness was conceived as a complex of symptoms and signs, which the specialist had to recognize if he wanted to make a firm decision about the nature and the seriousness of the disorder, and the appropriate level of treatment.