The culture of the clinic

We concentrate here on the spectacular presentation and representation of patients, their bodies and their identities within the specialist clinic. We suggest a broad historical and cultural pattern that brings together the spectacular display and the oracular pronouncement as longstanding (although by no means immutable) features of medical knowledge and the importance of a deeply entrenched visual and oral culture in the creation and transmission of medical knowledge. We trace the intersection of visual culture and nosographic classification in the Rett clinic. The specialist clinic is a site in which we can observe the complex, practical work of diagnosis and of fitting a patient, in this case a child, with Rett syndrome. We consider this diagnostic work in terms of the spectacular display of the

clinic and examine the expert’s competence in ‘seeing’ cases and interpreting visual representations. This is in turn repeated in the expert’s right to make ‘oracular pronouncements’ concerning the patient’s characteristic appearance and its clinical significance. We go on to discuss the intersection of genetic technologies and clinical judgment in the identification of this syndrome and examine the other functions of this clinic, the moral and sentimental work of reassurance and of repairing parents’ identities in the context of this diagnosis. We affirm the continued significance of the clinic and the importance of resisting premature or oversimplified appeals to geneticization or technologically driven reductionism.