Background The article defines a comprehensive concept of cognitive objectivity applied to embodied subjects in health care. The aims of this study were: to specify some necessary conditions for the definition of a CCCO that will allow objective descriptions and assessments in health care, to formulate criteria for application of such a CCCO, and to investigate the usefulness of the criteria in work disability assessments in medical certificates from health care provided for social security purposes. Methods The study design was (...) based on a philosophical conceptual analysis of objectivity and subjectivity, the phenomenological notions ‘embodied subject’, ‘life-world’, ‘phenomenological object’ and ‘empathy’, and an interpretation of certificates as texts. The study material consisted of 18 disability assessments from a total collection of 86 medical certificates provided for social security purposes, written in a Norwegian hospital-based mental health clinic. Results Four necessary conditions identified for defining a CCCO were: acknowledging the patient’s social context and life-world, perceiving patients as cognitive objects providing a variety of meaningful data, interpreting data in context, and using general epistemological principles. The criteria corresponding to these conditions were: describing the patient’s social context and recognizing the patient’s perspective, taking into consideration a variety of quantitative and qualitative data drawn from the clinician’s perceptions of the patient as embodied subject, being aware of the need to interpret the data in context, and applying epistemological principles. Genuine communication is presupposed. These criteria were tested in the work disability assessments of medical certificates. The criteria were useful for understanding both how objectivity fails during work disability assessments and how it can be improved in the writing of certificates. Conclusion The article specifies four necessary conditions for the definition of a CCCO in health care and social security medicine and the corresponding criteria for its application. Analysis of the objectivity of work disability assessments in medical certificates for social security confirmed the usefulness of the criteria. (shrink)

Today, there is a considerable interest in phenomenology within psychiatric academic communities as well as among clinical practitioners; as a result, a growing number of institutions demonstrate their commitment to phenomenology as a privileged speculative companion. The main focus of existing teaching programs in phenomenology is usually placed on psychopathological issues and on describing the experience of mental illness from a non-naturalistic and person-centered perspective. In this article, I argue that phenomenological training should also be focused on the role of (...) the psychiatrist in providing such a phenomenologically informed patient-centered approach. In this perspective, phenomenological interviews such as EASE, EAWE and EAFI appear to be a particularly relevant form of training, as they allow the trainee to engage actively in the learning process. To focus on the person of the psychiatrist allows, however, to reconsider the meaning of the clinician’s neutrality, advocated by the authors of the phenomenological interviews. The attitude produced by adopting the phenomenological approach should instead be described as a particular reflective attitude which allows for paying attention to the embodied dimension of experience. This attitude differs from both the neutrality associated with the objectivity of classic psychiatry, and the neutrality to which a psychoanalyst strives. By taking into account embodied awareness as characteristic of phenomenological attitude, one then may address, through training, the specifics of phenomenological practice, such as its unstable and laborious nature, its integration in the lived experience, and the challenge that it poses to the psychiatrist’s scientific background. (shrink)

The centenary of Karl Jaspers' General Psychopathology was recognised in 2013 with the publication of a volume of essays dedicated to his work. Leading phenomenological-psychopathologists and philosophers of psychiatry examined Jaspers notion of empathic understanding and his declaration that certain schizophrenic phenomena are ‘un-understandable’. The consensus reached by the authors was that Jaspers operated with a narrow conception of phenomenology and empathy and that schizophrenic phenomena can be understood through what they variously called second-order and radical empathy. This article offers (...) a critical examination of the second-order empathic stance along phenomenological and ethical lines. It asks: Is second-order empathy possible? Is the second-order empathic stance an ethically acceptable attitude towards persons diagnosed with schizophrenia? I argue that second-order empathy is an incoherent method that cannot be realised. Further, the attitude promoted by this method is ethically problematic insofar as the emphasis placed on radical otherness disinvests persons diagnosed with schizophrenia from a fair chance to participate in the public construction of their identity and, hence, to redress traditional symbolic injustices. (shrink)