Cognitive objectivity in contemporary social security medicine Hans Magnus Solli, MD, PhD, Vestfold Hospital Trust, Tønsberg, Norway António Barbosa da Silva, theol. dr., Ansgar University College and Theological Seminary, Kristiansand, Norway

Ontological underpinnings: From positivistic “objective findings”… “Objective finding”: traditional criterion –E.g., X-rays, computed tomography (CT), magnetic imaging (MRI) and laboratory tests Often cannot be found or are not conclusive. In most mental illnesses, “medically unexplained symptoms”, work (dis)ability assessments Ontology should be revised

..to The First Condition: embodied subject’s life-world as basic ontology ICF-model one step in right direction Life world: The immediate world of everyday experience, of surrounding world of nature, culture, work-places! and other humans in societies. Embodied subject: the concrete living human being, dynamically linking material embodiment, subjective experience, and natural, cultural and social environments together. –The phenomenologists Edmund Husserl, Martin Heidegger and Maurice Merleau-Ponty

Second Condition: A variety of ways that the patient/claimant present him-/herself, providing different kinds of data Signs of pathology from clinical examination Psychometrics - psychological assessment data Behaviour understood by empathy –Activities and actions/activity limitations in environments (as described by, e.g., the ICF) –Expressions of mind through body and movement postures, movements, gestures, facial expressions, gazes of the eye and tones of voice –Reflection e.g., concerning environmental facilitators or barriers, goals (intention, motivation) and abilities (competences) –Psychiatrist and philosopher Karl Jaspers ( )

Third Condition: Interpretation - applying theory/experience in context Theoretical knowledge - parts of it are models Empirical knowledge, from both uncontrolled and controlled experience –EBM has its place, albeit a limited one Sometimes applying narrative accounts

Fourth Condition: Applying criteria of cognitive objectivity Professional matter-of-factness concerning body, mind, situation etc Impartiality Accuracy and correctness Intersubjectivity, verifiability –Dialogic - with the patient/claimant –Professional - related to the professional community

Four conditions for the definition of a comprehensive concept of cognitive objectivity Embodied subject’s life-world as basic ontology A variety of ways that the patient/claimant present him-/herself for health personnel and provides data. Interpretation - applying theory/model/experience in context Applying criteria of cognitive objectivity

Short version: Cognitive objectivity in social security medicine The expert claims general validity concerning descriptions and judgements Based on data from what she/he can perceive and interpret professionally in a meeting with the patient/claimant And using established criteria of objectivity An article about this concept will be published in an open access journal during Winter 2017