the legacy of Cartesian “objectivity” makes it hard to understand patient verbal reports

clinical neurophenomenology, embodiment, introspection, medicine, symptom reports

Psychiatrist Allan Beveridge (2002) hones in on a facet of the patient-physician relationship relevant to neurophenomenology: the over-adoption in medicine of the scientific attitude of objectivity towards phenomena. While entirely appropriate in the many research contexts, this may make understanding the personal body-knowledge of the patient more difficult (pg. 101):

In the mental state examination, a standard method of describing the clinical encounter is to contrast the patient’s supposedly ‘subjective’ account with the doctor’s ‘objective’ description. In this model, the doctor is granted a privileged position: the clinician’s perspective is taken to be superior to that of the patient. The doctor’s objective approach is considered neutral, scientific and representing the truth of the matter. In contrast, the patient’s subjective report is regarded as unreliable, distorted and potentially false. The lowly status of the subjective perspective is further emphasized by the frequent use of the accompanying prefix, merely. On reflection, this dichotomy is an extraordinary one. It is held that the doctor is an authority on the patient’s inner experiences. The doctor knows more about how the patient is thinking and feeling than the patient him-/herself

This “scientific” medical stance towards patient subjective reporting is consistent with the Cartesian heritage of the sciences of the mind. The implications, hidden or unexamined commitments should be critically examined if the verbal reports about patient body-states are to be better grasped by science and medicine. To the extent cognitive science, psychology, neuroscience, and medical fields uncritically base their methodologies on unexamined premises, certain problems may appear just due to the very choices of what is considered “data”. The relegation of patient verbal reports to the category of “merely subjective” allows for Cartesian assumptions about cognition to create difficulties at the outset of any research project attempting to model personal knowledge of the body. It may be that the very categories of subject and object, or scientific knowledge vs. subjective or “folk psychological” naïve theories of the body, present foundational problems for understanding how neurophysiological processes relate to verbally reportable knowledge of the body. But as a practical matter, health care professionals must simply cope with patient statements as one more data source (Ersser and Atkins, 2000, pg. 68):

Clinical decisions involve information of a necessary type and quality. Professionals take account of both objective and subjective data during the clinical assessment process to decide on a patient’s health care need and care plan. The difficulty lies in professionals understanding how best to reconcile their objective perspective with that of the patient, when formulating clinical judgments

Before a doctor revives technical training, he or she is a person with experiences of health and sickness. The verbal reports of patients are interpreted by professionals with their own history of embodiment. To what extent does their personal body knowledge consciously or unconsciously affect their clinical intuition about the accuracy of patient verbal reports? Does expert knowledge of the body gained from studying anatomy and physiology allow for better knowledge of one’s own body? Such questions point to our current rather murky understanding of embodied cognition, underscoring the need for models capturing richer, more subtle aspects of experience, cognition, and brain.

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