Monday, May 12, 2008

Placebos

The last post, regarding experimental design and placebo effects, got me thinking about all the "cures" that have been superseded throughout medical and psychiatric history with newer and presumably "better" cures. I recall reading of instances in which schizophrenia was "cured" through psychotherapy or re-parenting or...

Of course, schizophrenia results from a genetic predisposition. It is a physical condition, not a psychological illness. Still, there are reports of people recovering from schizophrenia. One of the few longitudinal studies that spanned over 50 years (my recollection is not perfect here) showed that almost 30% of accurately-diagnosed schizophrenics were eventually no longer schizophrenic. The concordance rate of schizophrenia between identical twins is around 90%, and that's with identical genes. So there is (or are) additional factors that enable the gene to express or to stop expressing, and, of course, we don't know what they are.

Setting aside, for the moment, the issue of how genes get activated or inactivated, people throughout the centuries have reported themselves (or been reported by others) as "cured" of a variety of illnesses and disorders that we KNOW were not treated effectively. "Bleeding" people as a medical technique had many adherents for centuries, and there were many people who believed they had been successfully treated in this manner.

The fact is that we do not know, even remotely, how the body cures itself from otherwise major or deadly diseases. We read about someone recovering from a 100% fatal cancer and living for many years, but we have no idea what the mechanism for this might be. The human body has mechanisms and modes of operation we can't consciously call upon. "Hysterical strength", in which someone under the right kind of circumstances can exert forces normally totally out of our range of function, has been known for a long time.

The "placebo effect" includes our ability to function in these extraordinary ways, and it is apparently fueled by belief or conviction, even mistaken beliefs and erroneous convictions.

Saturday, May 10, 2008

A friend of mine sent the following:
Harry, I'd be interested in a skeptical take on the following: I stand face toface with someone, an arm's length apart. He puts his arm straight out from the shoulder, palm up, resting his wrist on my shoulder (his right wrist on my left shoulder). I tell him I am going to try to bend his straightened arm, and he is to resist as much as he can. I cup my hands from both sides of his arm over the inside of his elbow and pull down hard, trying to get his elbow to bend downward. Depending on the person's size and strength, I have to use more or less force, but I can always get the elbow bent at least 60 degrees, usually more.

We then reset in exactly the same position with the same task as before. This time, however, he is instructed to visualize 'energy' flowing up from the earth, through the soles of his feet, up his trunk, into his arm and out through his fingertips and beyond, like a five-nozzled fire hose shooting out water under high pressure. He is told not to focus on resisting, but simply on maintaining the visualization. Once he indicates he is ready, I try again to bend his elbow, and I can't, no matter how much pressure I put on it.

I have done this dozens of times, with all kinds of people, with myself and/or others as subjects. Aside from whatever psychobabble and metaphors are used to describe what happens, the result is the same every time.The only "objective" difference is that the person is apparently thinking differently from one trial to the next; how does that make them (apparently) stronger?


This is a great example of the kind of incomplete thinking for which scientfic rigor was invented. Imagine that you wanted to test the hypothesis that some kind of "energy" could be used by some sort of"mental control" as described above. The null hypothesis is that there is no such effect apart from that produced bythe belief itself. To test this and eliminate experimenter and subject bias, you would want to have a double blind experiment. This would be one in which neither the subject nor the "tester" would know what exactly was happening.

If the effect was only produced when both parties to the experiment knew which experimental condition was in place, you would know that the effect was the result, not of the experimental condition, but of the belief/credulity of the parties in the experiment. That is, of course, exactly how the experiment described by my friend works. What you observe,therefore, is NOT some mystical and unexplained force occurring through some sort of equally ill-described mental energy, but the "placebo" effect itself. The amount ofenergy difference in the two conditions described is exactly the definition of the amount of energy produced by a belief system itself.

My friend has come upon a perfect demonstration of the placebo effect. What you believemakes a difference, not in the way the universe operates, but in how you operate. Occam's Razor states that when there are two hypotheses that explain the same data, you should be biased in favor of the simplest. It is usually stated in the form "Do not multiply complexities". In practice I think this means that a higher standard of experimental proof is required for an hypothesis that requires a radical change in the way the world is viewed. Sometimes that needs to happen, and our world-view is wrong and needs to change. But the level of proof needed is still a high level of proof. In the example given by my friend, the standard of proof that is offered is just the willingness of the participants to believe that "something" is happening. That standard of proof gets us belief in the supernatural, the phlogiston theory, humours, astrology, and the endless pantheon of silly and ill-informed beliefs that seem to constitute proof for much of the world.

Rationality may not seem to be enough, but it's way ahead of whatever is in second place. Just because a ready explanation isn't available doesn't mean we should leap to an irrational one.

Tuesday, May 06, 2008

Election frustration

We all know that we are not told enough valid information for us as individuals to have an opinion on political matters. Bush told us that war in Iraq was necessary because"they" had "weapons of mass destruction". What other information did we have?

Do we think we have more information about the war in Afghanistan? Do we think that opium/heroin has anything to do with it? and if so, what? How are we supposed to have a valid opinion when we are not given information that is worth a fart in a windstorm?

That's why we have a representative government, rather than a true democracy. We vote for people that we have to trust to get all the information, even the information that is not available to us, so that they can vote as they think we would want them to. That's the theory. What's the checks-and-balances on this system? We have no way of knowing whether they voted in a way that represented their constituency. Essentially we have to trust them, trust the integrity, honor and sense of duty of our elected representatives.

Do other people have the same failure of trust that I do? If so, the problem is not a simple one, one in which electing different people will solve it. The problem is that there is no way to know whether a politician is voting as he believes we would vote if we had all the facts. We have to guess from outcomes and newspaper/tv articles.

So, what have we accomplished in Iran? Do we honestly believe that we can impose a representative and democratic government on people who want to follow religious leaders blindly? In the last 2000 or 3000 years, how many democratic governments have there been?
Particularly in the middle East, which in most relevant ways is still peopled by tribes battling for territory and water rights, where national boundaries are relatively recent and still relatively unimportant, where a winning tribe celebrates by killing as many as possible of the losing tribe, where there are no rights for those not members of your group, it is impossible to see how representative government would work. It doesn't even work that well here. And what gives us the right to try to impose our form of government on people who are not interested in democracy? What do we care what form of government they have?

The answer has to be that fighting for "democratic governments" in the middle East is the same as fighting against "weapons of mass destruction" in the Middle East. That's not why we're there, it's just why we're TOLD we're there. How much faith do we have that the secret reasons we are in the middle east and Afghanistan are good and valid? It's not so much that our leaders lie to us. There are probably good tactical and strategic reasons for doing that. It's that without ever, even eventually, knowing the REAL reasons, we can't decide whether our elected leaders are doing right or not.

I no longer believe that national elections serve a useful purpose. Changing from one set of dishonest and corrupt politicians to another is only marginally better than keeping the original group. Representative government is purely and simply an act of faith, and I seem to be in increasingly short supply of that item.

Sunday, May 04, 2008

Accumulating feelings as evidence

It's not good for us to "save up" bad feelings in order to justify an eventual explosion. When we do that, we accomplish nothing except to vent. The person we "explode" at simply sees us as being "emotional" and easily becomes defensive. No problem was ever solved while people were attacking and defending emotionally. Problems only get solved by thought, not by explosion, as far as I know.

But we notice when someone persistently and consistently criticizes us. When the issue remains the same over weeks or months, it is a specific single issue which is important and must be dealt with. On the other hand, when the criticism is constant but its content varies, the issue is not about a particular issue but is about us personally. In Transactional Analysis language, we begin to experience the criticisms not as "doing strokes", that is, negative strokes for specific behaviors, but as "being strokes", or criticisms of the whole person. There is a critical difference between the two kinds of strokes: "doing" strokes are limited to the behavior and gradually dissipate over time; "being" strokes are relatively permanent.

So when we begin to infer or guess that the negative comments made by the other person are about how we are as people, they become much more damaging to the relationship between us. It's one thing to gripe at someone because they forgot to get something at the grocery store; it's quite another to accuse them of being "thoughtless and inconsiderate". The former, a negative "doing" stroke, is fixed when we go back to the store, or is forgotten over a period of time. The criticism is not a personal one, and is really simply a request for a change in behavior. The latter stroke, that of being "thoughtless and inconsiderate", is a relatively permanent and attributive critism of the person to whom the comment is made. It has a permanent impact on the relationship and on one's expectations for future strokes.

As a result, in any important relationship, we are more attentive to "being" strokes than to "doing" strokes. When the negative comments and criticisms are for a variety of different behaviors, we begin to sense a deterioration in the relationship and a more and more toxic quality to the comments. When we "blow up", we are beginning to acknowledge that our relationship has become more toxic. We hope that this is not true and that "things can be fixed", but we are beginning to experience negative "being" strokes which in the long run are fatal to intimacy.

Relationships in which we are not liked are toxic. No one can live in an atmosphere of perpetual disapproval without emotionally withdrawing. Intimacy is not possible in such a relationship. It's important that we be careful with what we say to each other. We can and should listen to and sometimes give negative criticisms of behavior, but we should be careful in the extreme not to give negative "being" strokes, which leave permanent marks on the relationship and the person to whom they are given. And when we consistently criticize the other person for a variety of things, they begin to experience negative "being" strokes.

Sticks and stones may break our bones, but they will heal. Words can cut us deeply and can leave marks that simply never go away.

Stages of development

Human growth seems to be describable in a number of ways. I'm particularly interested in that pattern that describes the relative dominance of each of two functional parts of the brain: the emotional self and the intellectual one. I'm sure that each is intuitively obvious. They do not develop in step with each other, however. This is largely due to the fact that the actual physical development of the brain, especially the myelination of the connecting neurons, doesn't get completed until the early 20s, although the emotional capacity of the brain is largely complete at birth.

Small children, up to the age of 4 or 5 (and ages are very generally given) have little capacity to subordinate their feelings to their intellect. They may even be able to understand in a particular instance why they should do so. But if their feelings are even a little stronger, they dominate the child's behavior easily. In the second stage, from about 5 or 6 until puberty, they are more easily able to control their emotions with their intellect. During this (very pleasant!) age, you readily get a look at the person they will become as an adult.

When puberty strikes, the emotions greatly increase in intensity fairly quickly, but the brain continues its slow and steady development. As a result, the emotional self easily dominates the behavior and choices of the person, even though (at least at times) they are able to recognize how irrational and inappropriate their own behavior is. They are simply unable to muster the power to override their impulses. The teenager feels greatly conflicted by his/her own inability to make their behavior match their newly chosen values and beliefs. They are difficult to tolerate, even to each other.

When the person reaches the early twenties, assuming they haven't been done in by a parent, their growing intellectual power to suppress or inhibit emotionally-dominated behavior makes them more consistent and reasonable. The balance between emotional self and intellectual self remains precariously stable for many years, becoming more and more dominated by inhibitory power and intellect as the emotions (especially sexual) become weaker with age.

Since our emotional drives tend to diminish as we get older, we are more and more able to make our behavior fit our values consistently, and so our values become stronger and more reinforced by our actual choices. There is no age at which the emotions are totally dominated by intellect, of course, otherwise even us old people couldn't make impulsive and irrational choices. Such choices are clearly less frequent, however. At least I hope so.

Saturday, May 03, 2008

Voting "against"

I have been voting in Presidential elections for a great many years. Sometimes I have been enthusiastic about a candidate, sometimes not. In recent years two things seem to have happened that have changed my attitude.

In the first place, it's become more and more clear that regardless of who is elected President, there is little they can do without a majority in Congress. The President seems largely a figurehead and to serve as a marker in meetings. (The current President functions mostly as a doorstop, as far as I can tell.) Not only does it not seem to matter who is elected, it seems increasingly clear that both candidates are almost equally inept, and fortunately, because of their lack of genuine power, that doesn't seem to matter either.

Secondly, and this may conflict with the paragraph above, nobody can be elected in a national election without selling some part of his or her soul to the large, moneyed corporations, assuming the candidates have a soul to sell. When a candidate takes a large sum of money, regardless of what he or she promises, they at least owe the money-provider more favorable attention than all of us who did not provide the money. The determinants of choice are not the issues which are most relevant to the welfare and even survival of our country. Instead the politicians are openly willing to be biased by special interest groups, without even the flimsiest pretense at fairness or the welfare of the country as a whole. Can anyone imagine what John Adams or Tom Jefferson would have thought? The system is corrupt from the beginning, and we all know it, and we don't seem to be willing to do anything about it. I would be more apathetic, but it's too much trouble.

We could finance all national elections through a tiny national sales tax on non-essential items. However, if candidates have to make a choice between unlimited funds from corporations and wealthy individuals OR a limited amount under government supervision and scrutiny, why would they even hesitate to choose the former?

Something is also wrong about how candidates are presented to us through the media. For example, I was totally unimpressed by Al Gore during the debates on television. He seemed wooden, unresponsive, cool and vague. His opponent, now the President, He Who Must Not Be Named, looked (God help us) "better". HOW DID THAT HAPPEN? Watching Gore on talk shows or presenting his material on global warning showed me a totally different Al Gore, one who would easily have gotten my enthusiastic vote in that election. How can we vote meaningfully when the information we are given is so inaccurate and inadequate?

I have no intention of voting for President again under the current conditions. The choice between TweedleDumb and TweedleDumber is not palatable. I wish there were a space on the ballot for "None Of The Above". Absent that, perhaps we could all just stop voting until the broken system is fixed....