health – Becoming Human

Dealing with Life’s Decisions – (1) Blinded by Science

This piece is the first in two on the question of how to make decisions in life.

Some decisions we simply take too hastily, using cognitive shortcuts pre-programmed in our brains, and we would benefit from slowing down, thinking them through, applying a structured decision framework to them, and so on. A good example of this class of decision problem is investment. Provided you can frame the problem narrowly enough – i.e. that logically prior issues have been solved – investment decisions will be improved by thinking them through, because they will be freed from several cognitive errors which typically characterize them. This type of problem is simple and much has been written on it, so I will put it aside.

I also want to put temporarily aside the “big decisions” of life – whether and whom to marry, whether to have children and how many, and so on. These decisions will have consequences which, obviously, you cannot compute when taking them. I will reincorporate this type of decision in the second piece in this series.

In this article I want to look at decisions which are more everyday, which obviously may also have uncomputable effects (you sign up for the art class, at which you meet someone who changes your life) but which are usually designed to have more prosaic ones. For example: which classes to take at school; which sports to practice; dietary regime and so on. These are decisions in relation to which a certain amount of “evidence” exists, but where this evidence is not conclusive. Those are most decisions in life, and there is a reason why we have evolved cognitive short cuts to deal with them. It is not my intention to argue that there is nothing to be gained from applying more structured thinking to this type of decision (or other decision heuristics which go beyond “gut feeling”). What I do wish to do is to show that, almost inevitably, we think about this sort of decision in the wrong way. In short, we are so conditioned to acknowledge the supremacy of “rational” reasoning over our instincts that in fact we allow ourselves to be swayed by arguments which have the appearance of rationality but suffer from shortcomings which are so pervasive and fundamental that we would almost always do better to ignore these arguments altogether.

I am going to take an entirely typical example, of the kind we encounter many times on a daily basis, at least if we try to keep ourselves abreast of the news. Let us say we read a journalistic article, purported itself to be based on a scientific article, reporting on certain alleged health benefits of yoga. Those benefits speak to some issues or concerns we have with our own health, and so the idea has been put in our minds of giving yoga a go. Should we?

Please note that this example is just that. The media disseminates claims like this all the time. For example, we might read that playing a musical instrument is associated with higher intelligence. Or that bilingualism is negatively correlated with Alzheimer’s. Or that a diet rich in proteins results in more durable weight loss. And so on, and so on (I made all those examples up just to give the flavour of the type of truth claims we are dealing with and the problem which they pose).

Now, let us suppose that the underlying scientific study is at least correctly carried out and that the journalist has not entirely misrepresented its conclusions. Those are already two hefty assumptions which may or may not apply, but the context may give us an indication as to the confidence we can have that they indeed hold (for example, this is, ceteris paribus, more likely to be true of an article on the BBC than in the Daily Mail). What errors may we still make if, on this basis, we allow the article to modify our behavior?

A whole host.

Changing behavior has costs. There are the obvious direct costs, which may be greater or less depending on the case: in the yoga example they are likely to be fairly limited (yoga subscription, transit to the class, kit….). But then, there are also the sizeable opportunity costs. Yes, this may be a good use of my time, but is it the best use? Do I need to pre-commit resources up front?

This question cannot be answered unless you know what your priorities are: those outcomes which will make the biggest difference in your life. Ideally, that would be a pre-existing exercise. But even if you know you need to address a particular issue – say high blood pressure – and the evidence presented in the article actually shows some efficacy for the course of action in question (yoga), you can still go very wrong. By plumping for yoga, you go with the availability heuristic, which privileges the course of action you just heard of over what you might need to do more work to identify. By taking action, you lessen cognitive dissonance, and therefore the nagging feeling inside which might have prompted you to do more serious research or thinking customized to your own situation. Yoga will work on some cellular pathways, but those are certainly not the only factors involved in giving rise to your condition. There may be much more important ones, but ones which you are much more resistant to addressing – say your work, your relationships or where you live.

Even if the information is accurate, it has neither been produced, nor has it reached you, by chance. Someone decided to test a particular yoga program (which may have nothing to do with what is on offer in your locality). They did so because they have a predisposition to finding a favourable effect from yoga. But the same favourable effect might be produced in any of a number of other, unresearched ways – a problem which is particularly acute if the mechanism of action is not elucidated or hypothesized subject to a great degree of speculation. So there is a selection bias. This cannot be ruled out on the part of the media either, and if you got the article second hand, say through Facebook, your friend has also selected it in preference to others – with what reason?

In addition, the study may very well be partly or entirely attributable to the placebo effect (which is a great effect, but could be produced in other ways), with remaining variation explained by factors which yoga shares with other forms of exercise and/or other spiritual practices. The participants in the study may have self-selected, and therefore share attributes which differ from those of the population in general, and perhaps also from you. For example, imagine that those who do yoga are twice as likely to be vegetarian. Correlation is not causation: it could be their diet that explains all or part of the variation observed. You, in any case, are not Ms or Mr Average – you are older or younger, fitter or less fit. Yoga may be a fit for your other activities, or it may duplicate the benefit of them.

Now, I am certainly not saying you shouldn’t do yoga, nor that it doesn’t have benefits. I am saying that it’s almost worthless to read the article, and it may be worse than worthless to produce or distribute it. This article has in all likelihood not given you any new information at all. All it has done is make an incremental contribution to the “brand” of yoga as perceived by you. This, by itself, is not the core of the problem, however. The core is the idea you have that science should be your main tool to solve the problem you started out with. Although you have this idea, you have not in fact been scientific at all. You could have been more scientific – for example, read a book that discusses a series of approaches to your problem. That would probably have been a good idea (the article you read was not some kind of breaking news, so no need to be afraid that the book would be out of date). But even if you had done this, the problem would still have been orders of magnitude too complex for you to decide it on the basis of science alone. You not only will decide it on the basis of factors which you cannot really rationalize. But this is the only way to decide it. All the research you can possibly do is merely preparation, hopefully valuable preparation to make a better decision (there is, of course, a trade-off with the time you invested), but it will never provide an algorithm which decides on your behalf. Some people will choose to view this irreducible subjectivity as a lamentable concession to human nature. But, as I will explore in part two, it seems to me that all of the alchemy which turns research into outcomes is there, in the giddying sovereignty of the moment of decision.

Science, just like the mind, is a tool; something else – you – must be in the driving seat. Positivism is unscientific. Science makes a contribution, and yet if you have the belief that your decisions should be guided by science, it is very likely that, in combination with cognitive and selective biases, you in fact are led into decisions which are worse than those you would have made had you not had this belief at all.

Between the idea
And the reality
Between the motion
And the act…
Between the conception
And the creation
Between the emotion
And the response…

Between the desire
And the spasm
Between the potency
And the existence
Between the essence
And the descent
Falls the Shadow

T.S. Eliot, The Hollow Men

Tolerance and civil rights in the internet age: an essay in honor of national coming out day

Tomorrow is (inter)national coming out day.

I strongly believe that coming out – if you can do so safely – is both personally and ethically imperative. The personal imperative behind coming out is to live ones life in the light rather than in the closet. As LGBT writers and activists have made clear, living life in the closet, though it may be a necessary survival strategy, has extremely perverse effects. The Wikipedia article notes that reasons not to come out include (a) societal homophobia and heterosexism, which marginalize and disadvantage LGBT people as a group, resulting in potential negative social, legal, and economic consequences such as disputes with family and peers, job discrimination, financial losses, violence, blackmail, legal actions, restrictions on having or adopting children, criminalization, or in some countries even capital punishment as well as (b) internal conflicts involving religious beliefs, upbringing, and internalized homophobia in addition to feelings of fear and isolation. Coming out of the closet has even been shown by researchers in Montreal to have significant positive effects on health.

As an ethical matter, one should come out – in Western democracies at least – because the right to do so has been hard-won, and because doing so makes it harder to discriminate against ones community. It encourages others to follow in ones own footsteps, diminishing the personal cost to them of living their life in the light. It also avoids the risk of being blackmailed when ones sexual orientation inadvertently comes to light, and of living ones life in fear. For persons in the public eye this is particularly important.

The Montreal study cited above also contains the interesting observation that “contrary to our expectations, gay and bisexual men had lower depressive symptoms and allostatic load levels than heterosexual men.” (emphasis added)

This may well have been contrary to the researchers’ expectations, but it perfectly coincides with mine. We heterosexuals live our lives in the closet in numerous ways, including but not limited to the sexual. For my part, I can share that I am “monogamish” (that is, de facto socially but not sexually monogamous) and to some degree heteroflexible. In both regards (social monogamy merely being a choice of lifestyle and not an orientation), it is my belief and current understanding, as frequently argued on this blog, that I merely represent what a typical male of our species would be if social restrictions on these ways of thinking and being were removed.

Since I therefore belong to the entitled majority – albeit that majority may beg to differ – it shouldn’t be too difficult to out myself as a member of it. But it is non-trivial all the same. First I had to understand these facts about myself and accept them, which has taken half a lifetime (on an optimistic reckoning: and there may well be more I do not yet know) and then I, just like my LGBT brothers and sisters, have still needed to look societal prejudice in the eye (as well as consider the interests of my family) and say: tough, this is me (and by the way, it’s quite likely to be you too). Like I say, I don’t consider this act by a typical member of the entitled majority particularly brave. I think if I could not say these facts about myself publicly, I would be an outrageous wimp and betray generations of civil rights activists who have fought for the freedoms I now take for granted. I would be free-riding, and possibly living on borrowed time, instead of making my own contribution to a better, more tolerant and loving future for all of humanity. The ethical imperative is so overwhelming it is the greatest no-brainer I know of.

Today I read – I believe it was in Flemish daily Het Nieuwsblad, though I haven’t found a link to the article – that new rules requiring telecoms operators to log internet use are likely shortly to become law in Belgium. According to the article, these rules go beyond a European guideline of 2006, and it has been argued by police and judicial authorities that they need to do so in order to keep up with technological developments and stay ahead of criminals using new technology to dissimulate their plans. The article didn’t talk about civil right safeguards or give much detail on the specific arguments behind the plans. Although I certainly start from a position of caution regarding limitations on freedom, I don’t want to judge these plans here, and certainly not on the basis of that one article. But what does seem to be the case is that the space for freedom of expression which the internet has opened over the last decade and a half is starting, globally, to become a little less private than we thought it was. And this means, the closet is being busted into. Aside from the benefits of coming out, the closet is no longer a safe place to stay.

In the space of only a few years, we have become used to a freedom we never before imagined. The internet has been so tremendously successful as a social platform because it addresses basic human needs to communicate and build community. But long before the state surveillance angle became a topic of discussion, it was already clear that the explosion in the social use of the internet and in self-publishing meant that society was faced with a choice between one of two paths: either to embrace greater tolerance and diversity or to foster an environment in which everyone was enabled and hence driven to share, but nervously required, like in the communist societies of the past (and many of course still today), to look over their shoulder at the possible worst-case social consequences of their sharing.

As time has gone on, this social choice has become more and more stark. It is now certain that both governments and major corporations have the means to put together a very detailed picture of any internet user, even the more careful – their political and religious views, sexual orientation, fantasies and paraphilia, their friends and family, socioeconomic status, and a host of consumption preferences. To some extent the use of this information is constrained by the law: currently insufficiently, but conceivably and hopefully more robust legal safeguards will be put in place. Jurisdictions with stronger rules on online privacy may find themselves at a competitive advantage to host social internet services. Strong encryption systems and distributed peer-to-peer application topologies may wrest a certain level of control back for the user.

But I suspect it will always remain an uphill battle. And the consequence of this is that anything about which you may feel personal shame, or which may be societally disapproved of, always may come to light. Unless, that is, you bury it deeper than your relationship to it may make possible.

This in turn means that a host of situations in which collectively vast numbers of people are implicated and which today exist in a tolerated, if sometimes disapproved of, grey area, may tomorrow have to choose if they are black or white. Legal norms against widespread practices are routinely subject to a degree of latitude in their implementation. But if, tomorrow, we cannot leave this equilibrium untouched, we will have to legislate more sensibly and with considerably more regard for the facts relative to populist sentiment. Not only legislation, though, will have to change merely to maintain the status quo: ultimately, it is societal attitudes which will have to become considerably more accommodating if we are not to find the space for freedom and diversity shrinking intolerably and ourselves facing the prospect of a totalitarian control of society which formerly could only be imagined as the grimmest of science fiction.

I want our societies to be safe, and I want us to stay ahead of terrorist and criminal threats. This is not only a legitimate role of government, but one of its basic functions. Both sensationalist reaction and counterreaction are dangerous, and must make way for serious and informed debate. At the same time, democratic controls over the use of personal data by governments and corporations must be put in place and procedural safeguards made robust.

I also value the ease with which the internet makes information available and allows us all to grow in our knowledge of the world and of each other. The benefit to all of humanity of this must far outweigh the danger which this same fact poses in relation to persons with malicious intent.

Ultimately, we are only going to get this balance right if, collectively, we all grow up. In the internet age, every civil rights issue you ever heard of has merged with a host more of which you have not. We are all interdependent and the freedoms of all depend on the freedoms of each. I feel very close to the LGBT community, as I do to feminist thought and anti-racist campaigners. Ultimately, all of these have a single message: my right to be me. Society, whether through government or private initiative, has a right to limit self-expression only when there is an overwhelming, objective need to do so – not just out of political expediency in response to populist sentiment. This basic unifying principle must be placed at the heart of democratic institutions and of the law and replace the partial protections of the past – based on sexual orientation, race, gender, disability or religion – with a full protection of the human being as such. It must be constitutionally guaranteed.

Religion is the best example of what I am talking about, because unlike all of the other attributes it is not objective : I can change my religion in a way I cannot change my race, gender or sexual orientation. In fact I personally have done so more than once in my life, and am still not too sure what term to apply.

Although religion is not an objective attribute, the protection of religious minorities in fact antedates by far the protection accorded to any of the other categories. This is the consequence of one simple fact: the murderous wars of religion and the eventual realization, first tentatively recognized in 1598 by the Edict of Nantes, that it was only if the mutual right to exist was guaranteed by law that sectarian strife could be brought under control and stable, prosperous societies emerge (“Pour ne laisser aucune occasion de troubles et differendz entre noz subjectz, [nous, i.e. the King] avons permis et permettons à ceulx de ladite Religion pretendue reformée vivre et demourer par toutes les villes et lieux de cestuy nostre royaume et pays de nostre obeïssance sans estre enquis, vexez, molestez ny adstrainctz à faire chose pour le faict de la religion contre leur conscience, ne pour raison d’icelle estre recherchez ez maisons et lieux où ilz voudront habiter“).

Yet although religious rights antedate other minority rights by a substantial margin, it is not very clear – any more – what a religion is. Is there a positive list or can anyone found one? In the latter case, is there a presumption of legality, or a process to become included in the positive list? When religions fracture, do all groups acquire the rights of the parent religion, or do some have to reapply? What rights apply to individuals, and which to the religion as such? Do some religions have a more restrictive set of rights than others? What is a critical set of beliefs (or number of adherents) which sets a “religion” apart from a simple philosophical worldview? And so on.

I am sorry if this sounds ill-informed about the jurisprudence on this topic: it certainly is. But the point is that religion, if it ever was a simple matter, is so no longer. The reality is that each of us, today, is free to make up his own religion, and many of us actually do (if you want to try, Daniele Bolelli has even written a “how-to book without instructions“).

In the past, religion involved a choice between a very limited number of options and religions as such could have rights, not just individuals qua members of that religion. Now, many people espouse a religious identity with no audit trail of “membership”, chop and change, may differ widely in beliefs from any sanctioned mainstream dogma, and some religions (such as, to its credit, Islam) never had a single voice of authority in the first place.

Under these circumstances, religious rights cannot mean what they meant in the past – they must extend to the right to live ones life in any way one personally finds meaningful and which is not demonstrably and significantly dangerous to the rest of society or to vulnerable groups (like children) within it, whose constitutional rights may override religious ones. The rest of society may not like a particular worldview, agree with it or (even more likely) for that matter understand it: if it is my own, ever-changing worldview then the latter is certainly the case (not even I could tell you exactly what it is today but it certainly differs from what it will be tomorrow). But my right to hold it must be at least as sacred as the rights of Quakers, or Baha’i, Sufis or whomever. I should not have to seek sanctuary within any of these groups if I do not wish. As I argued in a recent post, true spirituality is creative and actually requires me to be different from anyone else – I cannot follow a dogma.

The internet age demands extraordinary efforts of adaptation on the part of society, but we have the resources we need, in the form of long-cherished principles of political liberalism, to seize this opportunity to build a stronger, better and more inclusive world. By standing up for who we are and what we believe, placing ourselves proudly within the illustrious heritage of all those courageous predecessors, each of us brings that world a little closer.

Healing the body

In this post, I want to review two books with a common theme: Bruce Lipton’s 2005 The Biology of Belief and Lissa Rankin’s more recent Mind over Medicine.

Lipton, in his book, sets about demolishing what he himself admits is a straw man: the notion that genes determine disease and its progression. In his view, genes only provide a blueprint for building proteins, and it is the cellular receptor proteins on the membrane which drive gene expression in response to their environment. Few genes are self-expressing.

This hardly seems controversial. Nevertheless, the book is, even if it is not its main intent, a good and very readable laymen’s introduction to the molecular biology of the cell, and worth reading for that reason alone.

The “belief” in the title refers essentially to the ability of the brain to command, whether consciously or unconsciously, the production of neurotransmitters and other signalling proteins which then tell cells what to do. This view, as Lipton acknowledges, is based on the ideas of Candace Pert, whose work Molecules of Emotion I reviewed earlier. Interestingly, Lipton reports that this signalling intelligence was first developed in unicellular amoeba communities, where the signalling compounds are released into the environment and operate between distinct individuals. Multicellular organisms came only later, and took over this system of signalling to regulate the behavior of the community of cells which had now come to be permanently associated in a single individual. Thus cellular intelligence underpins the intelligence of more complex organisms.

Despite its expositional merits, however, Lipton’s book does not get us much closer to an understanding of the actual mechanisms behind the control of cell behavior. For the most part, he relies on somewhat forced analogies from quantum physics, the pertinence of which is far from established. Whilst he seems authoritative in matters of cell biology, what he says about quantum physics is frequently wrong and sometimes breathtakingly so. Essentially his main argument is the same one picked up on by Rankin, which may well be valid but is nevertheless lacking in detail, namely that the body’s self-healing mechanisms are activated by relaxation and disactivated by stress, i.e. by the activation of the hypothalamus-pituitary-adrenal (HPA) axis.

These self-healing mechanisms may be astonishing, and may depend to a significant degree on the variables the authors cite, but they remain quite mysterious in their details. One possibility one might have hoped Lipton would explore, but which he does not, is that there is a macro equivalent of the cellular apoptosis mechanism which leads entire organisms to self-destruct when signals in their environment communicate to them that they no longer play a role in the community. This may be a gross simplification but it would fit with Lipton’s overarching metaphor whereby the human body is, in many ways, merely the cell writ large.

Lipton also prefigures Rankin by taking to task the medical community for overuse of prescription medicines without a proper understanding of their systemic functioning. However he does not, and cannot, establish any principles to determine whether or not the use of pharmaceuticals is appropriate in individual instances and whether the other healing resources of the body have been sufficiently activated and explored. As such, the criticism, even if one may have sympathy for it, seems superficial.

If Lipton’s book is written from the perspective of a medical researcher, Rankin comes at the subject as a practising doctor disillusioned at the lack of holistic attention to health which characterizes the Western medical community. Failure to grasp the holistic nature of the body’s self-healing mechanisms means that many people get poor medical advice and care. Rankin is at her best campaigning for a much greater awareness on the part of medical caregivers of how healing actually takes place (though in this respect she seems to draw heavily on the admirable precedent of Bernie Siegel).

Much of Rankin’s argument centers on the unnoticed efficacy of placebos, a notion she draws from Lipton without, it seems to me, adequate attribution; indeed even some of the examples she cites already appear in The Biology of Belief. Rankin claims to have researched the placebo effect extensively, but at least sometimes she appears to permit misconception of the originality of her research. (A recent article in Scientific American is worth a look for anyone who doubts the strength of the placebo effect).

There are a number of important principles stressed in Rankin’s book which are often absent from other self-help guides directed towards recovering and maintaining health and which are welcome. Her insistence on finding meaning in life as a key contributing factor to wellness rings true, as does her defense of the power of affirmations given the need to override the negative messages which we are usually passing on to our bodies. She is also right in pointing to the value of community, although she passes lightly over important shortcomings of institutions like family and church the drawbacks of which may very well, in many instances, outweigh the benefits, and which are certainly some way short of the ideal. These institutions have quite likely been at the root of many of the health problems people experience. Moreover, even if community may be as important as diet and lifestyle, the recommendation to seek it out is difficult to operationalize if one does not have a healthy form of it to begin with. Rankin probably should also be commended for pointing to the importance of sexual life, but again, there is no clue in the pages of the book as to what might constitute a healthy configuration or even that this is a legitimate and important question to ask.

Unfortunately, for all its admirable qualities, Rankin’s book appears to take far too lightly the difficulty of modifying ones beliefs and actions in order to obtain better health outcomes, a mistake that Lipton avoids, since he is well aware that most of the body’s beliefs are encoded in subconscious scripts. The “diagnosis and prescription” part of the book is the least satisfying one, often asking the reader to answer in a few sentences what many seekers have needed decades to unearth and understand. In this sense, Rankin’s book looks like a typical US cultural artefact which uncritically endorses the errors of the positive thinking fraternity, discussed by me here.

This is disappointing, because Rankin is a much better self-publicist than Lipton and has acquired a significant new media voice which could have been used to promote deeper healing modalities than those she herself is able to offer. This unfortunately means she gives the impression of overextending herself where greater humility might have been in order, and accordingly coming across as superficial. Parts of her own “prescription” for herself read like an awkward list of endorsements of particular personalities, and there is no indication why they should be of value to someone else; they appear to be simply plucked from the air. Making a diagnosis of the factors in ones life which promote illness and writing a prescription to deal with them – even if one accepts this way of speaking – remains a major task and a daunting endeavor.

These criticisms aside, it is clear from both books that a major shift in social consciousness around health and healing is underway and increasingly forcing its way into the mainstream. For those who continue to place undue faith in the mechanistic and simplistic ideas which have hitherto underpinned Western allopathic medicine, either or both books will be very helpful antidotes. We may be still a long way off adequately describing how the body’s self-healing mechanisms work, but there seems no doubt at all that they make a key contribution to health outcomes and, if only for this reason, should be nurtured. In reality, of course, the quest for optimal health only dictates what the spiritual path anyway demands on other counts: a conscious uncovering of reality, and the courage to listen to what we already know.

Smartphonitis

I just read this article on WebMD which discusses the endemic compulsive use of smartphones in modern society, its possible reasons, consequences, and how to deal with it. Here is a summary sentence: “the smartphone, more than any other gadget, steals from us the opportunity to maintain our attention, to engage in contemplation and reflection, or even to be alone with our thoughts.”

I believe this is true and it is a matter about which we should be concerned. Yet the question of why this compulsion arises is not satisfactorily answered in the article, though it gives a few clues. Therefore I would like to put forward an alternative explanation. Continue reading “Smartphonitis”

Reich’s economic model of psychosomatics (4 – a reappraisal)

In my previous articles on the development of Reich’s thinking*, I have explained how his inquiry into Freud’s libido theory eventually led to his positing an equation between somatic and psychic states, an identity which I believe has been very therapeutically fruitful.

Reich of course went on to engage in work of a much more (some would no doubt say “even more”) speculative character, in which he sought to identify the energy present in orgasm with other energies physically present in the cosmos. From our modern perspective, this effort seems very strange, and to many of Reich’s admirers it is no doubt an embarrassment.

Bernd Laska’s biography helps us somewhat to see the chain of reasoning from Reich’s own perspective, and thus more sympathetically, but it remains evident that Reich in his later period wandered far from scientific method and truth, and one cannot help asking what these later developments imply for the scientific validity of his earlier orgasm theory.

And it seems to me that there is indeed a major flaw embedded in the earlier theory, which does not undermine its therapeutic validity but did lead both to the raft of later speculations and to a certain alienation from authentic sexual experience.

Reich’s error seems to me simple: he confused correlation with causation. Continue reading “Reich’s economic model of psychosomatics (4 – a reappraisal)”