The Elephant in the Brain & The Folly of Fools

 Two more books to recommend:  

The Folly of Fools (2011) by Robert Trivers and The Elephant in the Brain (2018) by Kevin Simler & Robin Hanson are both about the human tendency to engage in deception: not only the deliberate deception of others but the deception of self.  

Trivers approaches this issue from the point of view of genetics (he was the first to characterize the evolutionary biology of reciprocal altruism).  The capacity to deceive can be beneficial to survival, as we see in many species of animals, and in many human examples.   But such deception can only work up to a certain point, an equilibrium point in terms of frequency, otherwise the strategy fails.  If deception was too frequent, the evolved strategies to counter deception would render the deceptive strategy ineffective.  Similarly, cheating can be an evolved strategy, but if cheating occurs too frequently in a population, it would no longer be effective due to widespread awareness and countermeasures in the population.    

Trivers goes on to argue that self-deception is a type of advanced deceptive strategy.  The capacity to effectively deceive others is enhanced if we can deceive ourselves.  If you REALLY believe you can win a fight (despite poor objective evidence), you are more likely to convince your opponent that you can win, and therefore are more likely to actually win, even if you utterly lack fighting skills. 

Unfortunately, self-deception leads to many serious problems in society.  Trivers goes through many examples, showing that horrible accidents, wars, biased research, and religious phenomena, are often driven by self-deceptive factors which end up causing disastrous results.  

His chapter called "religion and self-deception" is particularly recommended.  

While I consider this book important and highly recommended, I did find it often to be quite informal in reasoning, punctuated by forays into humour, but this could be a bit problematic when he is wandering into areas (for example about politics, wars, and religion) that many people could be quite sensitive or easily offended about.  There are bound to be sections in this book which could cause people some offense.  

The Elephant in the Brain is quite a remarkable review of ideas from social psychology and behavioural economics.  There is influence from Kahneman, Trivers (The Folly of Fools is referenced), Haidt, and many other leaders in the research of this area over the past decades.  I think it's astounding that these two authors, who are not specialists in these areas, produced such a comprehensive and compelling summary of this research.  

The thesis of this book is that humans have a powerful motive to signal membership in groups.  The tendency to form ingroups is a powerful human trait, evolved over millions of years.  Group membership allows us to trust and collaborate with our group members, for safety, defence, maintaining a food supply, dealing with illness, finding a mate, and raising children.  But unfortunately, this tendency to form ingroups can become such a powerful motivation, often without our awareness, that it overwhelms reason, fosters needless and often terrible conflict with outgroup members, and can become very destructive or at least inefficient.    And the phenomenon tends to perpetuate itself, since members of ingroups (be it political or religious or cultural) tend to socialize, mate, and have children with fellow ingroup members.  

They refer to Bryan Caplan's argument about education, showing that a great deal of education leads to only an indirect signal of skill or competence.  Most people do not use subject matter they learned in university very often if at all in the work they do afterwards.  Instead, the degree and grades serve mainly as a competitive signal to employers about capacity to achieve work, conform stably to demands, etc.  I have reviewed Caplan's book elsewhere (I do have some disagreements about this).  

The authors show that political and religious membership have powerful ingroup effects.  The tendency to form strong beliefs about elements of religious doctrine can be understood as a badge of group membership; if one can engage in successful self-deception about these doctrinal elements, it is all the more effective as a group membership badge.    The beliefs become shibboleths which can allow some feeling of trust with co-believers, and a sense of distrust or frank dislike of outsiders.  Such belief systems can develop independently of rational moral reasoning.  While all religious systems contain positive insights about morality (e.g. "love your neighbour as yourself", "blessed are the meek", "blessed are the peacemakers," "judge not lest ye be judged", "do unto others as you would have them do unto you," etc.), the moral prominence of these beautiful insights is often lost in a cloud of doctrine that becomes more about maintaining an emblem of group involvement, an "us" vs. "them" mentality.  This mentality is a manifestation of an evolved trait pushing all humans towards group involvement, formation of local communities in which we can feel trust and belonging, but with the unfortunate consequence of having outgroups which we would not trust, and which we would treat with less positivity, warmth, and generosity.  

The same phenomena occur in political beliefs.  While there could be core rational beliefs about positions on a political spectrum, with regard to preferred economic strategy, international affairs, management of public works, etc., a great deal of political involvement involves doctrinaire beliefs that are badges of group membership, and which have nothing to do with any understanding of policy.  Most people don't even know what the policy positions are, exactly, of the candidates they vote for.   Many others support their ingroup's politicians even though the associated policies would be harmful to themselves economically or socially.    We have tragically seen this happen during the pandemic.  Extreme beliefs about vaccines, masks, etc. became emblems of political group membership; many people made decisions about these issues not because of rational evidence (which strongly supported vaccine and mask use, for the protection of everyone's health, including the anti-vaxxers' own health and well-being), but because of the beliefs of fellow ingroup members in political or religious factions.  Masks and vaccines have almost nothing whatsoever to do with religion or politics -- they are simply common-sensical public health measures -- but once these issues became badges of group involvement, the issue spiralled into disaster, to the detriment of everyone.  This is an extreme example of the phenomenon shown in the famous children's study, where kids randomly given shirts of a different colour end up forming hostile ingroups, opposed to each other.  In the case of the pandemic, a great deal of anti-vax belief was simply driven by factors akin to having a different shirt colour, just to show difference from an opposing outgroup.  

In both books, reference is made to psychiatric theory as an example of self-deception.  Psychoanalytic theory is basically a set of ideas akin to religious doctrine, with a strong ingroup community of "believers" who couch discussion of psychiatric issues through the lens of a theoretical system which is mostly fictional.  As with religions, there are core beliefs in psychoanalysis which reflect deep insight and wisdom.   For example, the idea of psychological defenses came from psychoanalysis, and is ironically an insight into the tendency for humans to engage in self-deception, with the implication that we should try to become aware of our defences, and to be able to set them aside.   Similar insights warning about self-deception can be found in religious texts.  But most of psychoanalytic theory is arbitrary, based on bizarre inferences made from case reports, coloured by the already biased opinions of the therapists.   But as with religious practices, much of the therapeutic value in psychoanalysis has nothing to do with the literal belief system, it has to do with the practice itself.   Visiting a trusted minister or priest, who would most likely be kind, gentle, understanding, supportive, and wise, could be a wonderfully healthy practice, as could a meditative practice of daily prayer, or visiting a congregation of loving friends.   These healthy and possibly healing effects would occur regardless of the belief system held by the group.  Similarly, the practice of psychoanalysis (or psychodynamic therapy more generally) requires frequent visits with a wise, compassionate, gentle, kind therapist who probably has some useful feedback about life problems, and there would be a healing effect of simply having a stable therapeutic relationship over a long period of time, irrespective of the fictional theoretical belief system held, such as strict Freudianism.  

While we can empathize and even endorse the benefits of ingroup membership phenomena, I believe it behooves us to strive for improved rationality, to guide our knowledge and decisions so as to benefit ourselves, our neighbours, and the world in the most effective way.  Societies across the world have improved in this way over the centuries, as Steven Pinker has shown us (see Enlightenment Now), but we have a lot of work to do to continue progress in building a just, peaceful, prosperous society.  

In both books, we are wisely cautioned to look to ourselves for our own self-deceptions.  It is another human tendency to see self-deception or folly in others, while not noticing our own.  In my case, I recognize this will be a work in progress.   I surely have beliefs or practices that are products of my ingroup or other biases; I hope that I will be able to keep working on better awareness of these issues over time, in service to my patients and to myself.   

Review: Shrinking Violets: The Secret Life of Shyness, by Joe Moran

 Joe Moran's book is a nice exploration of various historical figures (such as authors, poets, and musicians) who had what he calls "shyness."  Moran alludes to his own shyness as well.  

A thematic goal of the book is to understand shyness as a part of the tapestry and variety of human life, as opposed to a pathology that requires treatment, or that is even treatable at all.  

Moran is a good writer--he's an English professor, and it is always a delight to read a book in this type of genre written by someone with a mastery of the language.  

This book is interesting as a historical or biographical journey, but I found it quite limited as a serious study of shyness from a psychiatric point of view.  First of all, "shyness" is a very limited term to describe the many varieties of anxiety, introversion, personality styles, and autistic traits likely present in some of his case studies.  

Near the end of the book, Moran encourages a position of gentle acceptance of shyness, but this acceptance seems to disparage the potential value of attempting to help people manage or change their social anxiety or avoidance using therapeutic techniques.  One chapter is even called "The War Against Shyness," which is a pretty strong condemnation of the therapeutic culture.    

There are many shy people, who have what might be considered social anxiety or autistic traits, who might find therapy helpful, to improve social skills, to find ways of facing fears more comfortably, or even to reduce anxiety a notch (including with the help of medication).   We should always have modest or limited expectations of therapy; also we need to take care to affirm an accepting rather than a pathologizing stance, particularly when social behaviour and experience always exists on a spectrum.  Yet the best of modern therapy is affirming and accepting; it just helps people to suffer a little bit less, to help people have a little bit more freedom in their lives to do things they might find meaningful, enjoyable, or essential for survival or prosperity.  

Review: Blueprint by Nicholas Christakis

 I am happy to have discovered Christakis and his work, in an area I would call “evolutionary sociology” or “mathematical sociology.”  

Blueprint: The Evolutionary Origins of a Good Society is an excellent companion to books by Steven Pinker, Jonathan Haidt, and Richard Dawkins, and even behavioural economists such as Kahneman, looking at issues concerning the genetic components of individual and group behaviour, and the intersection or interplay between “genetic” and “environmental.”     Christakis shares Pinker’s general optimism about human progress, though through a social and anthropological lens rather than a strictly individual, rationality-based one.  Haidt and Christakis both look at dynamics of group differences, Haidt as a psychologist, Christakis as a sociologist.  And Christakis looks at gene-environment interaction on a group level, a continuation or elaboration of Dawkins idea of an “extended phenotype.”  

Near the beginning of the book, there are very interesting case studies presented about small groups that isolated themselves from the rest of society, either through choice (e.g. the Shakers), or through disaster (shipwrecks), then having to develop some means of survival, stability, or happiness.  Some organizational styles were successful, especially when there was some form of effective but not overly rigid leadership, combined with respect for individual differences, and a culture encouraging playful interactions.   Some styles led to failure (a very low survival rate), such as if warring factions developed, “Lord of the Flies” style, or if the community was either too anarchistic, too insular, or too tyrannical.  

Christakis introduces network analysis of groups, which I would like to learn more about.  I consider this to be in the mathematical discipline of “graph theory,” another nice example of pure mathematical concepts and modern data science allowing us a deeply insightful view of aspects of human nature.     I consider this type of analysis especially important in this age of online connectivity, which has the potential to amplify or distort connectivity phenomena, leading to powerful forces of social change, leadership, and spread of ideas or culture.  

After finishing this, I am motivated to finally start Christakis’ next book, Apollo’s Arrow, which is about  the COVID pandemic, again studying it through the lens of sociology and group dynamics.  

A general takeaway point from this book, from my perspective as a psychiatrist, would be to even more strongly value an understanding of social and group dynamics in a person’s life, to understand the nature of connections, connections of connections, group memberships, friendships, communication, and community, in much greater detail, as a component of understanding psychiatric phenomena and strategizing about therapeutic help, rather than stopping at the level of individual psychology only.  

The Urge: Our History of Addiction, by Carl Erik Fisher

The Urge: Our History of Addiction, by Carl Erik Fisher is a good book about the history of addiction, weaved together with a story of the author's own alcohol use problems and rehab.  

The original use of the word "addiction," as Fisher shows us, was more general or broad, referring to situations we might now consider "behavioural addictions," habit problems, or just very strong preferences.    This usage of the word, despite objections from some addictions specialists, may be most accurate from a neurobiological point of view, according to recent evidence.  

He emphasizes many times how addictive phenomena lie on a continuum of severity in different people and within the same person at different points in time, and are influenced strongly by social, economic, and political circumstances.   For some people addiction is a symptom of, or a means of coping with, horrible environmental circumstances.  For others, it is a trap leading to loss of control even when environmental circumstances have improved or are normal.  

Understanding and helping addiction problems has had an interesting history, with some compassionate medical and community help approaches evolving since the 1800s, but often interrupted or negatively influenced by social factors such as stigma or criminalization.  

I agree with his conclusions, that addiction treatments need to be individualized, and that there can be various different causes or problems which underlie addiction for different people.  AA or other 12-step groups can be valuable for many people, but this is not the only effective approach.  Other group styles, such as the "SMART" program, can be preferred.  Abstinence-based models of treatment may be preferred or necessary for some people, but for others it is effective to aim only for moderation without abstinence.  Some people do not want or need peer or group support, and prefer one-on-one counseling.  Others may prefer to manage their addictive problems alone; Fisher cites data showing that many people with addictions can recover without any therapeutic treatment at all.   There are medications that can help, such as naltrexone.  

Fisher acknowledges the importance of loss of control in addiction, and of the phenomenon of denial which delays or prevents many people from seeking help.  

There have been big problems in addiction management that must change.  First, there needs to be much more availability of addiction treatment programs for those who desire or need them.  There should not be economic biases causing some groups to have less access than others.  For opiate addiction in particular, there needs to be easier availability of methadone or buprenorphine maintenance for those who would like to try this approach.  Harm reduction strategies in general have a very strong evidence base.  

Second, public health interventions can be simple and effective, such as restricting the advertising or marketing of addictive products (such measures have been useful for reducing tobacco use in the population).  There is still a big corporate influence on policy (from the alcohol or gambling industries, for example), which should not be allowed to continue.   Third, there should be less focus on prohibition and criminal punishments, which in general have often made addiction problems worse, particularly by focusing expensive social resources on law enforcement rather than on community improvement and rehabilitation.  

Belief Bubbles, Delusions, and Overvalued Ideas

 One of the most important posts that I've written on my blog, in my opinion, has been "Political polarization, propaganda, conspiracy theories, and vaccine hesitancy: a psychiatric approach to understanding and management," initially published on September 1, 2021 but edited and updated numerous times since then.   I check periodically how many people visit my blog, and I see that there are relatively few.  If I could recommend just one of my articles to be published widely, it would be that one, since I think it is so important regarding individual and public mental and physical health issues in the world today.  

The topics in that post focused on misinformation, propaganda, and deluded beliefs regarding the pandemic.    

I frequently see similar issues at play in my daily work as a psychiatrist.  

What causes fixed false beliefs?  When would we call these "delusions" as opposed to overvalued ideas, or simply examples of erroneous thinking?  

In psychotic states, the mind creates delusional beliefs without any reinforcement from a social community.  This is caused by genetic factors, abnormalities in dopamine circuitry in the brain, magnified by psychosocial stress.  As a result of the individual nature of psychotic illness, fellow members of the community can easily recognize the problem, and hopefully attempt to help.  Such delusional beliefs are unlikely to spread in a social network.  

There are examples of "shared psychotic disorders" in which an individual may have a primary psychotic illness, leading to close associates or family members adopting the same beliefs.  But this is a relatively rare phenomenon.  

A much more challenging problem occurs when false beliefs are spread in a social network.  In this case, the beliefs may or may not have anything directly to do with the other beliefs or values within the social network .  For example, extremist anti-vax beliefs are more common in particular religious or political groups, but vaccines have very little to do with theology or ideology.   The process of ideological spreading in these cases is analogous to what Dawkins calls a "meme", though driven not by a natural selection process, but by a process akin to "sexual selection."   In "sexual selection" traits such as peacock feathers propagate together with traits for recognizing and desiring the initial trait.  For example, bird songs or feather colours are sexually selected due to the song or feather itself and the desire of other birds to recognize or value the song or feather.  The song or feather comes to be an emblem of the species itself, rather than having other adaptive or communicative value (bright or decorative feathers do not lead to improved flight).  Many examples of "mass delusion" such as anti-vax beliefs are likely similar; they have become emblems of membership in particular religious or political communities, which are found to be attractive by those within the communities, even though the beliefs are harmful to the group and contrary to the group's positive values.  In this way, they are ironically similar to a virus:  anti-vax dialogue and behaviour has become much more prevalent or even dominant in these religious or political groups, such that the groups' core values or policies are utterly neglected or contradicted.   People from outside these groups would be disgusted by this phenomenon, leading to the groups becoming more insular, decried as hypocritical and immoral by outsiders, and obviously less able to offer charismatic outreach.  In particular, values such as love, care, and freedom are profoundly contradicted by beliefs which decry life-saving public health protections.  

Anti-vaccine and other "anti-public-health" propaganda is extremely harmful to society; it causes needless suffering, death, and economic hardship.  The propagation of such ideas is shockingly dissonant with the core values of many of the groups associated with it.  Disparate groups have endorsed such beliefs, leading to an unusual medley of fundamentalist religious groups, biker gangs, and racist groups joining in protests or defiance against vaccine and public health mandates. 

It is very difficult to address or improve problems of this sort.  When beliefs have been adopted as an emblem of a tight-knit social community, they are strengthened greatly by group association, and group members will defend these ideas from outsiders, almost like people might defend their home or family from invaders.   These ideas become adopted as almost sacred core values,  as though the beliefs (in this case about vaccination, wearing masks, etc.) were enshrined in a sacred religious text such as the Bible.  

As with psychotic illness, there are degrees of severity.  In mild cases of psychosis, affected people may be able to question their beliefs or request help; in more severe cases they have the insight to know that others would see their beliefs as paranoid, so they are able to refrain from discussing their beliefs, even though they still are fully believing their delusions.  In more severe cases, people will start expressing, or casually "slipping in"  the paranoid ideas in casual conversation (even with a psychiatrist) almost as though to test or evaluate the conversational partner, perhaps to seek a kindred believer or to be warned about a "nonbeliever."  As with some examples of religious practice, "believers" may seek to attempt to "convert" others as though expressing the delusion has a sacred value.   

I think it's pretty important as a psychiatrist to gently inform people that there are delusional beliefs going on.  With entrenched delusions this may need to be done with the greatest care and empathy, but I do think it needs to be discussed at least a little bit, otherwise there is a risk of the person feeling their delusions have been endorsed.  In the case of socially-spread overvalued ideas, it's a more difficult process to address in a therapy setting.  In some cases the discussion risks spreading to a focus on ideas concerning religious or cultural beliefs, which are generally off-base.  But when new "contagious" beliefs are spreading in a social network, straddling the boundary between a "cultural belief" and a "delusion," unbridled and harmful spreading is more likely.  This is similar to the epidemiological dynamics of COVID itself:  COVID is deadly, but its death rate is low enough to insert itself into populations in a seemingly harmless way, until a few weeks or months later when hospitals and ICUs are overflowing with severe cases.  Ironically, if the mortality rate of COVID was much higher, it might be easier to control at a community level, because there would be more unity of action.

As I discussed in my "political polarization" post, there are many social actions that can help this situation.  It is most valuable for rational, persuasive pro-vaccine, pro-public-health members of affected social groups (such as religious leaders, truckers, political leaders on both sides of the political spectrum, police, military personnel, alternative health care providers, and people formerly part of the anti-vax movement but who have changed their position) to speak out as educators and leaders.   Scientists and public health officials, etc. should still do their best to offer effective public communication, with efforts to reach out to these groups, but they are less likely to have a substantial impact in these communities, since they will be dismissed or derided as threatening outsiders.   Some of the communicative efforts from scientific leaders could at least involve building a better rapport with disparate communities, so that scientists would not be seen as elitist or part of an "ivory tower," out of touch with the rest of the population.    Meanwhile, there is evidence that the rest of us should continue to do our best to combat the spread of misinformation, and to do our best to speak the truth, rationally, resisting the urge to give up in frustration.