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Book Excerpt: Why Do We Insist on Lying to Ourselves?

Self-deception often compels us to attribute successes to our own effort, skills, or intelligence, but we tend to excuse our failures as due to external causes or problems on the part of others. “Mistakes are made,” we may claim when things don’t go well for us, instead of stating the simple fact, “we’re wrong,” or “we’ve flunked.” Even when there is nobody to lay blame on, we may still look for a scapegoat: We split ourselves into past and present personalities, then claim that our past self didn’t do so well, but our present selves are doing much better. We are new people now.

Clearly, many people are unable to recognize, much less admit, the ceiling of their own capabilities. Otherwise, how could most be above average — to a degree that the very term “average” has lost its statistical meaning?

Psychologists have been engaged in a major effort to understand self-deception since the 1990s. One of the notable studies was done by Justin Kruger and David Dunning at Cornell University. The duo recruited 65 regular human “guinea pigs” — psychology undergraduates — and asked them to estimate their abilities in answering questions about humor, grammar, and logic before they knew their real scores.

As it turned out, participants who did poorly rated themselves far higher than their actual performance. This cognitive distortion was the worst for those in the bottom quarter, who overrated themselves by more than 45 percent to be near the 60th percentile.

But if deceiving ourselves won’t do us good, why do we still do it?

Placebos through psychological processes such as Pavlovian conditioning, social learning, memory, and motivation can affect our mental state. This may in turn activate the genetic, immunological, and neural responses that are unleashed by real drugs with actual biological effects. That’s why inactive substances, words, rituals, signs, symbols, or treatments, if perceived as beneficial to our condition, can trigger a placebo effect.

Placebos are known for improving a range of conditions, including sleep, mood, a variety of diseases, and sex lives. Pain researchers have found that one of the primary pathways through which placebos work is kindling hope, which in turn can reduce anxiety. This activates the dopamine-mediated reward center in the brain, reducing a patient’s pain. When used with an effective drug (such as the painkiller remifentanil), placebos may further enhance the drug’s potency.

Not all people respond to placebos, however; nor is it easy to predict who will. Nevertheless, a general pattern is still noticeable for those who do respond: The more expensive the placebo is in terms of the pill or the treatment, or the more invasive the treatment is, the more effective it becomes. The same can be said for the perceived sense of medical authority in therapy.

Associative learning plays a key role in the placebo effect. Besides the color, shape, and taste of pills, other factors such as the appearance of clinics, medical instruments, and health care paraphernalia, and the presence of, or interaction with, physicians and nurses, all have the potential to produce or enhance a placebo response. These settings can mentally suggest to patients that a cure is coming.

And the more patients have been exposed to these reminders of the medical profession, the stronger the placebo response will be. Patients, in concert with their immune systems, have been conditioned to respond in this way. This may explain why patients, even after being told that they are being treated with a placebo, may still respond positively.

Some scientists adamantly discredit alternative medical treatments, equating them with snake oil. The hypothetical meridian system that underlies acupuncture has been labeled “prescientific gobbledygook.” Such views are biased.

The real concern about the use of placebos lies in the issue of medical ethics. Are physicians and therapists allowed to deceive patients? If healing is the goal, then taking full advantage of the placebo effect becomes clinically relevant and ethically acceptable. Yet, the same practices would clearly violate informed consent and constitute breach of trust between physicians and patients.

Would you be satisfied if your doctor prescribed a drug for your back pain without telling you it’s just a sugar pill? What if the placebo doesn’t work for you, or worse, works against you in what is known as the nocebo effect? And even worse, when you discover it, you may have already missed the best window of time to be treated with a real cure. For all these reasons, whether and how placebos should be used will remain controversial. What we might all be able to agree on, however, is that placebos should be given a try when there is no other medical alternative.

Category: Technology

Source: Undark

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