A problem for psychotherapy.

It is well-documented that people’s memories are fallible; their perceptions are unreliable; and their view of the world—no matter how strongly believed—may well be contrary to the facts, even contrary to physical law. All of these aspects of mind can be manipulated by experts, and by others. The evidence for false memories is considerable. Memories can be implanted easily. Sometimes, even without anyone manipulating us, we can catch ourselves remembering impossible events, such as being held as a child by someone who had died years before. Yet we remember the event clearly. We can remember putting something away in a particular place, and insist on it, until we find it where we really put it—and then remember putting it there.

Perceptions can be altered. Anyone reading a newspaper can see reports of people, especially in groups, misperceiving events. Crowds look up at the sky and see stately space ships gliding by because everyone else in the crowd sees them also. The face of the Virgin Mary appears on a piece of toast and is venerated. Law schools have classes in which it is readily demonstrated that eye-witness testimony—however sincere—is often wrong. The growing number of convicts demonstrated by genetic evidence to be innocent of the crimes for which they have been convicted on eye-witness testimony demonstrates that fact over and over again.  People claim to have been abducted by space aliens and interfered with sexually; and others believe them. Some individuals see ghosts, or communicate with the dead. And other people believe them. There are superstitions that hold many in thrall. I have patients (a number of them) who have to pick the “right clothes” to wear in the morning, lest something bad happen to someone in their families. And they truly believe that.

The world is full of people who believe opposite things. To mention a few: matters of religion, ethics, historical fact, politics, and even science, and so on. Our political scene is dominated by men and women who do not seem at first glance to differ much by education or intelligence coming down very strongly on opposite sides of the abortion and contraception controversy, the social obligations of government, the appropriateness of  different military interventions at different times and, it seems, almost every other act of policy. None of us is surprised by these revelations as they come to our attention. They are what we have come to expect of each other. What is astonishing—at least to me—is how certain we are in our beliefs. Given the fact that we readily recognize folly in others, why can we not entertain the idea that we, ourselves, may be in error from time to time when we remember something, or when we think we experience something, or when we have come to believe something?

As a psychiatrist I treat a number of people who are afraid of drugs. I often read to them a list of the symptoms that patients in a drug study have developed after taking the drugs. These are some of them, along with the percentages of the subjects who experienced the side effect:

Headache 15.5 %

Nervousness 8.5%


Anxiety 5.5%

Diarrhea 7%

Nausea 10.3%

Then I inform them that these were subjects who had taken the placebo—a sugar pill—and not the drug itself. In such a way I can convince them that these negative placebo effects occur readily. But when they come in with reports of having their own side-effects to prescribed medicines, they insist that in their case the symptoms are “real.” Of course, they are real. If I see someone in front of me throwing up, I know that person is not making up a complaint of nausea. But there is the possibility that the nausea comes not from the drug itself, but from an expectations of the effect of the drug; and I cannot very often get patients to contemplate that possibility. It is an important distinction. Some of these drugs are critical to treatment. If the side-effect is a placebo effect, it is likely to disappear in a few days with continued use of the drug. I would prefer not to stop the drug unnecessarily.  Of course, often I cannot tell ahead of time whether the complaint is “real” or not. Some side-effects, such as a rash, I know are a reaction to the drug. Some other side-effects such as those I mention above often come solely from the idea of the drug.

Believing is Seeing.

What we believe is important because our experience is likely to be twisted in ways that support those beliefs. We perceive things we expect to perceive; and we then behave in ways consistent with those beliefs. These are sometimes called “self-fulfilling” predictions. What troubles patients often is precisely these preconceived notions, I list some of them here:

I am unattractive and unappealing to the opposite sex.

Even if others are impressed by me, I know deep down I am fooling them. I am incompetent.

If something bad is likely to happen to someone, with my luck it will be me.

All men are interested only in sex. All women are catty.

There are germs everywhere, especially in public bathrooms; and you got to watch out for them. Otherwise you’ll get sick.

If I have a really strong feeling, like a panic attack, I can lose control of myself and act crazy. Or I might have a heart attack.

Getting upset all the time is dangerous for my health. Also, it is important to have a good bowel movement every day and a good night’s sleep every night.

I usually lose money gambling, so I’m overdue for a winning streak.

I can never learn how to do those things—even if everyone else can do them. My coordination is so bad, I’ll never be able to learn to drive.

New York City is dangerous, especially at night.

If I ask for a raise, they’ll fire me.

Blind dates are dangerous.    And so on.

These ideas are crippling. They undermine the patient’s confidence and lead to withdrawal and depression. They undermine any chance for success, whether it is success in business or in social relationships. Psychotherapy is above all else, an attempt to undermine these bad ideas and help the patient to see himself/herself, and the world in general, more accurately. So, the fact that these ideas are held to stubbornly interferes with therapy. “I know the way I am,” patients sometimes say, to devastating effect. If they cannot be different, their experience of the world cannot change.

It would be nice also, I can’t help thinking, if everyone—not just patients—was less certain of being right all the time. We would all get along better. I am tired, though, of inveighing against the self-righteousness of others and the smug certainty of ignorant people. I have no reason to think I am any better than they are. In fact, I have some reasons to think I may be worse. I know when I am proven wrong about something, I am bothered more than other people would be.

Since these defects of thinking seem to be part of the human condition, it is worth wondering why. Why do some people hold onto their ideas in the face of overwhelming evidence of being wrong? The best examples of these are scientists, who, after all, are supposed to be dealing with objective fact. Still, those geologists who ridiculed the idea of continental drift never changed their minds. They died first. Similarly, the theory of relativity when it first was published was dismissed by some of the world’s great physicists. And some of them continued to feel the same way long after everyone else was convinced of its accuracy. Just as a body in motion tends to remain in motion, beliefs tend to continue even when contradicted by facts.

I think these are some of the reasons:

  1. We are pack animals. We have evolved to live and work in groups, and we are inclined to share ideas and ideologies intrinsic to those groups, including among them religious and political beliefs. There is a survival advantage to belonging. We feel comfortable with others who think the same way. Sometimes reality is shunted aside.
  2. Most of the time what we learn from others is reliable. Think of the weatherman or the doctor. Skepticism is less useful more of the time than the willingness to be instructed by people in whom we believe. Sometimes, obviously, we are led astray, but there is an advantage in holding to ideas that have formed over a long period of time, instead of being pulled in different directions all the time. It is anxiety-provoking to be in doubt.
  3. Many fixed ideas are self-congratulatory. We feel morally superior. We know the truth. That is a comforting idea and colors our reaction to anything that seems contrary to what we believe. (Think of the cable news channels. Conservatives tend to watch the same news channel all the time while liberals watch a different one.) It is embarrassing to be wrong about important matters, especially when we have expressed ourselves strongly about them.
  4. Changing our attitudes and ideas is likely to imply that we should change our behavior. Behaving differently risks failure and ridicule. It is easier to justify to ourselves continuing to do whatever we are accustomed to doing. We have a stake in being right.
  5. Perception is so malleable, we miss the chance to learn something new at the very first instant of hearing it or seeing it. Seeing is not believing. It is the other way around. Believing is seeing. All of experience tends to confirm what we already think.

There is a price to pay in not knowing the truth of things. The fallacious and self-destructive ideas that most psychotherapy patients have, some of which I mention above, are good examples. They interfere with the ability to engage life effectively. But we are the sort of creatures that do not learn new things easily, if they contradict what we think we already know. We hear and read selectively. That is the way things are. It is so important for us to maintain our long-held perspective on ourselves and on the world, that we are more likely to martyr ourselves for our beliefs than admit to ourselves, and to others, that we may be wrong.   (c) Fredric Neuman. Follow Dr. Neuman/s blog at fredricneumanmd.com/blog/ or ask advice at fredricneumanmd.com/blog/ask-dr-neuman-advice-column/

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