The Extended Mind: The Power of Thinking Outside the Brain

Annie Murphy Paul

         

I have constrained my review of this book to one long excerpt due to the implications it has for vision, attention, learning, problem-solving, and memory.   

An oversized computer screen has been developed to which users can bring some of the same navigational capacities they would apply to a real-world landscape. Picture a bank of computer screens three and a half feet wide and nine feet long. Robert Ball, an associate professor of computer science at Weber State University in Utah, has run numerous studies comparing people’s performance when interacting with a display like this to their performance when consulting a conventionally proportioned screen.

The improvements generated by the use of the super-sized display are striking. Ball and his collaborators have reported that larger high-resolution displays increased by more than tenfold the average speed at which basic visualization tasks are completed. On more challenging tasks, such as pattern finding, study participants improved their performance to 200 to 300 percent when using large displays. Working with the smaller screen, users resorted to less efficient and more simplistic strategies, producing fewer and more limited solutions to the problems posed by experimenters. When using a large display, they engaged in higher-order thinking, arrived at a greater number of discoveries and achieved broader, more integrative insights. Such gains are not a matter of individual preferences. Ball emphasizes; everyone who engages with the larger display finds that their thinking is enhanced.

Why would this be? Large high-resolution displays allow users to deploy their “physical embodied resources”, says Ball, adding, “With small displays, much of the body’s built-in functionality is wasted.” These corporeal resources are many and rich. They include peripheral vision, or the ability to see objects and movements outside the areas of the eye’s direct focus. Research by Ball and others shows that the capacity to access information through our peripheral vision enables us to gather more knowledge and insight at one time, providing us with a richer sense of context. The power to see “out of the corners of our eyes” also allows us to be more efficient at finding the information we need, and helps us to keep more of that information in mind as we think about the challenge before us. Smaller displays, meanwhile, encourage a narrower visual focus, and consequently more limited thinking. As Ball puts it, the availability of more screen pixels permits us to use more of our “brain pixels” to understand and solve problems.

Our built-in “embodied resources” also include our spatial memory: our robust capacity, exploited by the method of loci, to remember where things are. This ability is often “wasted”, as Ball would have it, by conventional computer technology: on small displays, information is contained within windows that are, of necessity, stacked on top of one another or moved around on the screen, interfering with our ability to relate to that information in terms of where it is located. By contrast, large displays, or multiple displays, offer enough space to lay out all the data in an arrangement that persists over time, allowing us to leverage our spatial memory as we navigate through that information.

Researchers from the University of Virginia and from Carnegie Mellon University reported that study participants were able to recall 56 percent more information when it was presented to them on multiple monitors rather than on a single screen. The multiple monitor setup induced the participants to orient their own bodies toward the information they sought – rotating their torsos, turning their heads – thereby generating memory-enhancing mental tags as to the information’s spatial location. Significantly, the researchers noted, these cues were generated “without active effort”. Automatically noting place information is simply something we humans do, enriching our memories without depleting precious mental resources.

Our embodied resources engaged by large displays include proprioception, or our sense of how and where the body is moving at a given moment, and our experience of optical flow, or the continuous stream of information our eyes receive as we move about in real-life environments. Both these busy sources of input fall silent when we sit motionless before our small screens, depriving us of rich dimensions of data that could otherwise be bolstering our recall and deepening our insight.

Indeed, the use of a compact display actively drains our mental capacity. The screen’s small size means that the map we construct of our conceptual terrain has to be held inside our head rather than fully laid out on the screen itself. We must devote some portion of our limited cognitive bandwidth to maintaining that map in mind; what’s more, the mental version of our map may not stay true to the data, becoming inaccurate or distorted over time. Finally, a small screen requires us to engage in virtual navigation through information-scrolling, zooming, clicking-rather than the more intuitive physical navigation our bodies carry out so effortlessly. Robert Ball reports that as display size increases, virtual navigation activity decreases-and so does the time required to carry out a task. Large displays, he has found, require as much as 90 percent less “window management” than small monitors.

The book also mentions other options, where appropriate, such as large white boards or cork boards. During this past year, many children have been going to school on Chromebooks. At least some of our patients were able to hook them up to their televisions, which helped, but this book also confirms that our best learning still takes place person-to-person.

Useful Delusions:

The Power and Paradox of the Self-Deceiving Brain

Shankar Vendantam and Bill Mesler

Most of us feel that we are rational individuals who make knowledge-based decisions, believe that lying is wrong, and believe that delusions are a sign of mental weakness, if not mental illness. This book may change your mind.

What Shankar Vendantam learned, with Bill Mesler’s assistance, changed his mind. It has not changed my mind as much as it has increased my appreciation of the importance of delusions and how natural they are.

Since I was a child, I have often envied people who were certain about things that did not seem to qualify for certainty. Being uncertain was unsettling and still is. Being able to be certain would be much more comfortable and satisfying. It would also be much easier to explain and enable you to be more decisive in conversations.

Most of us appreciate that emotions play an important role in how we think and act even though we consider rational thinking to be far more important in our lives. But what about love, and friendship, and what we do that we enjoy and that provide satisfaction? What about being a sports fan and routing for a team? What about many of the things that we purchase?

While we believe the truth to be important, most of us lie numerous times each day. Most are benign, like compliments that you do not really mean. Some may be more problematic such as not responding when you disagree with something that someone has said causing them to assume that you agree. We tell our children to be truthful and to be also be polite to others, which is not always possible.     

You may not be comfortable with all of what the author has to say. I do not want to risk confusion by being an intermediary, therefore I am going to use excerpts which tell the story.

One reason people cling to false beliefs is because self-deception can sometimes be functional – it enables us to accomplish useful social, psychological, or biological goals. Holding false beliefs is not always the mark of idiocy, pathology, or villainy.

Foregoing self-deception isn’t merely a mark of education or enlightenment – it is a sign of privilege. If you don’t believe in Santa Claus or the Virgin Birth, it’s because your life does not depend on your believing such things. Your material, cultural and social worlds are providing you with other safety nets for your psychological and physical needs…. At the core of our troubled relationship with the truth lies a dilemma: We need hope in order to function, but the world gives us endless reasons not to be hopeful.

Life, like evolution and natural selection, ultimately doesn’t care about what’s true. It cares about what works…. Consider the simplest of examples – the organ you are using to read this book: In any given second, the human eye collects about a billion bits of information. This flood of data is compressed a thousand times…. The amazing thing is not that your brain reduces books to blurbs on a moment-to-moment basis: It is that your brain gives you the illusion that you are seeing everything…. Our eyes and brain are not in the truth business; they are in the functionality business…. Your brain has been designed to help you survive, to forage for opportunities, to get along with mates and friends, to raise offspring to adulthood, and to avoid feelings of existential despair. From the perspective of evolution, objective truth is not only not a goal, it is not even the only path to that goal.

Natural selection isn’t really interested in the truth. It is interested in what works. And your odds of survival are better when you see the world through rose-tinted glasses.

 People crave from their doctors what we always crave in the face of suffering: understanding, patience, and compassion. When we construct modern medical systems using only logic and rationality – and all of us have been to such facilities – we certainly benefit from the discoveries of science and medicine, but we instinctively know we are a long way from the balm of healing.

While seeing what we want to see can certainly be a source of trouble, it is simultaneously true that a generous sprinkling of positive illusions can help us perform better, stay happier, and avoid the pitfalls of depression and low self-esteem.

Our minds are vulnerable to myths, falsehoods and fictions not merely because we are dumb or stupid, but because we are frail, flawed and easily afraid…. People gain a sense of meaning and purpose when they submerge themselves in the myths, stories and rituals of their tribes…. Groups of humans needed to band together to aid one another and to confront enemies in the ancient past. Then, as now, the human desire to be part of something bigger than just ourselves helped to ensure survival.

“To live on a day-to-day basis is insufficient for human beings; we need to transcend, transport, escape; we need meaning, understanding, and explanations; we need to see over-all patterns in our lives. We need hope, the sense of a future.”

-Oliver Sacks

Less Medicine, More Health, Part 2

Dr. H. Gilbert Welch

Dr. Welch states that the primary problem with healthcare for a large segment of the population, is that there is too much of it. While much of our healthcare is outstanding, there is also a significant component which is of little value and can cause harm. “Too many people are being made to worry about diseases they don’t have and are at only average risk to get. Health is not simply a state of physical being – its’ also a state of mind.” Dr. Welch organizes his concerns around seven assumptions:

ASSUMPTION #1: All risks can be lowered.

Public health has made large reductions in health risk by providing cleaner water and air, getting lead out of paint and gasoline, reducing smoking, and promoting vaccines. While the correlation between smoking and illness is a straight line, other conditions such as blood pressure and blood sugar have a U-shaped curve. “Treating very high blood pressure is one of the most important things doctors do,” but blood pressure and blood sugar can also be too low.

All healthcare interventions have associated risks. The risks must be compared to the expected gain, particularly when you are well. These considerations change when you are ill or have been ill. “Even for those at the highest risk, there is every reason to go slow and not let the perfect get in the way of the good.”

ASSUMPTION #2: It’s always better to fix the problem.

Dr. Welch uses managing heart conditions as an example. Balloon angioplasties are proven to be valuable for people who have had heart attacks. They live longer than they would with other treatments or without treatment. They have not been proven to do the same for people with heart conditions but have not had a heart attack. Under these conditions, patients tend to do better with medical management and have less risk of complications.

ASSUMPTION #3: Sooner is always better.

“The value of cancer screening is counterintuitive. Cancer screenings work in two directions: it has both benefits and harms. And unfortunately, the harms are much more certain that the benefits. It turns out that screening is the fastest way to get cancer. (Cancers are diagnosed that would not otherwise be diagnosed. Improved technology can find small clumps of cells that would never progress.) Furthermore, it turns out that the survivors whose cancers were caught by screening are less likely to be evidence of the benefit – and more likely to be evidence of its harms.” Treating these “cancers” makes the cure rate go up, but just as many people are dying from cancer as before. “Screening is the systematic search for abnormalities in those who have NO symptoms of disease.” The gains that have been achieved in reducing the death rate for women with breast cancer is not due to early detection. It is due to more effective treatments.

“To get people interested in screening we have to get people to worry about the disease we are screening for. The phrase typically used to describe this effort is to “raise awareness”. It’s a nice euphemism but it really doesn’t describe what needs to be done: some ‘dis’-ease needs to be introduced into the population. You may not consider that a harm, but remember health is not simply a state of physical being – it’s also a state of mind. It’s more than a little ironic for a health-care system to scare people about their health, particularly when we know that doing so can adversely affect their health.”

“What is most certain about screening mammography in the United States is that it leads to a lot of false alarms.” “Overdiagnosis occurs when a cancer is diagnosed, yet cancer is not destined to cause symptoms or death.”

It is now known that there is a barnyard of cancers. The first is turtles. They are not going to progress or cause death. Some cancers are birds. Those are the ones that we cannot cure at this time despite early detection. The ones to watch are the rabbits. They can run wild, but we do have the ability to stop them with early treatment. A fourth category are the dodos. They will disappear without treatment.

“Understanding cancer requires understanding the human ecosystem. Reducing cancer burden is undoubtedly more about keeping that ecosystem healthy, not devising new ways to find smaller and smaller collections of wayward cells.” “Time has real diagnostic value.” If you have a test come back positive, wait and have it done again. It is rare that you would not have time to do this safely.

ASSUMPTION #4: It never hurts to get more information.

“As we try to amass more information about a patient’s symptoms, we increase the chance of stumbling onto something else. We even have a name for the things we stumble onto: ‘incidentalomas’. Just because you have data doesn’t mean that you have more information. Having information doesn’t mean that you have useful knowledge. And wisdom – well, that’s a whole new ballgame.”

“Genes are only one determinant of your health, and every few are reliably predictive of any one disease.”

ASSUMPTION #5: Action is always better than inaction.

“The fact that healing without intervention is possible can be lost in a highly medicalized society.” Patients expect intervention. Doing something can make them feel better even if it isn’t the cause. The problem is that interventions can have significant side-effects. Many interventions that have been proven to be ineffective are still being done. Now that we have minimally invasive surgery, the temptation is to do even more.

ASSUMPTION #6: Newer is always better.

Anything may be tried when a patient is at the end of life, but this may shorten life and decrease the quality of life of the days left. Atul Gawande writes about this wonderfully in Being Mortal. Dr. Welch prefers to stay with the tried and true unless there is not an older drug that has been successful. “Most of medical care is not about acute, life-threatening disease – it’s about managing chronic diseases.”

ASSUMPTION #7: It’s all about avoiding death.  Disturbing truth: a fixation on preventing death diminishes life.

Most elderly patients prefer being comfortable and are not in favor of heroic intervention. The story is different when the individual is younger, but there are still limits. Interventions should be the patient’s choice – if possible.

WHAT TO DO WITH THIS INFORMATION? There are many things that we can do and not do to improve our health, but we cannot ignore the effects of the chance of our genes and luck. Atul Gawande put this in perspective in Being Mortal when he stated that is it not the person who is here the longest who wins the game. Most of our minds are not designed to do well with statistics. The fact that we may feel that we may be making life and death decisions will not improve our statistical acumen. Dr. Welch uses the simple of example of a situation in which your risk doubles, going from 1% to 2%. This still isn’t high, but it is double and may seem to be more of concern than the statement that your chance of not having the occurrence decreasing for 99% to 98% which may seem trivial – but is the same thing. What is important is that we tend to have incorrect assumptions for a variety of reasons. Before we make serious medical decisions, it is important to get someone to clearly explain the numbers and to consider getting a second opinion. This does not pertain when you are in a medical emergency. In those circumstances you need to rely on the knowledge and experience of the professionals who are doing their best, but you have more time for most medical decisions and it is usually safe to take time to monitor your condition. Changes over time may make the decision much easier.

Less Medicine, More Health, Part 1

Dr. H. Gilbert Welch

If you are curious about health, I recommend that you take advantage of this very readable book. Dr. Welch practiced primary care medicine for almost 40 years, taught medicine at Dartmouth, and researched healthcare, especially the benefits and harm from the early diagnosis and treatment of cancer. He divides the book into rebutting seven assumptions that drive the overutilization of medical care to the detriment of wellness by a segment of our population. This will be the focus of part two of this blog. What follows is my perspective on how these problem effect eye health and vision care. 

Comprehensive eye exams have five primary components:

  • interviewing the patient to find out what they do and to discover any symptoms or difficulties that they are having;
  • assessing the health of their eyes;
  • evaluating the patient’s vision including how comfortably and efficiently they are functioning for school, work, hobbies, and sports;
  • probing for connections between health, medications, vision, and eye health;
  • explaining the results of the examination, making recommendations, and answering questions.

During most examinations, the primary concern is about the patient’s vision. Visual demands have increased dramatically for many of our patients. The accelerated expectations for reading cause a mismatch for some children between the development of their visual skill and the new norms. Almost all jobs involve the use of computers, and many adults are now spending a significant portion of their waking hours using illuminated screens. Vision changes are usually gradual and often take place without the individual’s recognition making tasks unnecessarily difficult for them. Visual comfort and efficiency can often be improved even when problems are not reported and may not be recognized until after they are improved.

With an aging population and the increased incidence of diseases like diabetes, eye health and the effects of systemic conditions and medications on eyes and vision are increasingly important to monitor. Glaucoma is a silent disease and is not recognized by the patient until significant vision loss has occurred, and it is difficult to halt its progress. Diabetic retinopathy can also cause blindness and early detection can halt and even reverse this retinal disease. This can also be true of macular degeneration.

With diabetes, upstream intervention would be even better. Diabetes is increasing in our population due to many factors which can be improved by more focus on wellness, not medicine. The reduction in smoking in our country is one of our biggest gains in the battle against preventable disease. Lung cancer is more prevalent that the next four most common cancers and smoking also is a significant factor in those diseases. Smoking also the biggest preventable factor in the development of macular degeneration.

Dr. Welch discusses how difficult it is to assess the quality of healthcare. Critical factors, such as doctor-patient relationships and communication are impossible to measure. Therefore, markers that are easier to measure are used, but are often totally erroneous. He discusses the number of screening mammographies as one example. Diagnostic mammographies are powerful tools, but screening mammographies do not reduce the risk of women dying of breast cancer but how many of them are done are used as a measure of quality care. Optometrists are required to test children for glaucoma which improves that quality score for the doctor and the insurance company but testing children for glaucoma is a distraction. I have not heard of a case of childhood glaucoma in my five decades of practice. I received an admonition as I was reading this book that I had not reported performing an extended examination of a patient’s retina for diabetic retinopathy. She has diet-controlled diabetes. This means that she has normal blood sugar findings due to lifestyle changes. We assessed the health of her eyes, which are fine. She is no more at risk for diabetic retinopathy than other people who have normal blood sugar. This is not a measure of the quality of care that she received. As Dr. Welch emphasizes, a great deal of data can now be obtained, “but it is not all about data collection; connecting with people is a central part of primary care – central to the ‘caring’ function of medicine.”

The Geography of Madness

Frank Bures

Frank Bures is so curious about life that he has traveled around the world investigating a fascinating cultural difference – how mental illnesses are manifest in different cultures. This quest was initiated by a year that he spent in Italy as a high school exchange student. Before he experienced another culture, he had not realized that he lived in a culture and how much it affected him. After becoming acculturated to Italy, he no longer felt comfortable in either culture. It disrupted his naïve certainty and he started to question who he was and who he was becoming. It also led him to begin to write as part of the process of discovery.

Most of us never get to live in another country to have this experience. We understand that other countries have cultures, but our society appears to be culture-neutral because we only see it from the inside. Its effects on us are invisible. Bures has spent decades investigating how culture influences us. He has visited many remote places with much greater cultural gaps than his initial experience in Italy. He has investigated what psychiatrists in the United States call “culture-bound-syndromes”. They are very unusual by our standards but some of our syndromes, such as bulimia, are rare in the rest of the world.   

For those of us whose curiosity cause us to reach for our electronic devices many times a day, it is difficult to conceive of traveling to cultures that are remote to try to go beyond the influence of globalization; places where you do not know the language and where it may not be safe. The observations that he has accumulated gradually developed into stories about the different expectations of happiness and the variations in stress response around the world. Even within the Western world, psychiatrists in continental Europe have a more existential view of life than those in Britain and the United States whose view is more mechanistic.

Bures reveals that the Diagnostic and Statistical Manual (DSM), which guides diagnoses world-wide, is not scientifically derived but is the consensus of a team of Western specialists. There are almost no objective tests for psychopathology. The primary psychopathologies appear to be universal; anxiety, depression, psychosis, and disassociated states, but their incidence and manifestations are highly dependent on culture.

Our culture endorses the “biomedical model”. “If something can’t be explained in mechanistic terms, we tend not to believe it’s real. And yet, things are often more complicated than that.… The shortcomings of our mechanistic model is something we’ve barely begun to come to grips with.” explains Bures. Perhaps everything cannot be explained in solely mechanistic processes. “In reality, everything in the DSM, and in life, is culture-bound.”

“For years now, there’s been a growing body of research that challenges the idea that the body produces real effects and the mind does not…. Your mind changes your body’s response.” After decades of research on the placebo effect, it has been proven that people respond to the placebo by feeling less pain because their bodies have produced natural pain killers. Nocebos work in similar, if opposite, ways. Placebo effects are natural. They are not an aberration. We should not be trying to eliminate them. We should be trying to understand them. How care is delivered and by whom makes a difference.

Those of you who know me understand that I am sentimental. As I was writing this, I was reminded of a favorite old movie, “People Will Talk”, in which Carey Grant portrays a physician and professor who has exceptional abilities to heal his patients. He has his own clinic and, as the story evolves, you find out that he raised the money for his clinic while working as a healer in a remote town. When his patients found out that he was a licensed physician, they felt deceived and he left town in a hurry. The movie is 70 years old, but many of the concerns about healthcare are familiar. If you enjoy sentimental old movies with happy endings, Linda and I recommend this one highly.

Upstream: The Quest to Solve Problems Before They Happen

Dan Heath

Moving upstream is to move back in time from a problem to see if there was a time at which preventative action could have been taken effectively. Preventing a problem can be much more effective than fixing it, but prevention tends to go unnoticed, and the effects of the intervention are much more difficult to document. If the outcome is a non-event, the value of the intervention is particularly difficult to prove, and we need to look back at what was happening before the intervention was initiated and make comparisons.

One impressive example of upstream intervention that may be overlooked is that we have not had a significant terrorist attack in 20 years. How many of us would have predicted that on September 11, 2001? We must recognize the good fortune involved, but this was not just serendipitous. It took a lot of upstream activity to protect our country, most of which we will never know about. Like much upstream action, it tends to go underappreciated and we question why our country is spending so much money for nothing.

Dan Heath discusses the challenges of moving upstream and the difficulties of measuring the success and cost savings of what is accomplished. Often, as in the case above, when the costs involve lives or the quality of lives, the benefits are difficult to quantify. We tend to be particularly shortsighted in the United States and tend to keep patching, which is visible and immediate, instead of moving upstream to the cause of problems. Heath provides examples in healthcare, education, homelessness, and poverty. To shift action upstream, it must be appreciated that effective actions are available and that a change of mindset is required.

There are examples in vision care. Research is being done on the prevention and progression of refractive errors (farsightedness and nearsightedness). The early detection and treatment of diabetic eye disease has become effective but is not as effective as going farther upstream and doing more to reduce the prevalence of diabetes. Loss of vision due to glaucoma is managed effectively due to early detection from routine eye and vision exams. Many people’s vision loss due to macular degeneration has also been mitigated due to early detection and treatment. Routine optometric exams are an important upstream factor in healthcare including providing optimal visual efficiency in our visually demanding world.

A problem that we see in our office routinely is children having difficulty learning to read and becoming efficient readers. Most of the children who are referred to our office have been having difficulty for a long time. Many of these children are frustrated and discouraged by the time we see them and report that they “hate reading”.  Reading is complex. There are many potential causes and combinations of causes which make it more difficult to learn to read and to develop effective reading skills, some of which are visual, but visual problems are often overlooked.

Most reading problems are difficult to predict before children start to learn to read. Children’s development varies in many ways. The visual skills involved must become automatic and sustainable to support reading. Accelerating the expectations for when children should know their letters, sight words, and start to read have not affected those children who were going to read early anyway, but have created what may be lifelong problems for many children who were going to take longer to learn to read. More time spent on reading will not make many children ready who were not developmentally ready or cause many children to enjoy reading. This is especially true if they have inadequate focusing, eye teaming, tracking, ability to handle crowded pages, or issues with visual processing. The best time to start looking upstream at those skills which have been identified as prerequisite to reading is when children have been identified as having reading difficulties or are not reading to the expectations of their teachers and parents.

Since the multiple ways in which vision is involved in reading is often not understood, few children are referred to the appropriate specialist to determine if a visual problem is involved and, if so, receiving the necessary treatment. A differential diagnosis of the causes of reading difficulties and their remediation is an excellent example of upstream thinking and action and much more effective than more time doing the same thing as all the other children who are having reading problems.

The Catalyst

Jonah Berger

The subtitle of this book is “How to Change Anyone’s Mind”, but the value of the book is broader and less contentious than the subtitle. Jonah Berger’s catalysts are tools to facilitate communication. Effective communication on complex or charged issues is so likely to fail that it is often avoided. Complex issues are now presented in sound bites or tweets. Politicians’ messages are crafted by professionals whose role it is to win elections, not to improve the function of government. “Keep the message simple”, but the issues are not simple. It may be comforting, but disingenuous, to imply that they are.

The overall message, which is not listed as a catalyst, is to get to know the other person, their opinions, and why they have them. We need to be good listeners. The only thing that may be more important than this is understanding our own opinions and why we have them; examining if they are consistent and questioning how well we can explain them. We are unlikely to open up and explain ourselves to someone unless we respect them and trust them and feel that they are sincerely interested in us and our position.

Jonah Berger does not mention that doctors, an important part of whose job it is to get a clear narrative from a patient, are not universally good at this. Doctors tend to come to closure too soon and interrupt the patient’s story with questions that interrupt instead of facilitating clarification. We need to learn to be good listeners. It is much more than just hearing and is not passive.

Jonah Berger’s catalysts are ways to remove the roadblocks to substantive conversation. They require patience and flexibility and, if the conversation is important to us, we must provide the initiative. They catalysts are:

REACTANCE: It is completely natural for us to react as if we are being attacked physically when our beliefs are challenged. Our instinct is to feel more strongly about our beliefs when they are questioned and defend them instead of trying to understand the other person. This even happens when the other person is clearly trying to be helpful, not argumentative. This is easier to see in others than it is to see in ourselves. To have a meaningful conversation, which involves an exchange of ideas, we need to resist reactance in ourselves and not provoke it in others. Catalysts, such as conveying interest and asking the right questions at the right times, have the potential to reduce reactance.

ENDOWMENT: Loss aversion is a strong motivation which often causes us to avoid or delay action. The desire to not lose something we have is stronger than our urge to obtain something new. Inflating the value of what we have inhibits change. Because the new is unknown, most of us prefer to stay with what we have, but there are hidden costs of not acting. Catalysts make these costs visible and facilitate better decisions.

DISTANCE: It is not possible to have a conversation if we cannot find common ground. This can seem impossible at the beginning of some conversations, but there may be areas of agreement which are hidden by the contentious issue. It is not unusual for the disagreements to be about mechanisms to achieve a goal we agree on. The advice proffered most often is to strive to feel the way the other person feels by employing empathy. While this sounds nice, it is virtually impossible at the onset. We may be able to find a different issue on which our feelings match those of the other person and use this to realize that we share a common ground.

UNCERTAINTY: Most of us are uncomfortable with uncertainty and avoid uncertainties whenever possible. What we may overlook is that the things that are in our comfort zone of predictability may be more uncertain than we realize. This is difficult and it is painful watching our children learning this lesson. In making a purchase, many things can be done to assuage our uncertainty. Decisions can be softened by making them reversible. There may be a trial period or a money-back guarantee, but the book does not address that these options are not available in the important personal decisions of life.

CORROBORATING EVIDENCE: This is what most of us use first which causes immediate reactance. It is a last resort because it is rarely incontrovertible. Jonah Berger put it last because this is where catalysts are least effective. The examples given are a last resort for confronting people who have addictions or mental health problems which they do not recognize or accept, and other options have been exhausted.

The Catalyst stimulates thinking. How can we do better? Conversations are part of who we are. They are necessary to solve problems. STEM falls under the final catalyst and the discussion and book would not be necessary if STEM caused universal agreement. The author adds powerful examples that demonstrate that meaningful conversations leading to the resolution of problems are possible. The book is refreshingly positive.

Reclaiming Conversation

The Knowledge Illusion

The Viral Storm

The Dawn of a New Pandemic Age

Nathan Wolf

This book contains more information about viruses than most of us would like to know, but there are a few pieces of information which will be of interest to everyone. The first thing we need to know is the credibility of the author. Nathan Wolf is a biologist who has been a professor at Johns Hopkins, UCLA, and Stanford and is part of a group for decades whose goal is to prevent future pandemics. Also, this book was not put together quickly in response to our current pandemic. It was published in 2011.

The science, which is complicated to follow and too complicated for me to remember, is that the viruses that humans have we have gotten from other mammals. One of the primary reasons for this is just numbers. There is estimated to be over a few thousand species of mammals on the planet and only one species of humans. The diversity of microbes that can infect us from other mammals has and will always be substantially greater than the diversity of microbes that already does infect us. P. 152 Scientists know the potential hot spots where the transfer of another virus to humans is most likely to take place and continuously monitor those places.

There are multiple reasons that, despite this vigilance, pandemics have become increasingly likely. Over centuries, the world population has increased, more people are living closer together, and people travel more, all of which increase the potential for pandemics. Cities facilitated the plagues due to the concentration of people and rats. Most people are aware that smallpox is the first disease to be eradicated through widespread vaccination. Influenza is the infectious disease that kills the most people world-wide and measles, which has been virtually eliminated in the United States due to vaccines, is second. Malaria still kills two million people a year

Our relation to animals and how we raise and prepare animals for consumption has changed. More and more animals are raised by fewer and fewer sources. Putting huge numbers of animals close together, something that would never take place in nature, makes it much easier for viruses to propagate.

While applying what we know from science is our best tool to prevent pandemics, it is important to understand that science continues to evolve. Infectious disease is currently one of the most common causes of death in the world even though most scientists 60 years ago believed the infectious disease would be conquered by now through the use of vaccines and antibiotics.

Viruses evolve more rapidly than any other organism on the planet, yet we understand less about them than any other form of life. P. 8 Compared to some of the other major scientific breakthroughs over the last few thousand years, our understanding of the dominance of unseen life occurred only recently. P. 23 (Entangled Life) A mad rush to respond to pandemics has been the mainstay of global public health for the last one hundred years. P. 13

Just like not having a major terrorist attack on US soil since 2001 is not just attributable to good luck, the reason that we have not had a pandemic of the magnitude of our current pandemic is not just due to good luck either. It is useful to keep in mind “the dog that didn’t bark” from Sherlock Holmes. We tend to overlook what does not happen, but it is often at least as important as what does happen. A great deal is going on behind the scenes to make the absence of pandemics possible, just like a great deal is being done to prevent terrorist attacks. This book tells of that we do not see or hear.

The Great Influenza

John M. Barry

There are a few excerpts from this book which augment and provide perspective to our current world situation that are printed below. This book was published in 2004.

Before that worldwide pandemic faded away in 1920, it would kill more people than any other outbreak of disease in human history. Plague in the 1300s killed a far larger percentage of the population – more than one-quarter of Europe – but in raw numbers influenza killed more than plague…. Epidemiologists today estimate that influenza likely caused at least fifty million deaths worldwide, and possibly as many as one hundred million. Scientists at the time predicted the pandemic. The war took precedence as did not alarming the public.

Public health was and is where the largest numbers of lives are saved, usually by understanding the epidemiology of a disease – its patterns, where and how it emerges and spreads – and attacking it at its weak points. This usually means prevention.

Viruses are highly evolved, elegant in their focus, more efficient at what they do than any fully living being. They have become nearly perfect infectious organisms…. By entering the cell, as opposed to fusing with the cell on the cell membrane – which many other viruses do – the influenza virus hides from the immune system. The body’s defenses cannot find it and kill it.

Influenza is an RNA virus. So is HIV and the coronavirus. And of all the RNA viruses, influenza and HIV are among those that mutate the fastest…. Influenza kills more people in the United States than any other infectious disease, including AIDS.

Like many other children’s diseases – especially viral diseases – when measles strikes adults, it often strikes hard. (Early in the twenty-first century, measles is still causing one million deaths a year worldwide.)

Many things that work in vitro, in the narrow universe of a test tube, fail in vivo, in the nearly infinite complexity of life. Nothing today can cure influenza, although vaccines can provide significant – but nowhere near complete – protection, and several antiviral drugs can mitigate its severity. This is another strong reminder that we have to improve our relationship with nature and that we need to continue to improve how we all live together. We are not as unique and independent as we tend to think that we are.

Think Again

Adam Grant

This book is on the NY Times bestseller list, an indication that, in this challenging time, people are concerned about being more open-minded and making better decisions. I suspect that many of them (like me) have read similar books. Perhaps they continue reading about flawed thinking patterns for the same reasons that I do. It is a reminder that, despite my good intentions, avoiding reflexive flaws in thinking is still a challenge. Changing habits and instinctual behaviors is not easy. It is easier to see the flaws in others than it is to see our own flaws and that realization is uncomfortable.

Adam Grant shares that Philip Tetlock has described our tendency in thinking and in conversation to become a prosecutor, preacher, or politician and that none of these is an effective way to communicate. (Philip Tetlock has also spent decades showing how poor experts are at making predictions and demonstrating that how we think is more important than what we know when it comes to making good predictions.) The complexity of reality can seem like an inconvenient truth when we are pointing out flaws in another person’s reasoning, defending something that we believe in, or when we are trying to win an argument. Prosecuting, preaching, and politicking do not facilitate meaningful discussions with exchanges of information and opinions and they almost preclude reaching a compromise plan.

Most of what follows are direct excerpts from the book. For easier reading, I have omitted quotation marks. When I have inserted personal opinions, I have put the print in italics.

Questioning ourselves makes the world more unpredictable. It requires us to admit that facts may have changed, that what was once right may now be wrong. Reconsidering something we believe deeply can threaten our identities, making it feel as if we are losing part of ourselves.

Rethinking requires humility. It requires that we be flexible in our thinking – not indecisive – and it enables us to see other perspectives. Those who are quickly decisive are often judged to be more intelligent, but they are more often wrong and tend to be less likely to reconsider their decision.

Questioning our values is uncomfortable. Adam Grant states that the goal of this book is to help us to anchor ourselves in flexibility, not consistency. Rethinking is a path to learning more from the people around you and living with fewer regrets.

If knowledge is power, knowing what we don’t know is wisdom. The curse of knowledge is that it closes our minds to what we don’t know.

“Ignorance more frequently begets confidence than does knowledge.” Charles Darwin

Humility is a crucial nutrient for the mind. Humility is often misunderstood. It’s not a matter of having low self-confidence. It is about being grounded – recognizing that we’re flawed and fallible. Learning requires the humility to realize one has something to learn.

“You must not fool yourself – and you are the easiest person to fool.” Richard Feynman

Who you are should be a question of what you value, not what you believe. Values are your core principles in life.

Unfortunately, when it comes to our own knowledge and opinions, we often favor feeling right over being right.

“Although small amounts of evidence are sufficient to make us draw conclusions, they are seldom sufficient to make us revise them.” Kathryn Schulz

“People who are right a lot listen a lot, and they change their mind a lot.” Jeff Bezos says. “If you don’t change your mind frequently, you’re going to be wrong a lot.”

The absence of conflict is not harmony, it’s apathy.

Another challenge is to listen well, to really try to understand the other person and not assume that we know what they are thinking and how they feel.

Listening well is more than a matter of talking less. It’s a set of skills in asking and responding. It starts with showing more interest in other people’s interests rather than trying to judge their status or prove our own. Listening is a way of offering others our scarcest, most precious gift: our attention.

We’re all vulnerable to the “righting reflex” – the desire to fix a problem and offer answers.”

Binary bias is a basic human tendency to seek clarity and closure by simplifying a complex continuum into two categories. When experts express doubt, they become more persuasive, but it doesn’t go viral like certainties.

Adam Grant has a wonderful section on teaching, learning, and the goals of education. The pandemic and virtual school are too new to be included, but I believe that safe extrapolations can be made. Most students prefer explanations over having to work answers out, especially in teams. When excellent lectures are used, which is easy to do now with electronics, they are liked even more. But it has been proven that we learn better when we have to work and be engaged to find out the answers. It is also valuable to understand that most things are a process. Entangled Life emphasizes that living is a process. When history is taught well, the story is told as a process, individuals at that time were struggling to solve problems and come to agreement as we are now. Science is best taught historically, sharing not only about the process, but that it is done by people who have assumptions, feelings, and values, not by robots. Education has the potential to do better preparing people for the problems of life that may not be solvable with data, especially outdated data from when they were in school.

This is not easy, but if we are trying to improve ourselves and our effectiveness, being aware of our natural flaws in thinking and communicating is important and is necessary. Adam Grant could have spent more time distinguishing between values and beliefs and how we are to not have differences in values affect our opinions of people. I will close with a quote in the book from E. L. Doctorow who says that writing out a plan for your life “is like driving at night in the fog. You can only see as far as your headlights, but you can make the whole trip that way.”

Anxiety and Depression

Lost Connections

Johann Hari

The expression of genes depends on our experiences from the time we are conceived. Genes which influence our physical and behavioral traits have been evolving from long before we were classified as humans. The only things new about anxiety and depression is that the incidence is increasing and that we try to treat them solely through chemical means despite their causes primarily being social and emotional experiences. Experiences change our brains (learning). If there is an error in our cognitive learning such as misspelling a word, we change it through conscious, logical processes. Using those processes to change emotional learning is less successful. Changing social and emotional learning is best done through positive social and emotional experiences. This is why these conditions are more than medical and to address them we need to look to changes in our society and values. This may seem impossible, but this has been done in the past and is happening now. Women’s suffrage is just over 100 years old and we are now seeing changes in racism and attitudes about those with non-traditional sexual orientations.

One of the causes of adult anxiety and depression is emotional trauma early in life. While Johann Hari discusses this in a section of this book, if this is your concern, I recommend The Body Keeps the Score by Bessel van der Kolk. Others must agree because it is on the NY Times bestseller list despite having been published in 2015.

Another cause of anxiety and depression is a disconnection from meaningful work, apart from the amount of money that is made. Work forms a major component of our lives. When I was outside yesterday, I spent time talking with the gentleman who was delivering the Pennysaver who was telling me about his job. He is performing a needed service. He is not told specifically what to do, just to get the papers delivered. He needs to work out the most efficient way.  He could have a job that we feel is more important, but have it be less satisfying due to having fewer freedoms in how best to accomplish his task. Research has demonstrated that this lack of freedom makes a job more stressful and correlates with more stress-related diseases.

Loneliness is stressful. It is equally damaging to health as is obesity and causes the same degree of stress hormones to circulate as does being physically attacked. Loneliness must be distinguished from solitude. You are not lonely when you care about others and know that others care about you. You can be lonely in a crowd. One of the other books that is currently on the NY Times bestseller list is Think Again by Adam Grant. Serious thinking takes time and solitude. Too little solitude does not enable reflection and leaves us more prone to what is promoted on the media and leaves us more susceptible to Hivemind.

In his recent memoir, psychologist Howard Gardner shares that he could have made more money in industry than he did in academia. One difference that he noted between himself and many others who have more possessions is that he has enough. Extrinsic rewards do not provide the lasting satisfaction of intrinsic rewards. The goal of advertising is to make you feel inadequate, but, if you purchase what they are advertising. To make life good, there is always something else. Beyond meeting certain needs, the next possession does not provide lasting satisfaction and meaning. Some countries are passing laws about advertising to youth who are strongly influenced as to what they feel that they need and what they must have to eat, which has been proven to be damaging to their mental and physical health.

We all require and deserve a certain amount of status and respect. “Robert Sapolsky discovered that having an insecure status was the one thing even more distressing than having a low status.” “The more unequal your society, the more prevalent all forms of mental illness.” Much of this information is in Robert Sapolsky’s book Behave.

Our modern lives can easily disconnect us from the natural world, and we may be so busy that we don’t consciously miss it. Jason Gay is a talented thinker and writer and his piece in the April 10, 2021 issue of the Wall Street Journal is well-worth reading. It is important to remember that we were animals before we became conscious, reasoning creatures. Nature is still an important part of who we are. We did not evolve to sit all day. We need to be physically active and, if it is outside, so much the better.

We are all distressed if we do not have a secure future or don’t see the likelihood of a secure future; that we will keep our job, that we can provide for our family, and that we have things to look forward to. We say that we cannot predict the future, but unfortunately, many people can confidently predict that nothing good is likely to happen in their lives. While the playing field can never be perfectly level, we can come closer to the promise of equal opportunity.

I took this photo when I was on a walk this morning. Yes, exploring fields and woods and ponds and gardens and cemeteries is wonderful, but it is not necessary. I didn’t need to leave the village to see, flowers, the grass turning green, see and hear birds, and to smell spring (and to sneeze). We have a neighbor who is in her 90s who sits outside whenever possible and people stop by to talk with her. She is not too old to need to be out in nature. Have a wonderful day today and also your tomorrows.

Related:

Have Smartphones Destroyed a Generation?

Anatomy of an Epidemic

Girls on the Edge

Is it all in Your Head?

Reclaiming Conversation

Road to Character

Boys Adrift