A related consideration is to distinguish between felt knowledge -- such as hunches and gut feelings -- and knowledge that arises out of empiric testing. Any idea that either hasn't been or isn't capable of being independently tested should be considered a personal vision. Shakespeare does not demand that we accept Hamlet as representing a universal truth. We agree and judge him according to the standards of art, literature and personal experience. Hamlet is neither right nor wrong. If in the future, Hamlet is found to have a gene for bipolar disorder, we are entitled to reassess our initial interpretations of Hamlet's relationship to his mother. Hamlet is a vision. No matter how seemingly reasonable and persuasive, each begins with a very idiosyncratic perception that seeks its own reflection in the external world. Each writer's personal sense of purpose drives the arguments, picks out the evidence and draws conclusions. Such ideas should be judged accordingly -- as visions, not as obligatory lines of reasoning that must be universally shared.
To retreat from claims of absolute "knowing" and certainty, popular psychology needs to explore how mental sensations play a fundamental role in generating and shaping our thoughts. We can't afford to continue with the outdated claims of a perfectly rational unconscious or knowing when we can trust gut feelings. We need to rethink the very nature of a thought, including the recognition of how various perceptual limitations are inevitable.
At the same time, if the goal of science is to gradually overcome deeply embedded superstition, it must be seen as a more attractive and comforting alternative, not as inflammatory exhortation and confrontation with a none-too-subtle whiff of condescension. Try to peddle the vision of a cold, pointless world at a Pentecostal revival meeting and you have an inkling of the challenge. In a recent survey, nearly 90 percent of Americans expressed the belief that their souls will survive the death of their bodies and ascend to heaven. Such beliefs, no matter how counter to the evidence, provide the majority of Americans with a personal sense of meaning. If forced to choose between reason and a sense of purpose, most of us would side with purpose. This apparent choice isn't even an entirely conscious decision. If science hasn't yet made a dent in such beliefs, it seems unlikely that further efforts will miraculously turn the tide.
Such discussions pose the same ethical problems inherent in placebo treatments. Simply put, a placebo effect is a false belief that has real value. To insist that there is no soul or afterlife is the moral equivalent of taking away the placebo effect arising out of an unscientific belief. Studies have shown that sham arthroscopic surgery can allow some patients to walk comfortably again. No one should recommend sham knee surgery, yet many physicians are comfortable recommending less drastic but unproven treatments for pain.
The answer lies in a personal risk-reward calculation -- how to provide comfort without undue side effects or cost. But the intentional use of a placebo comes at a cost. Even without side effects or excessive cost, the precedent of falsely representing benefits of a treatment has its own long-term undesirable effects. The most serious would be the erosion of trust between the physician and patient. On the other hand, eliminating all placebo treatments because they are intellectually dishonest raises its own set of problems, including the cynical zeitgeist of valuing science over compassion. There isn't an easy solution or right answer; each of us will calculate the risk versus reward according to our own biology and experience.
In medicine, we are increasingly developing ethical standards for complex medical decisions that allow for hope and the placebo effect, yet don't fly in the face of evidence-based medical knowledge. The guiding principle of the Hippocratic oath is primum no nocerum -- above all, do no harm. This same principle should be a cornerstone of how science competes in the world of ideas. Science needs to maintain its integrity while it retains compassionate respect for aspects of human nature that aren't "reasonable."
This balance of opposites extends to all aspects of modern thought. For example, it doesn't make sense to ask someone if he'd like to take a placebo; the very question strips the placebo of much of its intended benefit. Similarly, it isn't clear how to have a reasonable discussion on the nature of the self that both maintains the integrity of science -- the self is an emergent phenomenon and not some separately existing entity -- and allows each of us to feel that we are individuals and not mere machinery. I cannot imagine a world in which we fully accepted and felt that we were nothing more than fictional narratives arising out of "mindless" neurons. And I cannot imagine how much empathy we would have with others if we saw disappointment, love and grief solely as chemical reactions. Faced with this chilling interpretation of our lives, it isn't surprising that most people opt for the belief in material "souls" and/or anticipate that real live virgins are patiently awaiting their arrival in heaven.
F. Scott Fitzgerald described an easy-to-accept but difficult-to-accomplish solution: "The test of a first rate intelligence is the ability to hold two opposed ideas in the mind at the same time and still retain the ability to function." This juggling act requires us to keep in mind what science is telling us about ourselves while acknowledging the positive benefits of nonscientific or unreasonable beliefs. Each opposing position has its own risks and rewards; both need to be considered and balanced within the overarching mandate -- above all, do no harm.
Just as we learn to cope with the anxieties of sickness and death, we must learn to tolerate contradictory aspects of our biology. Our minds have their own agendas. We can intervene through greater understanding of what we can and cannot control, by knowing where potential deceptions lurk, and by a willingness to accept that our knowledge of the world around us is limited by fundamental conflicts in how our minds work.
Which leads us back to the beginning. Certainty is not biologically possible. We must learn (and teach our children) to tolerate the unpleasantness of uncertainty. Science has given us the language and tools of probabilities. That is enough. We do not need and cannot afford the catastrophes born out of a belief in certainty.
From "On Being Certain" by Robert A. Burton, M.D. © 2008 by the author and reprinted by permission of St. Martin's Press.
About the writer
Robert Burton, M.D., is the former chief of neurology at Mount Zion-UCSF Hospital and the author of "On Being Certain: Believing You Are Right Even When You're Not." His column, Mind Reader, appears regularly in Salon.
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