Cause and effect
The sun, talking trees, and sham surgeries
In Kazuo Ishiguro's Klara and the Sun, we see Klara, a solar powered “artificial friend,” attributing all that's good to the power of the sun. Klara bargains with the sun and credits him (the sun is a he in the book) with things that could well be the result of random chance or any other number of factors.
It echoed something else I'd read, All the Agents and Saints. Stephanie Elizondo Griest's book investigates the lives of people living on the US's northern and southern borders. This includes the story of the talking tree, which is believed to have the power to bestow wisdom and answer prayers. I found it interesting that the talking tree was viewed as the source of good fortune even when there were other potential sources of the healing, such as scientific medicine.
Cause and effect is rarely clear. Who's to say if the reason for a spontaneous remission is a saint or a tree or a medication? Certainly many people believe they work together. Slime Mold Time Mold recently featured a piece outlining the shortfalls of a scientific method based on changing one variable at a time in large samples of people in a world where there are millions of variables and each person is unique. As much as I theoretically care about everyone in the world, when I'm hoping for a cure I'm usually thinking of a specific person. And what seems to work at the population level may have no impact on that one person.
Who hasn’t tried to figure out the trigger for symptoms, only to realize there are too many variables and no easy answers? During my lifetime researchers were surprised to realize just how few genetic diseases are caused by a single gene.
The number needed to treat is a concept that I think of before filling any prescription. When a patient is given a treatment known to be effective at the population level and they recover, we typically don't know if that particular person was helped by the treatment. Maybe it was the treatment. Maybe it was the candle lit at the cathedral. Maybe it was a talking tree. Maybe it was regression to the mean, the placebo effect, or something no one on the treatment team considered. The real world is too complex for our current medical models, even with all of our fancy technology.
Sometimes the line between modern medicine and faith healing is pretty blurry.
The way different people draw such different cause and effect relationships from the same experiences keeps coming to mind as I pass shrines. Wandering around Guimarães the past few days, there have been a lot of shrines. There's also the pilgrimage route of the Camino de Santiago passing through town.
Perhaps not all of us can relate to the belief that walking hundreds of kilometers to pray to the body parts of saints or pressing an ear against a tree to hear a message can cure someone. Certainly, many people have this sort of faith, based on the piles of crutches at shrines and the line at the gift shop at the Fatima bus station. Even if I don't have this kind of faith, I can understand the deep desire that drives us to do these things.
In The Psychology of Money, Morgan Housel discusses appealing fictions. We craft our own explanations of how things work when we have limited control and face high stakes. We take the evidence we have and craft a narrative that makes sense, not realizing that we don’t have nearly enough information for our story to be true. Appealing fictions can drive us to take actions that would otherwise seem outlandish and extreme. Like push someone we love to take on the risks of an experimental surgery or walk across a country to place their hand on a pillar and pray to a man who died 1,979 years ago.
I’ve faulted doctors for diagnosing things in an instant and lacking the curiosity to consider other possibilities, to look at all the evidence and the big picture. This is how so many people are misdiagnosed or denied adequate care because they’re poor (probably drug seeking), women (probably psychosomatic and better treated with therapy), fat (probably just need to lose weight), or some other group that doctors often see as stereotypes rather than people.
How often have I done the same thing? I don’t practice medicine, a fact that doesn’t prevent me from thinking I instantly understand a situation I really know nothing about. It certainly doesn’t make me immune from connecting the dots one way and behaving as if those are the only dots and the only possible way of connecting them.
Morgan Housel isn’t a medical doctor either, but I think his advice is sound: Let go of easy answers. Hold our stories lightly and stay open to revisions. Remember that life is full of odds, not certainties.
“it’s actually quite telling that Freudenberger saw himself and his burned-out coworkers as akin to burned-out buildings. Though he didn’t acknowledge it in his own exploration of the term, those torched buildings had generated value by being destroyed. In transposing the city’s creative destruction onto the bodies and minds of the urban care workers who were attending to its plight, Freudenberger’s burnout likewise telegraphed how depletion, even to the point of destruction, could be profitable. After all, Freudenberger and his coworkers at the free clinic were struggling to patch the many holes of a healthcare system that valued profit above access.”
On having a child with cancer:
“In these years as cancer caregivers, we have often been told how brave we all are. I always find the sentiment lovely but misplaced. Bravery implies some agency in the matter. And what choice do we have? We have spent the last 38 months putting one foot in front of the other.”
Totally out of context Heather Havrilesky quote of the week:
“In order to feel truly safe and protected in this world, you have to surrender to the fact that you will never escape the hard parts.”
Speaking of artificial friends.
Want to die at home? Start saving.
I continue my argument that old people are the opposite of “cute.” Cute is for kittens and babies, not people with far more life experience than I have.
Thank you Cori. I just spent an hour reading through your excellent links. So much food for thought.