Editor’s note: You can read the first part of this article here.
We are likely to tolerate an expert if he or she can produce clear categorical, and preferably dichotomous, output. When they do, we respond like one of two kinds of child: We either accept the output at face value, satisfied that this has settled all our doubts, or we demand access to the process and criticise it. One is the child who, knowing that hiding her eyes does not make the feared object go away, nevertheless does so. The other is the child who, worried that his parent is insufficiently powerful to contain the excesses of his exploration, appetite, or refusal, embarks on a destructive testing of this parent’s power.[perfectpullquote align=”right” cite=”” link=”” color=”” class=”” size=””]We want to feel safe. We think that certainty is what is needed to achieve this. We no longer trust authority per se, or expert opinion that is not reductive and/or transparent in the extreme.[/perfectpullquote]
These could be seen, respectively, as “internalising” and “externalising” responses to the intolerable fact that we can’t have it all as solid as we want it.
The scientific expert is driven by two pressures: an internal pressure to favour a transparent process, and an external pressure to produce simplistic output.
While the experts prefer a computer and an algorithm over a human because, to them, the former are more transparent and therefore open to scrutiny and if necessary manipulation, the public prefers computers and algorithms because they are, to them, more complex and arcane. Of course here I am guilty, myself, of over-simplification. Not only can people not be cleanly divided into scientific experts and “the public”, but our attitude is one of ambivalence. We (the public) prefer a simple and enjoyable life and so want to hand over to the expert the power to make judgements on our behalf. Yet we want these judgements to be reliable and we find we are suspicious of the expert’s motives and/or credentials. We demand to know and understand the process that the experts are using so that we can make our own judgements about the judgements they have made. In so doing we have dethroned the experts and defeated out own purpose.
To summarise so far: We want to feel safe. We think that certainty is what is needed to achieve this. We no longer trust authority per se, or expert opinion that is not reductive and/or transparent in the extreme. Yet we are deeply confused about this: “If I understand it, then it is not powerful enough to be relied upon. But how can I trust it if I don’t understand it?”
Meanwhile, scientists know that they cannot trust subjective opinion or the experience of an individual as a route to the sort of output that is demanded of them by the public or that satisfies their own need for manipulability.
The clinical analogy is addiction. We crave the impossible. When fed an approximation we are temporarily satisfied, only to feel the pangs of craving return more powerfully than before.
What is the answer?
A step back is needed. Not least, at this point, because I need to appease a scientific audience. As well as being a creative (therapeutic) artist within the clinical relationship, I was brought up, and remain, a scientist of sorts. I do understand the importance and relevance, as well as the limitations, of the empirical method. It is just that I believe that we have to treat it, not as an all-powerful saviour, but as a useful resource. We have to move away from our regressed positions and relationships as (to use the Karpman Drama Triangle) victims, persecutors, and rescuers, and practice a more mature outlook.
In chapter 3 of Being With and Saying Goodbye I drew a distinction between evidence in its broadest sense –inclusive of the subjective and qualitative – and the addictive, dichotomous, narrow, mechanistic brand of “evidence” which I placed in inverted commas, and which I have been talking about here. I suppose I thought of “evidence” as a sort of manufactured opioid, and I listed its side-effects:
- The fuelling of the addictive relationship with an elusive and illusory certainty
- The marginalisation of instinct, trust, compassion, and hope
- The rendering of people into countable units, commodifying interpersonal relationships and infiltrating them with a utilitarian ethic
- The impoverishment of our notion of both evidence and treatment.
Being With and Saying Goodbye was written from within a therapeutic context and for a professional audience, but my conclusions are adaptable to a more personal and universal context and I offer them here.
We need to practice our tolerance of uncertainty. What will enable us to do this, I suggest, is less instrumental doing to, and more being with, each other, our circumstances, and the environment. This means that we:
- patiently allow ourselves continuity of contact with each other and our environment over time, so that we can…
- inform and refine our interactions with each other and our environment through an iterative process of relatively direct observation and feedback.
- Rely less on all-or-nothing statements and predictions, and become more receptive to our internal cues as well as to both conscious and subliminal feedback from each other and our environment on a moment-to-moment basis and evolving throughout the course of our lives.
- Practice the sensitive gathering and use of a kind of evidence that is rich, personalised, and lacking in dangerous side effects.
- Acknowledge the insecurity intrinsic to life, valuing what we have now instead of desperately trying to preserve it in perpetuity.
To be completely clear, I do not advocate total abstinence. We do have to make decisions.These are not certainties, nor are they based on certainties.They are simply decisions based on evidence. We would be idiots to neglect empirical evidence, but we must remain a) alert to the harms it can do when relied upon to excess and, b) open to all the other kinds of evidence, not despite, but because of, their partnership with uncertainty.
Andrew West is a Child and Adolescent Psychiatrist in the National Health Service. That is true at the point of writing, and has been for fifteen years, but will not be true forever. Never a very comfortable “joiner” he wandered through violin-making (he still plays his own violin), teaching English in France, cycle-touring, and farm labour in Scotland, before starting a Law degree in Cambridge. You can follow him on Twitter @
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