Prediction and Propinquity

No small part of the life of psychiatrists (and other doctors, I suppose) is made up of writing papers and reports.  A rather astonishing part of this are reports that are supposed to predict other people’s behavior.

This is basically impossible.  I remember hearing and never forgetting, early in my training, a supposedly ironclad rule of behavior prediction.

“If they did it before, they will do it again.”

Sometimes it had slightly different forms, made to appear more authoritative. “Past behavior is the solidest predictor of future behavior.”

Certainly common wisdom endorses this point of view.

As a basis for schlogging through life, it is (curiously) found and applied in job interviewing.

The truth of the matter is simply that prediction of behavior is tough.

The folks at UCLA seem to have tracked the prediction of whether or not somebody will use sunscreen, as a function of public service announcements suggesting same, to a certain place in the brain, the medial prefrontal cortex, in about 34 of folks.

They (charmingly) caution that other people, who suggest that other parts of the brain may be responsible for phenomena directly measurable in behavior prediction, well, they have more enthusiasm than facts.

Personally, I think it makes little or no sense to base advertising response upon neurological findings at this point, as seduced as I am by new uses of data about the brain.

I think it is a lot easier to chart the success of advertising by measuring who buys things.  This is absolutely not a time to buy into that great research fallacy that the most important thing is to determine the mechanism by which things work.

If you are buying advertising, the most important thing you have to learn is how to sell what you have to sell.

If you are a cock-eyed academic (and I can call them that now that I am not one) you have to write papers so that you get tenure.

But back to the past determining the future.

Why should it be any different?

People can — and do — change.  It certainly is not a simple process.  It can be accomplished by psychotherapy; I have seen it.  It takes time and insight and support when something in life, and it may be something other than the problem that seems to need changing, changes.  There has to be a lot of motivation, sometimes a lot of means, and always a lot of perceived payoff at the end.

So most of the time things won’t change.  I usually find, when I am asked to predict that some patient will sin no more and let him back to his or her family and or customary state of employment or leisure, that I have created knowledge and insight, and that the person now has responsibility for his or her actions.  In other words, I have done all that my art can, and nothing of what it can’t.

I have on occasion written such lovely paragraphs to this effect that I gave others (preceptors who graded me, of course) the right to use them verbatim.

When I was first researching the material that eventually became my seminar and book “How to Locate and Marry your Lifetime Love,” — long before I found mine — I remember most distinctly reading that 71% of all people marry either a coworker, schoolmate, or neighbor.  In other words, someone whom pure chance, if one believes in such things, has put in their path not once but again and again.

In addition to playing out distorted Oedipal complexes, clearly there is another force going on here that predicts who people will marry.  It also turns out to predict whom people will befriend, and even like. The folks in Practical Psychology at UC Berkeley agree.

This is quickly followed by physical attraction.  Is anybody surprised?

So unless there is an immediate distaste, which can happen but is probably not all that much of a biggie most of the time, repeated contact is a major force in at least that one choice, the one of whom you marry.

It may be one in whom you like.

So marrying is easy.  Often surprisingly thoughtless, 71% of the time to somebody with whom there has been lots of repeated contact.

I also learned, while researching the piece of work to which I have frequently referred as the best science I have ever done (because my husband is such a sweetie) that most people spend a lot more time researching what car they are going to buy than thinking about or researching whom they are going to marry.

Both fairly complex situations and fairly complex choices.

So here is the report writing situation.  A person has done something horrible.  Molested his own child.  Raped somebody at work.  A psychiatrist placed in the horrible prediction situation can use a slick paragraph writing style like me and that is all.

Or we could do something that could actually work.  Whether sexual harassment or child interaction, we know almost nothing about changing behavior, but we know once a behavior, or exposure, or whatever is repeated, what has been done before is the most likely thing to be done again.

In our rich and wonderful ways of simulating humans by computer, this is what we should be doing.

We should be putting the rapist repeatedly through virtual computer generated but incredibly life like repetitions of the situation in which the rape occurred.

We should be putting the abuser in situations like where the abuse happened.  Without harming anybody, a track record of healthy interaction with children can be established.

Then, a psychiatrist’s report will not have to be a simple exercise in verbal manipulation to exculpate the psychiatrist from the useless nature of the science.