Ellen Langer

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  • PsychToday
  • Oct 28, 02:18 PM

A Second Opinion About Second Opinions

The medical world often encourages us to get a second opinion before embarking on expensive procedures. While getting a second opinion may seem straightforward, a closer look reveals that the process is not so simple. There are hidden effects of language at work here: First, the word “second” is typically not as good as “first,” regardless of what it modifies. Next, if we take the word of our doctor as truth, then what might we expect when we compare “truth” with an “opinion?” Just as second is less than first, opinion is less trustworthy than diagnosis.

In a class demonstration in my decision-making seminar, I asked half of my students the following question: “A doctor tells you that you need surgery. You get a second opinion and that doctor tells you that you don’t need surgery. On an eleven point scale ranging from 0 meaning ‘definitely not’ to 10 meaning ‘definitely yes,’ how likely are you to get surgery?”

I asked the other half of the students this question: “A doctor tells you that you need surgery. Another doctor says you don’t need surgery. How likely are you to get the surgery?” You’ll note that for the first group, the term “second opinion” was used but not for the second group. When a doctor gave a “second opinion” the average score of the response was 5. The average response where “second opinion” was not mentioned was 2.5. That is, it became twice as likely that the first doctor’s view would be followed when posed against a “second” “opinion.”

Dr. John Glick of the Abramson Cancer Center at the University of Pennsylvania has estimated that when patients come to him for second opinions regarding a treatment plan, his view only completely agrees with the first opinion around 30 percent of the time. In another 30 to 40 percent of the cases, he and his colleagues recommend significant changes to the plan. Sometimes his team comes to a completely different diagnosis.

If physicians are all trained in the same approach, they very well may suggest the same course of action, but if trained differently, different opinions might prevail. Thus, we could have physicians viewing the same facts but differing in their views of them and we could have different facts considered by the different physicians.
People often don’t get second opinions. Is that sensible? If we got a second opinion, regardless of what the second doctor tells us, she really doesn’t tell us what the next fifty doctors would say. One doctor is a very small sample size and as such may not be reliable. On the other hand, there could be a hidden positive side effect second opinions. When a patient and her doctor consider the need for a second opinion, they are implicitly acknowledging uncertainty. Uncertainty promotes mindfulness which is good for our health. So, we’re right to get a second opinion, but not because we’ll now have better information. Of course, we could save money by not taking this circuitous route by just recognizing the inherent uncertainty in everything and remain open to experience.

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  • PsychToday
  • Oct 28, 10:00 AM

It may be better not to ask

If we were paralyzed for several months or years and couldn’t walk, taking even a few steps would constitute proof that we’ve changed. On the other hand, if we question our character, say, for example that we often used to lie, what would constitute proof that we have outgrown that style of behaving? If we tell the truth, it does not mean that we won’t lie again. If we think our spouse is having an affair, what could show us that we’re wrong for sure? If he went bowling on Thursday night as he said, it does not mean he didn’t see her some other time. If our cancer went into “remission” what would constitute proof that it will not return? If I’m fine today, it doesn’t mean I’ll be fine tomorrow, after all, I thought I was fine until I found that lump in the first place. If I were a depressed person, what would constitute proof that I’m doing better? There is no proof available. Let’s focus on the last of these because it is the most difficult to see how sometimes asking the question creates the problem.

Consider that we can be in one of two states of mind at any moment. Either we are experiencing ourselves or we are evaluating ourselves. The moments we are actively engaged in what we are doing, we are centered in ourselves and experience being situated in the present. These are the moments we seek. In order to evaluate ourselves, however, we have to take ourselves out of this engagement, hold ourselves “constant” and observe who or how we were. Essentially, to evaluate ourselves we must step outside of ourselves, away from our center.

When we are happy, we tend to go about our business without questioning our every move. Imagine, being in such a state and then coming across something that leads us to feel bad. For example, we didn’t finish the project when we had hoped to, the plan went awry, someone misunderstood our intentions, or the evaluation we were given was not up to our expectation. If we let these things lead us to question our basic worth, and we try to answer the question by evaluating ourselves, we may unwittingly begin a vicious cycle of feeling bad.

When we feel good we don’t ask ourselves questions about our self worth. When we feel bad, too often those are the very sorts of questions we do ask. What this means, in some sense, is that the answers we are left with weigh more heavily than they should. If we evaluated ourselves when we felt good and we evaluated ourselves when we felt bad, we might have a reasonable way to decide which feeling is dominant for us. Because the very act of evaluating ourselves prevents us from these positive evaluations, it might be better to just let ourselves be. Just think about it, this kind of ignorance really may be bliss.

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  • PsychToday
  • Oct 21, 03:04 PM

Learning to Learn from Experience

There are those people who seem to learn from experience and those who don’t seem to learn anything at all. But even for the former group the lesson is rarely all it could be. Typically, we do something, something happens and we experience some consequence. For example, I paint and drop the brush full of paint on my pants. I’m displeased and conclude that I should wear a smock the next time I paint to avoid this happening again. If we pay attention to a contingent relationship between what we do and what happens, we may try to work to avoid the cause if the consequence was experienced as negative or try to repeat it in the future if we experienced it as positive. There is more going on here, however, than most of us realize.

I was having a conversation with a friend who told me of an awful experience she had had some time earlier. She tried to change the light bulb in her bathroom by standing on the porcelain toilet, when it gave way under her and ripped her leg open. She told me how many stitches she had to have and said she learned her lesson. I tried to think of what she learned before asking her. Did she learn not to stand on toilets; on porcelain; not to change light bulbs; not to try and fix things around her house; not to do try to fix anything without enough light; not to do anything without light; not to stand on anything; not to drink so much coffee before attempting to balance herself; etc.. The list of possibilities goes on and on. For her there was only a single lesson to be learned: don’t try fixing things yourself in a house that’s still in construction.

Most of us suffer a naive realism. We act as if the world exists independent of human presence–it is just there the same way for all of us irrespective of how we look at it. And we engage in a single action and presume it has a single consequence. This makes life seem predictable. As will become clearer, however, we give up control to have this illusion of predictability.

One might counter and say, some contingencies are more important than others. If I put my hand in fire and get burned, shouldn’t I learn to keep my hand away from fire? Maybe, maybe not. But, as with the porcelain toilet, it is but one lesson we could learn from the experience. This raises the question of considering which of the many lessons we want to learn. Most of us don’t realize there is a choice. By becoming aware of our choice we have the advantage of coming to know ourselves better. Why this choice and not another? Our choices move us along our life paths. If we realize there is a choice, we can decide where we want to go or we can ignore the opportunity to decide. If we pay attention to these choices we may be able to get to where we want to go faster regarding our personal growth or we may even decide to go somewhere else instead.

The way we choose to understand our past actions or the actions of others, that is, the attributions we make for behavior, influences our future behavior. If I see your gift as a generous gesture, for example, I feel and act differently towards you than if I see it as a “payback,” or as an instance of ingratiation. Social psychologists have researched the importance of the attribution process for some time. What I am suggesting, beyond the important findings that already exist, is that once we realize there are multiple attributions and understandings available to us, it becomes interesting to /question why we chose as we did/. To continue the above example, Why do I see your action as less than generous when all these other explanations are equally available to me? Do I want to be so untrusting? Experience provides the opportunity for us to learn whatever we want to learn.

I just returned from the train station. I waited until a friend’s train was to arrive. She delayed going to the rest room so we could finish our conversation. Then she headed to the rest room only to find it was now about to be cleaned and the public had to wait. She turned to me and told me she learned her lesson. I asked what that was. She replied, “I shouldn’t buy a lottery ticket today.”

Just think about it: It has been said that experience is the best teacher. If 1) there are always several lessons that could be learned from any experience; 2) we choose which of these lessons we what we want to learn; and 3) we learn about ourselves by considering why we made the choices we made, wouldn’t that mean we don’t have to wait for experience to teach us? Rather, than just grow as a function of learning from our experience, we’d experience our growth as we selected what we wanted to learn.

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  • Oct 19, 04:19 PM

Ask a Better Question to Get a Better Answer

Outside of Jeopardy and the game “20 Questions”, we typically worry about answers more than questions. Yet, questions direct our information search and all but determine the answer. “Do you want chocolate or vanilla?” The question suggests you can’t find a way to have them both. “What time should we leave for the party?” suggests that we’re necessarily going and all that needs to be determined is the time.

The questions that may be most important to our well being, however, have to do with what we think of ourselves and our intimate others. “How good (smart, successful, generous) am I?” is not the same question as “How bad (stupid, unsuccessful, small) am I?” The question initiates a search for evidence. Seek and ye shall find. In the former case we’ll look for and find evidence of our positive selves; in the latter, all we uncover is ample proof that we fall short of our ideal self.

There is plenty of research evidence that people seek hypothesis—confirming data. When these hypotheses or questions are about ourselves, we need to take more care about what we are actually looking for and be smarter about the questions we ask ourselves. It turns out that I’m not so bad after all.

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  • Counterclockwise
  • Oct 8, 02:06 PM

If One Dog Could Yodel

In Counterclockwise I present many ways to increase the control we have over our health and well being, arguing that anything is possible. Some of this is discussed in the first chapter, in a section entitled, “If One Dog Could Yodel.”

Of course most people would say emphatically that dogs can’t yodel. Here’s some evidence of how wrong and limited people can be.