How We Know What Isn't So (24 page)

What all of this speculation amounts to is that while we await the results of further research in the field of psychoimmunology, we should bear in mind two ideas. First, the most extreme claims made about the extent of mental control over immune function (claims generally made by holistic health advocates who are not themselves a part of this field) are likely to turn out to be unfounded. Second, upon closer inspection, the world implied by these more extreme claims may be not be a very desirable one after all.

The Down Side of Holistic Medicine.
The holistic emphasis on personal responsibility for one’s state of health has many meanings and, as a result, has a number of costs and benefits. On one hand, as I noted earlier, it simply means that the individual, and not the individual’s doctor, is in the best position to look after his or her health. This can encourage people to adopt healthier lifestyle practices and to become more informed “consumers” of medical services. Alternatively, the holistic emphasis on personal responsibility can refer to the conviction that the proper thoughts and feelings can promote health. The down side, however, is the obvious implication that if the appropriate thoughts and feelings promote health, then a failure to adopt the right attitude looms as a plausible cause of sickness. The sick and disabled are subject to blame, by themselves and others, for their misfortune.

The ease with which the holistic philosophy can lead to blaming the victim is apparent in numerous comments made by representatives of the field. Recall the oft-quoted holistic credo that “it is much more important to know what sort of patient has the disease than what sort of disease the patient has.” Consider also the claim made by the author of an influential textbook on holistic nursing who states that “Illness occurs when people don’t grow and develop their potentials.”
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Similarly, New Age faith healer Elizabeth Stratton argues that “disease is merely a symptom of a deep psychological problem that the person probably isn’t even aware of…. What I look for is why they created the illness and why they’re hanging on to it.”
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Finally, Eileen Gardner, who served for a brief period in the Reagan administration as an aide to Education Secretary William Bennett, once wrote that handicapped individuals “… falsely assume that the lottery of life has penalized them at random. This is not so. Nothing comes to an individual that he has not, at some point in his development, summoned.” She also claimed that, “As unfair as it may seem, a person’s external circumstances do fit his level of inner spiritual development.”
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This is not exactly the philosophy that one would want in the upper reaches of the Department of Education, the department that is responsible for overseeing educational opportunities for the handicapped.

To be sure, there are many responsible advocates of a holistic approach to medicine who are aware of the potential for blaming the victim and who try to combat it. However, it is not clear whether their efforts can ever be successful. If one assigns a large role to psychological and spiritual factors in maintaining health, then logically one must suspect the absence of these factors in the etiology of disease. It is almost impossible for the victim of a disease or disability not to ask “why?” or “why me?” Often there are no real answers to these questions, and any salient cause can seem compelling, including the psychological and spiritual factors trumpeted by proponents of holistic medicine. A letter to the editors of
New Age
magazine is informative in this regard:

Sadly, this is not an isolated occurrence. Interviews with cancer patients indicate that many view their disease as partly the result of their own personal inadequacies.
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The tragedy of the disease itself is compounded by the anguish of believing that it stems from one’s own mental and spiritual shortcomings. What can be more cruel than adding self-recrimination to a victim’s misfortune?

I am reminded here of the central element of William Styron’s powerful novel
Sophie’s Choice.
Sophie is presented as someone running from a traumatic past, and only gradually does the reader learn of the grotesque cruelty of a choice she was once forced to make: Disembarking from the train that brought her to Auschwitz, she is told by an SS officer that only one of her two children may live—the other is to be sent to the gas chambers. She must decide who will be sacrificed so that the other may live. If she cannot decide, both will die. As doubtless any parent would do, she refuses to make the choice. Refuses, that is, until the SS officer motions for both her son and daughter to be taken away. Then, in instinctive response made with instant self-recrimination, she yells, “Take my little girl!”

Is it possible to imagine a more cruel fate, or a trauma from which one is less likely to recover? Sophie can never get past her nightmare as some Holocaust survivors have done, because she cannot fully externalize her misfortune or her anger. She cannot simply blame her fate on the malevolence of someone else and move on with her life because she played too large and too active a role. The SS officer made her an accomplice to her own victimization.

Victims of disease and disability face the same problem in a world in which their misfortune is thought to reflect “uptightness,” unresolved conflict, moral transgression, and arrested spiritual development. They are seen as accomplices to their victimization as well. Victims are not free to curse the fates for their affliction; instead they are left to torment themselves by wondering what they did to bring it about. Victims cannot turn to others for compassion without wondering what suspicions the others harbor or what inferences they have made. Susan Sontag argues in
Illness as Metaphor
that the belief that diseases are caused by mental states and can be cured by the exercise of will is “an index of how much is not understood about the physical terrain of a disease.”
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Until the terrain is understood, furthermore, those who suffer from the disease are blamed for having it—as those who suffered from tuberculosis were blamed for their affliction before the discovery of the tubercle bacillus.

Our knowledge of the terrain surrounding the relationship between mental states and illness is nothing if not uncertain. While this uncertainty lasts, perhaps we should err on the side of caution and assume that those who are ill did nothing to contribute psychologically or spiritually to their disease. Their burden is heavy enough already.

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Some people may be tempted to argue that the advantage would belong to those whose mental states could
enhance
immune function, but not depress it. True, but one cannot have it both ways. If one opens the door to the influence of transient moods and thoughts on the immune system, one must accept the good (enhancement) with the bad (suppression). In point of fact, the relevant literature seems to indicate that it is every bit as easy to show immune suppression due to negative mental states as it is to show immune enhancement due to positive states.

T
here are many wonderful things about teaching at Cornell University, one of the best being the faculty tennis courts. The courts are located at the bottom of a gorge on the edge of campus and they offer the faculty tennis player visual splendor, shelter from annoying winds, and a soft clay surface that slows the pace, extends rallies, and generally creates the illusion of having more skill than one actually possesses. I was playing on these courts recently when I overheard something like the following conversation between two nationally-known scholars and locally-known tennis enthusiasts.

P
LAYER
1: “This ought to be interesting; I haven’t had a chance to get on the court in a couple of weeks.”

P
LAYER
2: “I like having a layoff now and then. I feel fresh when I come back, and I feel like I can concentrate better.” ( Players 1 & 2 exchange further small talk)

P
LAYER
2 : “My knee is really bothering me. I twisted it while playing last week and haven’t had the same mobility since. Maybe I should see an orthopedic guy.”

P
LAYER
1: “Umm.” (Players 1 & 2 engage in further small talk, and then, after the first game …)

P
LAYER
1: “I’m not happy with the way they strung my racket. I can’t seem to get the same pace on the ball. Where do you get yours strung?” (Player 2 returns to the baseline, seemingly not having heard the question.)

As a social psychologist, this dialogue was unusually interesting to me because it nicely illustrates a phenomenon I describe in some of my courses, a phenomenon known as “self-handicapping.” Self-handicapping refers to our attempts to manage how others perceive us by controlling the attributions they make for our performance. By drawing attention to those elements that inhibit performance, the self-handicapper tries to induce the other person to discount a potential failure. Under such trying circumstances, it is implied, anyone would have failed. And things are even better if we succeed: Logically, the other person should augment his or her impressions of our ability. Anyone capable of overcoming such obstacles must be gifted indeed.

There really are two classes of self-handicapping strategies, real and feigned. “Real” self-handicapping involves placing visible obstacles to success in one’s own path. The obstacles make one less likely to succeed, but they provide a ready excuse for failure. The student who neglects to study before an exam or the aspiring actor who drinks before an audition are good examples. Sometimes failure is all but guaranteed, but at least one will not be thought to be lacking in the relevant ability (or so it is hoped).

“Feigned” self-handicapping, on the other hand, is in certain respects a less risky strategy, one in which the person merely
claims
that there were difficult obstacles in the path to success. This kind of self-handicapping consists simply of making excuses for possible bad performance, either before or after the fact. Although it is surely employed in all walks of life, this strategy is probably most common in areas such as sports and (undergraduate) academics in which outcomes are often unambiguous and performance can be precisely quantified. With respect to the world of sports, I trust that the dialogue that began this chapter is familiar to all. With respect to academic performance, students at many universities seem almost to be in competition for who can study the least—or claim to—and still get high grades. Indeed, there is a term, “sneaky bookers,” which refers to students who study only in the strictest privacy so that they can pretend to devote minimal effort to their courses.

The phenomenon of self-handicapping raises several interesting questions. Real self-handicapping makes one wonder about people’s preferences for how they wish to be perceived. Is it really better to be thought of as a talented drunk than as a moderately gifted person who has at least actualized his or her potential? How did wasting four years of college by not studying develop such cachet? I am reminded of a recent interview of tennis star John McEnroe on CBS’s
60 Minutes.
When asked to comment on his relative decline on the tennis circuit and the simultaneous rise of Ivan Lendl, McEnroe boasted that he was still the superior talent, but that Lendl was higher ranked “merely” because he worked harder at his craft. A curious form of self-presentation! Are we supposed to think less of Lendl because he has applied himself, and more of McEnroe because he has not? It speaks to how far perseverance and hard work have fallen in value in the current culture that such strategies of self-presentation are so commonly employed. It also makes one wonder about the future of a society that more visibly rewards beauty, glibness, and athletic prowess over determination and sustained effort.
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Another issue raised by the phenomenon of self-handicapping is the question of who the self-handicapper is trying to fool. Artists who drink to excess might do so to prevent others from concluding that they lack sufficient talent, or they might do so to shield
themselves
from a similar inference. Students who do not study (or pretend not to) do not want others to think of them as dull, nor do they want to think that of themselves. At whom, then, are the attempts at self-handicapping directed? This question has been the subject of much of the research in the self-handicapping literature and thus far a definitive answer has been elusive. Many self-handicapping attempts have been shown to be clearly directed at managing the impressions of others; in contrast, definitive instances in which such strategies have been employed to fool the self have yet to be documented.
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This does not mean, of course, that such instances do not exist, but rather that a conclusive answer to the question of why people self-handicap—to influence their own or other people’s impressions—must await the outcome of further research.

There is yet another “why” question that is raised by the phenomenon of self-handicapping, particularly by the phenomenon of feigned self-handicaps. This question does not involve “why” in the sense of to whom the strategy is directed, but “why” in the sense of how it is that people believe such strategies to be effective, or why people continue to employ them if they are ineffective. Our excuses sometimes “work” because it can be difficult for a person to determine whether they are genuine. However, most self-handicaps seem to meet with much less success and do not have the intended effect on how one is perceived. Instead, counterfeit excuses are generally seen through and given little weight. The two tennis players discussed earlier were clearly unimpressed by the hardships that supposedly confronted the other. College students are hardly in awe of the average peer who gets good grades but professes not to study—witness the aforementioned term “sneaky bookers.” Indeed, my colleagues and I have recently conducted several studies that demonstrate that feigned self-handicaps are generally ineffective. For example, we asked samples of students to think of people they know who claim to rarely study and yet do very well in school. When asked their opinions of these people, our respondents indicated that they believed very few of the claims, and instead considered them to be poorly disguised self-presentational ploys.
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