Rationally speaking, is a presentation of New York City skeptics dedicated to promoting critical thinking, skeptical inquiry and science education. For more information, please visit us at NYC Skeptic's Doug. Welcome to, rationally speaking, the podcast, where we explore the borderlands between reason and nonsense. I'm your host, Massimo Pierluisi, and with me, as always, is my co-host, Julia Gillard. Julia, where are we going to talk about today?

We have a full house today, at least virtually. Virtually. Yeah, right. So we have we have two guests here and both very excited about guess number one is Sally Fatele, who is a practicing psychiatrist and lecturer at the Yale University School of Medicine, where she focuses on mental health policy as well as political trends in medicine. She's published numerous books, including PC, M.D., How Political Correctness Is Corrupting Medicine. And then joining us by Skype is Dr Scott Lilienfeld, who is a professor of psychology at Emory University.

Scott has is a frequent contributor to Scientific American Mind, and he's also the author of a book that was one of my picks on, rationally speaking, at least a couple of years ago now, the excellent 50 great myths of popular psychology. And Together, Sally and Scott have just come out with an excellent new book titled Brainwashed The Active Appeal of Mindless Neuroscience. Scott, Sally, welcome to the show.

Thank you for having us. Thanks. Pleasure to be here.

So I'm going to jump right in and and ask about what is the big deal with the neural correlates of X? Because it seems to me perhaps a little bit naively as as as a biologist that, you know, everything that we do has is going to have a neural correlate. And so when I explain about neuro Carlina's Masimo.

Sure. The fact that in the shallows for our listeners. All right. So a neural correlate is the mapping of all the identification of a particular area or areas of the brain that correlate as in statistically correlate with a particular type of behavior or thought. So if I'm right now, I am talking, for instance, and if you were to do a live MRI scan of my brain, which you can't, but if you could, you would see certain areas of my brain are particularly active.

Those are going to be called the neural correlates of my talking. But the problem is that as nice and interesting as that may be, everything that we do, everything that I think about, then everything that I say is going to have a neural correlate. So what is the big deal to start with the basics? Why do we care about neural correlates to begin with?

Well, I I certainly agree that anyone who's taken Biology 101 knows that the the every every psychological event, every cognition we have, every emotion is is caused by some act, some physical activity of neurons and neural circuits.

I guess that's why we called it the book The Seductive Appeal. It's because even though this is something that most scientifically literate people know, there's something it seems endlessly fascinating about actually picturing it in the brain.

And that's that's, in fact, why we spent a lot of the book, not all of it, but a lot of it talking about brain imaging, because there's something special we feel about the image itself.

It's it's well, clearly it's visual. That's our most primary and compelling sense.

It takes advantage of just stupendous technology. It's absolutely dazzling. So you have that it's sort of an intersection or a perfect storm of about four things.

So that's the visual, which gives you the stunning biological portraiture. It's technology, which is amazing. It's about the brain itself, which is the staggeringly most complex organ in the body and also enormously fascinating.

And it also generates and mistakenly so the impression of a very tidy brain to behavior narrative.

So this lights up and that means someone did X, and that's not at all what it necessarily means. And there's a lot of confusion around that. And in fact, we have a whole chapter on that. We can go through some of the confusions that it generates very quickly, something called reverse inference.

You can see you certainly would see areas of the brain activated when a person is engaged in some sort of task or or some sort of perception.

But that part of the brain is often meeting, often mediates other sensations and activities as well. So it's very difficult, very tricky to look at the brain and say, for example, the amygdala is a much talked about and very important and highly conserved part of the brain.

It mediates fear.

Conserved, you mean evolutionarily? Yes. Right.

So it mediates fear, but it also mediates novelty and surprise.

So if you don't know these things and often people, I think, have an agenda, sometimes when they do this research they're looking for, I don't mean political agenda necessarily, but just a preconceived notion of what they're going to find.

It could almost serve as a Rorschach test. They're more likely to interpret it in that way. And it might not always be correct. I can just jump in real quickly, so I just to piggyback real quickly on what Sal said, I agree with everything she said. I think the one point I'd make and I certainly resonate to Massimo's question as well, which is it shouldn't be that surprising. There's neural correlate. But I think Paul Bloom at Yale kind of has it right, which is that Bloom was a developmental psychologist, notes that children, very young children, are implicitly mind, body duellists.

And even as adults, even when people claim not to be duellists, I think there's a little residue of dualism in almost all of us. Yes. And I suspect part of what happens is when someone is experiencing an emotion and there's a neural correlate like so someone's feels jealousy or love or hatred. And then the brain image of Maraire PET scan shows a neural correlate. People are surprised that go, wow, that's in the brain, too. You know, jealousy's in the brain and loves that.

All the stuffs in the brain. And of course, they shouldn't be surprised because, of course, it's got to be in the brain somewhere. But I think because people still implicitly are duellists, they are more much more surprised by these findings than they they ought to be. So I think to me, one of the great ironies of brain imaging is that on the one hand, it I think is the clearest evidence for mind body monism that mind and brain are made of the same material.

But at the same time, part of what makes them so popular and so seductive is actually people's implicit mind body dualism. I think they kind of capitalize on that very belief.

So that that reminds me of a cartoon that I've seen recently. This is why I think it was the Saturday morning breakfast cartoons. And there is this discussion, there's this debate between these two guys. And one says, I don't believe in love is just a bunch of chemicals in the brain. And so the second guy hits him and, you know, punches him and the gases are high. And the second guy says, well, I don't believe in pain.

It's just a bunch of chemicals in the brain. It sort of gets at this idea that, well, yes, of course it is. But right.

So it does sound like it has the combination of intellectual sophistication and meanness that you usually find in somebody coming to a cell. And it's got both of you. I just want to see if I'm correctly understanding the nature of your objection to the growing use of of neuroscience and all these different fields. The the way I understand it, your point is that data findings from neuroscience are both being used incorrectly in the sense of of people are oversimplifying the the data and and drawing stronger conclusions than they, you know, should be drawing from given the sort of crudeness of our current methods and and, you know, the complexity of the actual underlying issues.

But they're also trying to use neuroscience to answer questions that the neuroscience was was never designed to bear on at all and thinking that it resolves problems that it doesn't actually resolve.

Yes. That you you touched on it.

In fact, there are I see it as three general themes in this book, which which I consider more of a culture book than a science book if I had a culture of science books.

But one, as you said, is the overinterpretation of brain based data. But we do focus on on neuroimaging, even though, as we said before, it's just one of many tools. But it's the one because it's so spectacular that has given neuroscience. We think it's cultural presence. You know, why the why the brain is on the page of the pages of newspapers all the time.

So there's the overinterpretation and and there's premature application of it. And here we're talking about commercial domains. There's a field now called neuro marketing. There's neural neuro law in the forensic setting.

And so frequently.

Oh, and there's neural lie detection. And maybe we'll get on to this.

But those are not ready for prime time. But they're often being being used.

And and it's it's three general classes of folks who will do the exaggerating. It's most classically the media. But but not, I want to add, not careful science reporters. David Dobbs is one of my favourites. I mean, science journalists are usually very sensitive to this, but they're also a dying breed, unfortunately, but.

Right. And then there are occasional neuroscientists.

But but if anything, most neuroscientists are horrified when they see this sort of interpretive license taken.

And then there are these neuro entrepreneurs. And that's what's gotten I referred to people who are doing. The neuromarketing, some of which may be more legitimate than others, it's a little hard to tell and that the lie detection so that is one thing. Then the second of the three concepts, and this is probably Scott, where I know was my point of entry into this topic was what we've called neuro centrism, which is this this notion that understanding that the brain, the neural level is inevitably the most authentic, reliable, truthful, meaningful level of understanding, complex behavior.

And so this is an analogy with gene centrism, let's say, yeah, it's a difference.

And in fact, we yes, it's another some people I think of even even want to stretch it into a unifying theory of human nature. But so neuro centrism and the reason it meant a lot to me is in the context of addiction. And again, we can get into this later. But very, very briefly, I believe it's being highly over medicalized and there are enormous social and psychological components to it that are being downplayed so that there's a neuro centrism problem which really does figure in clinically in many ways.

And then finally, Julie, as you said, you know, what about biological explanations of behavior?

We're going to get better at at understanding them.

And we do every day, every day we can explain things better. But to many people we believe seem to interpret this, make the mechanistic behave excuse me, the mechanistic descriptions of behavior as evidence that these are that behaviors are then not under voluntary control. And sometimes that's true, but a lot of times it isn't. And in fact, as you can imagine, this is where the forensic realm really comes in, because defense lawyers love to put up pictures of their ah, this this is my client on a brain scan.

And you can see from this spot over there that he couldn't help himself.

The Twinkie defense was a forerunner of those is something you sure don't blame me, blame my brain and the end the public is you know, if they're not sophisticated about this, it's very it's a very compelling narrative.

Yes, Scott, I wanted to ask a more basic question, because before we get into the all this fascinating stuff about neural law and neural and neuromarketing, and that is what about the basic technique that seems to me what have been a misunderstanding or lack of appreciation of how this thing actually works?

What about an FMRI? What what is it we're looking at when we see these very nice, colorful pictures of our brain on whatever?

Exactly. So I think what's important for the person to understand is that these things, whether they're ephemeral eyes or PET scans or specs, they all use somewhat different techniques and they're looking at somewhat different things, whether they're oxygen consumption, as in the case of MRI or glucose uptake in the case of PET or what have you. So they're all using somewhat different Leganes and somewhat different measures of biological activity. But I think what's important for the average person to understand is that these things are nothing at all remotely like photographs of the brain in action.

They kind of look like photographs, especially from our eyes look like photos. But they're they're not they're they're highly processed and almost always averaged measures of brain activity that are kind of walked into a common space. So I think in that respect, they can be quite useful. And I think many thoughtful images understand that. I think most people who do demerging are very well aware of those limitations. But I think they can easily deceive us into thinking we're looking almost at a photograph of the brain.

I think also typically what I think is often missed is that almost always when we're looking at fMRI or Pat or what have you in an experimental context, we're looking at a subtraction technique that is worth very often comparing an experimental technique. So someone looking, for example, the emotional faces versus someone looking at neutral faces. And what you're seeing in the in the brain image is the subtraction. That is what's left over, which is actually perhaps psychologically interesting.

But people have to remember that what they're looking at here is, again, not the raw brain action, but rather a difference between two different conditions. One reason that's very important, by the way, is oftentimes the interpretation of the brain scan can just enormously on the nature of the control condition, which is almost never reported in the media because it's not terribly interesting. So it's a and then there are lots of other processes that go on that involves subjective decisions.

Again, I don't want to bash Imogene because there's simply lots of subjective decisions that go on and lots of other areas of science as well. But they're often smoothing procedures that go on where you have to kind of decide how much to smooth's different adjacent brain regions and so on. So I guess the key points that people understand is that the resulting images is often quite useful. It's quite informative, but it's often the result of a lot of small decisions that were made along the way that are often not reported or often not mentioned by the media.

So as Sally was mentioning earlier, there's you often hear this talk of how neuroscientists, neuroscience as a field will eventually just replace other fields entirely, like cognitive science, psychology or like the social sciences. And that, you know, and become we become good enough that neuroscience will be able to answer all the questions that we had in those fields using neuroscientific methods, neuroscientific terms and data. And so to me, that seems just pretty clearly wrong when we're talking about social questions that if we're asking why societies take the shape that they do, you know, the level of description there is just way too high to to for it to be useful to talk in terms of the movement of electrical impulses in individual brains.

But but I'm wondering about psychology, like what kinds of questions and psychology do either of you think won't could never be resolved in a useful sense by the development, the advancement of neuroscience? Well, you know, you're getting a really difficult, complex issue that I have to confess, I'm still struggling with a bit. Well, more than a bit. So it's and it's really an active debate among neuroscientists, also among philosophers. And I think there are thoughtful differences of opinion on both.

I think what what you're talking about is what to use the technical term, what's sometimes termed illuminative reductionism. Dennett calls greedy reductionism greedy because it's kind of gobbling up all the other levels of explanation above it. So the hope is that on the part of greedy reductionists is that eventually the the neural level of explanation will encompass and gobble up everything that's psychological and social and so on.

Of course, one see the cartoon mentioned above. Yeah, exactly. And there are a lot of those cartoons and it's possible I mean, I think it's an open, philosophical, scientific question. I think I'm I'm dubious of that. But I think it's possible. I think one point to bear in mind here, incidentally, is that what's often forgotten, of course, is that that kind of eliminated reductionism goes both ways. So eventually, of course, the implication is, of course, the brain level is by no means the most basic or fundamental level of analysis either.

So eventually we won't do neuroscience either because they will be gobbled up by chemistry and physics. It's all going to be physics. So that's possible. But I think that, like you, I'm more inclined to at least hold open the possibility, if not likelihood, of emergent properties, which I think the kinds of things you're talking about at the psychological level, there may be certain very complex emergent properties that involve very complex interactions at the social level. So like you, I'm I'm dubious that we're ever going to fully be able to understand all psychological phenomena, including, for example, people's interpretations of the world, the meaning that people impose on stimuli, whether or not we're ever going to be able to fully reduce that to neuroimaging, I don't know.

But we're nowhere near it. Right. So we I mean, that's for the foreseeable future. What we're never we're not going on in our lifetimes for sure. Neuroscience is not going to be able to help us explain those deeper problems.

I like to suggest something in this particular aspect of the discussion there is when I was reading your book, coincidentally, I also happened to read an article on critical of of overreliance on an Eurocentrism, as I was putting it earlier in The New York Times in the Stone, which is The New York Times philosophy blog. And this was pretty recent. And that the author reminded me actually of a very nice example that was you can find in an old book by Richard Lee Washington, who is a geneticist at Harvard who actually has had a lot of influence in my college career as a biologist.

Lewontin wrote a book years ago called Biology as Ideology, where it was looking essentially at the interface between biological research and societal problems. And one of the wontons examples was the following. He says, you know, when people say, well, what is the cause of tuberculosis? Right.

The immediate reaction, Midian answer you get from a biology, of course. Well, the bachelors of science, of course.

But but yeah. But if you zoom out for a minute, you actually realize that if you're talking about the cause of the causes of tuberculosis in human society, actually the major cause is a certain kind of living conditions. Poverty. Right. And, you know, if you if you act on those which, by the way, has all sorts of other interesting and positive effects, you are not going to have tuberculosis. And so it's a different idea.

Of course, was was not obviously not to deny that the bacillus has, you know, is a causal agent of tuberculosis. But the idea that if you focus on that particular aspect of it, you're missing the bigger picture and the bigger picture may be relevant.

Oh, that's exactly that's exactly right.

And in fact, I should say that what PCM was actually about I know that you were just using tuberculosis as an example, but it's as just a little aside, I want to just say that's why so much I think of public health schools are so politicized is because they'll often look at what they call the social determinants of health, which are important things to research and know about, no question. But your level of intervention as an epidemiologist or as a biologist is often not at the cultural level.

It's it's at the the biological level. And often and that's why we need interdisciplinary approaches to many problems.

But but, you know, I I certainly believe that's right. And that was a theme that figures very prominently, you know, again, in addiction. I also used to work with patients with post-traumatic stress.

Disorder and yes, there's a biological component to that, I think people know what PTSD is, we're talking about combat combat stress, which you could define very narrowly as a fear reaction that doesn't extinguish after the frightening stimuli is stimulus is removed.

But there is there are many complex layers of of meaning and existential crisis that envelop that it's not just a biological problem.

And and, you know, sometimes it's gotten a little frustrated at some of well, I guess my colleagues were the ones with the prescription pads that seemed to put little too much faith in in medication.

Now, all of these levels are are important. I work in a methadone clinic. I mean, frankly, I should be a social worker, not a psychiatrist. I'd help people much more.

And sometimes I actually place social worker. That's the level at which I'm I'm more helpful. It doesn't mean that there are methadone. So right there, that's a pharmacological intervention. So these, you know, should all work together, but you can't focus on one at the expense of the other. And some, depending on the question and the situation and the context, what some of those levels are just more relevant than others.

And I think just one thing to piggyback on London's example is that we we tend to be very sensitive to and I guess our brains probably work this way to not engage in maybe a bit of north central here myself. But I think our our brains, I think, are very sensitive. Our minds are very sensitive to variability. So when there's something that's kind of in the causal background, like poverty, which may be fairly ubiquitous in some parts of society, we don't really attend to it very much.

So we focus very much on what's variable or what's new like us. But in fact, sometimes the stuff that's in the causal background may actually be the most amenable to treatment and intervention, even though it's a lot less salient to us.

Scott. And one of the most intriguing parts of your book for me was the latter chapter, I guess, latter two chapters about, you know, the degree to which we are responsible or we can hold other people responsible for their actions as we learn more and more about the I don't even know whether to say that the natural causes of those actions or the neural correlates of those actions or the brain features and activity that are associated with those actions in some way.

And and in some cases, it seems more clear cut that if, you know, someone was a perfectly normal person and then suddenly started attacking and molesting children, and then it turned out that he he got a brain tumor that, you know, perfectly coincided with this completely unusual, unprecedented behavior that seems more like, well, that's you know, he's the victim here, not the you know, he's not responsible. And then and then, you know, you talk in your book about psychopaths.

There's maybe not a perfect certainly not a perfect correlation, but at least a strong, significant correlation between having the neural features of a psychopath and committing certain crimes. But at what point do we start saying, well, this thing that we're observing in the brain is just, you know, another way of describing this person's behavior and we're going to hold them responsible just as we always have. And at what point do we say this person is the victim of this feature of their brain?

Well, Scott and I have a division of labor.

I do the paedophiles and he does the psychopaths. So I'm all right. So it's not a projective tests.

So as far as the actually Julia's sighting, actually a real case, although when you think about Julia, how many you have, how many of these have you read?

You'd think you'd read a lot more of these are the neurological literature. This one is always cited, but nonetheless, it is so striking.

It is.

And and because it's an ABA design, you have this man, I think he's in his 40s or 50s and he was law abiding, never approached his I think it was stepdaughter until one day when he made advances towards her and and the mother became alarmed.

And then he actually went to some treatment where I think he was about to go to jail, actually, for sexual abuse. And right before he went to jail, he started having I believe he had terrible headaches. Some neurologic symptoms which should raise a red, would raise a red flag.

But he he. My impression was that he also had intense urges to rape, I don't believe you had ever raped the girl.

I think it was more like touching. But he had these intense desire to to physically assault someone.

And so he went to the emergency room and they discovered that he had a very large tumor in one of his frontal lobes and it was removed. And with this, his paedophilic desires were obliterated.

And so that's what appear to be cause and effect for sure. But then it was made more definitive when about a year later, he started experiencing these urges again. And when he got a brain scan, sure enough, that tumor had had regrown.

So that's is incredibly dramatic.

And I think the answer to your question well, frankly, it's always very hard.

Clearly, this was I think you'd call it a definitely a mitigating circumstance. The first the first episode was basically treated as an excusing circumstance, which is to say, I don't think there were criminal penalties for him once they discovered the the tumor. So that was understood to be a condition he had no control over.

But even so, you have and I'm very sympathetic to that.

But, you know, when he did present he one of the motives for him going to get to to present himself for help was that he felt this overpowering urge to rape a stranger. So even then, he was, do you say, trying to exercise some control over himself? I mean, within a bounded sense, he obviously had these profoundly undesirable undesired impulses.

But even then, he was trying to to protect someone from from himself so that his, you know, his capacity for control wasn't completely obliterated, but it was significantly compromised. No question.

And I think I think that was reasonably managed, which is to say that he did not suffer criminal charges. Now, the second time around, and this is what we see with with so many folks who have bad habits and bad behaviors, I don't think this is a bad habit.

I mean, some really bad behaviors, too, is that they have them before. And it's it's it's just not a new thing to them. So if people know, for example, look, I have a hair trigger behavior, it's smart not to drink and go to bars. Now, that may be a lot to ask of people, but I actually think a lot of people buying themselves these ways. But we don't know about them because they do such a good job and original binding behavior.

Was Odysseas right?

Self binding? That's right. To the mast. To the mast. In order to avoid the Saxon years and and binding to the mast to avoid the siren call. Exactly.

And, you know, there's a continuum, of course, here, because you get people whose cognitive capacities may not be may not be high enough to even figure out that kind of strategy. Well, then you've got someone who, frankly, no matter how you think about it being his fault, whether you whether you how much emphasis you put on the, you know, blame is is a different issue. The point is they need to be contained because they're just dangerous people.

Scott, you you were specializing on psychopaths, you said. Yes, that's my turn now, right? Yeah, right. That says about me. But that's actually why study I study people, psychopathic traits who for the benefit of your listenership. So I was try to do a little thing on this because it's a very misunderstood condition. So psychopathic people are not necessarily violent, although some of them are. But typically psychopaths are people who are superficially charming.

They make a good first impression on others, but they're also guiltless and callous and unsympathetic and repulsed, control and and dishonest and and they certainly are at high risk for violence. So I guess there are at least two issues which are probably more of two issues are I'll I'll with regard to brain imaging and psychopaths that I think may be relevant in this context. So, number one, which I guess the question you raised earlier is, is what do we actually learn from brain imaging in psychopaths?

And I'm not. It's interesting. I'm I'm doing a little bit of that work myself, so I'm not opposed to it, but I'm not totally sure how much we've learned from it. So we know, for example. Behaviorally, that people are psychopathic, tend to be pretty fearless and they seem to have a high fear threshold. I don't think that would scare the heck out of most of us don't seem to scare psychopaths. So we know that we've known that for decades.

And brain imaging has confirmed that. Brain imaging shows that we have to be careful here about a problem called reverse in French, which Saliman made earlier. But we certainly know that in brain areas that seem to be linked to fear, like the amygdala, for example, we see Markt under activation of those areas. When people are when psychopathic people are presented with fear provoking stimuli that doesn't prove they're not experiencing fear. That would be an of inference, but certainly consistent with that.

And everything we see in their brain imaging patterns seems to corroborate not proof, but corroborate what we seem to see in their behavior. So it's not entirely clear to me what we have learned yet. We may still learn one day and that can kill. And Mexico's done some interesting work finding some potential areas of brain abnormality in the Paralympic region. But around the limbic system that may be telling us something about psychopaths we didn't already know. I think that's quite possible.

I think his work is provocative, but I think it still remains to be seen. So one issue there is what we termed neuro redundancy in the book. It's not clear how much these images are truly giving us new information or really redundant. What we knew before, the harder issue in the legal context, and I can see arguments both ways. I don't think here's where science has its limits is what do we do that information and I don't know.

So there are two different schools of thought and I think both are potentially defensible. So one school of thought is if you see brain deficits in psychopathic people, which you do in imaging and I might argue it's almost inevitable you would have to write. I mean, presumably there's someone there in the brain. So you see these deficits and let's see you even see structural deficits. And there's some evidence for that, that there's some evidence that psychopaths may have less gray matter in their frontal cortex, which is consistent with the idea of the poor impulse control.

So let's say you see that. Well, what do you do with that? Well, on the one hand, you could argue that it should actually be a mitigating factor because, oh, they've got something wrong with their brains or their brains seem to so some structural deficits. So we should be more excusing of their behavior and forgive them. That's one argument. And I think that argument often comes from maybe a point of view that might tend to emphasize fairness, for example.

So people who were maybe tend to take a more fairness oriented approach to the law might say, well, maybe psychopaths should be given a bit of a break because after all, they seem to have some brain deficits and maybe they weren't as capable of controlling their behavior. Their choices were somewhat constrained. Well, that's one argument. But the opposing argument is more of an instrumentalist or consequentialist view, which is that, hey, you know, if these guys have have less frontal cortex that's involved in impulse control, that might mean they're more likely to recidivate, more likely to get in trouble.

So if anything, that should be not a mitigating factor. It should be an aggravating factor because these are people would be less likely to want to have on the streets. Right. So I think the problem here is scientific data can only inform this decision. It can't dictate. It really depends on what kind of function you think the law should serve. If you think the law should have kind of a just desserts function versus an instrumentalist function, they lead to very different answers.

And I think that's where scientists have to realize that they can inform triers of fact, but they can't and gets me a little frustrated. I see this. They have to realize they can't dictate that information because their underlying assumptions that are debatable and legitimate that go both ways. Right.

So that strikes me actually as an example of something we talked about on the podcast several times, which is what I call the under determination of empirical evidence of values, meaning that this is a perfect example is the empirical evidence is certainly, as you pointed out, relevant. But then what do you do with that? Empirical evidence is in fact a philosophical question or a question of ethics or a question of how far you want to put it?

Now, I want to open a slightly different line of discussion here because I was surprised by something reading your book, and that was to read statistics about how many people actually recover from alcohol and drug addiction. While the general view seems to be that recovery is in fact sort of the exception. And that, I suppose, is the view that I subscribe to, just simply because that's what you find in the media. That's what you hear.

Well, so what happened there? What caused that kind of disconnection?

Yes, that's that surprises a lot of people. And what we talk about in the book are data. From large National Institutes of Mental Health studies, actually about three of them, one on alcohol and another on substances of abuse.

So there's a lot of convergent and and consistent evidence which shows that most people who've developed an addiction and we mean addiction as opposed to a problem, because getting drunk once in a while is a problem when you get in your car.

But it's it's it's a different clinical phenomenon from an addiction or alcoholism anyway, that people in those situations usually start in their late 20s excuse me, late teens or 20s and within eight to 10 years, basically their career in that is is over a it I rush to say this doesn't mean if it's your friend, you sit there and say, oh, you only have eight more years now.

You convince the person to get help and you step in and you're as aggressive as you could be. But again, epidemiologically, the natural course is that these do resolve in a within the decade typically.

And people who go on to a chronic and relapsing course are much more likely to be individuals who also have concurrent mental mental illnesses.

And part of the distortion and belief is it comes from is nicely described by this phrase clinicians illusion, which was what they sociologist Scott the Jacobs psychologists, I think.

Conan, Patricia Cohen.

Oh, Cohen. OK, yeah, I think it was an Annals of Internal Medicine article, but it's just it's it's a phenomenon you see in all of medicine.

I imagine with any reparative enterprise, you see it even maybe with Plummers is that you see, what I mean to say is that you see the conditions, you see the people who don't do well.

Those are the people who come in to clinics. Those are the people doctors see. And that's why it's I mean, for the longest time, I thought, if you have schizophrenia or what we call schizophrenia, it's a very complex disease and probably has probably several variants of it. But but that you are destined to pursue a deteriorating course. And that, sadly, often the case of people who do come into the hospital in the clinic. But data suggest now that maybe 20 to 30 percent of people actually have some sort of recovery trajectory, but we don't see them.

And after 9/11, you know, there was a right, from my point of view, almost a mass hysteria about the fact that New Yorkers weren't going to be able to cope with this horrific event.

And that anxiety, while well-intentioned, of course, issued by trauma experts, were people who spent their life treating people who frankly don't cope well.

So they generalized that mistakenly to the, you know, the whole universe of people who have that experience.

So between the researchers, that universe is clearly not well represented in New York. So who do researchers study?

They not all of them. I mean, epidemiologists do look at, you know, normals and large populations, but clinicians tend to use what's called samples of convenience, that all the studies that I did at Yale where people who are already in the hospital for a problem. And so that's who researchers see.

And, of course, that's who clinicians see. So it gives you a skewed and the media, well, they're going to take the more florid examples of anything.

And and so that's the impression that's generated.

Now, these are the people who are the sickest, who consume the most resources and who need the most attention. So you can't there's no relief in a sense that, oh, well, the majority of people don't.

But it help. But it's very important for telling talking about prognosis. It's very important for allocating resources and it's very important for knowing the truth. I think.

So here's what Sally saying. I think that I agree completely. And I think because of the clinician solution, we tend to underestimate people's resilience in the case of substance abuse and lots of other problems, which I think probably fuels kind of this this rather simplistic brain disease metaphor that is somehow in the brain. And one has no control over it as a ineluctable control, ineluctable force. And the evidence to suggest the case of substance use. No doubt it's a powerful force and it's not to minimize that and it can be difficult to resist.

But I think sometimes I worry that as a field and I'm a clinical psychologist by training, I worry sometimes that we. Perpetuate this pessimism, this nihilism out there, which isn't always warranted. Just give you one quick example of this. I was watching TV this morning, I think it was CNN, and they had a little snippet of an interview with this chief, 15 or 16 year old girl, Hannah Anderson, who was kidnapped, just underwent this absolutely horrific ordeal where her mother and brother were killed and she was kidnapped by this guy, was shot and so terrible.

And they should have a snippet of an interview with her. And she seemed to be doing OK because I was on the verge of tears. But she said, I'm doing OK. I'm hanging in there. My mom taught me to be strong. I'm doing all right. And the one of the commentators turned to a psychologist and asked, is that normal? Almost as though that the commentators seem concerned that she did not seem more upset, that she or she seemed upset, but she didn't seem to be grappling with.

So can the commentator was almost implying there must be something wrong with her, that she's not completely devastated, which I think kind of exemplifies exactly this, the same erroneous way of thinking.

Scott, it reminds me of the presumption of fragility after 9/11. There was I remember writing about this that that there was a memo sent around at some schools that teachers should not tell the students to be strong. They should not tell them that.

So instead they hold in the grief counselors.

Yeah, that's that that's bizarre. OK, well, I remember this on the campus where I was here at Emory in Atlanta right after 9/11. And there are a lot of New York students here. And obviously it hit this campus very hard. But there were a number of people predicting I remember quite well on campus that there was going to be an epidemic of PTSD, not just in New York, but also in Atlanta, because there are a lot of connections between New York and Atlanta.

And of course, you look at the epidemiological data. Most people, myself included, by the way, were very upset after 9/11.

Most people had trouble sleeping and were diagnosable if you weren't upset. That's right. Speaking of psychopaths, those might be the only people who weren't upset afterwards. Right. But terrorists. But the fact of the matter is, the epidemic never really happened. Most people took the hit, were very, very upset, but then eventually went back to their lives.

Well, we're out of time for this segment of the podcast, so I'm going to wrap things up. But now we're going to move on to the rationally speaking.

Welcome back. Every episode, we pick a suggestion from our listeners that has tickled our rational fancy. This time we ask our guests Sally Satel and Scott Lilienfeld for their suggestions. Sally, first.

OK, well, one of the most important books I've read in psychology, I actually read within the last five years, and it was by Timothy Wilson, who's a psychologist at the University of Virginia.

And it's called Strangers to Ourselves.

I believe he wrote it in the early 1990s or not that long ago. And he talks about the implicit unconscious, the the idea of the book. And it's an elaboration of a famous paper he did in 1977 with Richard Nisbet. That's called saying more than you, telling more than we know. Is that right, Scott? Oh, I didn't mean to put you on the spot. Yeah, well, we will check a link to that, but so the idea the basic idea is that people are very bad at intuiting what they really why they like things and what their motivations truly are.

And and so the limits of introspection is what he wrote about. And it was it's very, very enlightening. It's it's not a self-help book, but could almost be read for the gems about how to think about your behavior and your patterns and and how other people view you. It's it's wonderful. And so basically, they describe, I'd say, one of now the four unconscious or implicit some kinds of phenomena that we experience, you know, one being, I would say Freudian.

I do think there are certain dynamics, psychodynamic concepts that that probably are valid.

The other is procedural unconscious, where you just do the same thing everyday, like drive home. You don't know how you got there, but you ultimately do. The third kind of automatic phenomenon is, again, this may be implicit unconscious, what Wilson would describe. And then there's when I would I think of as the kind of an unconscious sort of heuristics that we unwittingly applied to many situations that they're really great.

I love that breakdown of the different kinds of of unconscious thought. And and I also love your recommendation. I'm also a big fan of strangers to ourselves. And just like you said, Sally, it's not a self-help book, but it has so many valuable nuggets for self-help and self-improvement. And I, I teach various classes on sort of applied rationality. And that book was one of the major inspirations for my thought experiments class, where you sort of do a thought experiment to try to tease out some of the real motivations for what you want or what you do.

But what's your pick?

Well, I have a lot of exercise is really a golden era for books and psychology. I mean, it's just for psychology nerd like me. It's been a great decade. There's been so many good psychology books, a couple come to mind, but one and maybe you guys have had this one as a pick already. But I'll just go for it is a book by Chabris and Simons called The Invisible Gorilla, as you guys have looked it up. Right.

Go ahead. Go ahead. That's a really fun book. It's it's a really fun user-friendly book about how our intuitions can fool us. Came about a couple of years ago, The Invisible Gorilla. It's based on a famous study which probably many of your listeners have seen, where basically it's a very dramatic illustration of something called inattentional blindness, where a bunch of people are passing a basketball around very quickly and a large gorilla kind of struts in front of the screen and a large percentage of people don't even see it.

So it's a great example of how our perceptions can fool us. And to me, the book is a little bit of a counterpoint to Malcolm Gladwell book Blink, which everyone should read Blink as a fun book. I liked reading it. I worry a little bit, though, and I'm Gladwell is a great writer and a great storyteller. But I worry a little bit that some people may have come away from Blinkx thinking that we can always trust our common sense intuitions, which, in fairness to global, he doesn't actually argue.

But I think it was often perceived that way.

And we've occasionally considered doing an entire episode bashing Goodwill's books, but maybe we will get around to that.

Good job, guys. I have my criticisms. I think on the one hand I'm torn about it, but I think some of his books have done a great job of popularizing psychology. But I also worry that they may have perpetuated a few misconceptions here and there, too, and blink maybe one of them, although it has some some virtues. But but I think one great thing about The Invisible Grill is, I think very even handedly it takes on this issue of when our common sense intuitions are likely to be correct, when they're not likely to be correct.

It also does have some discussion of some of the perils of neuroimaging. And even though it's not a book about neuroimaging at all, although it touches on it a little bit, I think it really provides readers with some really good basic critical thinking skills for how to evaluate scientific studies, how to sort of know what to study is good, what to study isn't good. And and also points out that our our basic intuitions are often helpful for certain kinds of purposes in everyday life or for sizing up people, for example.

They're not too bad. But but when it comes to actually evaluating the truth or falsity of scientific propositions, I think it's pretty clear and I think this book makes pretty clear that our intuitions are often pretty faulty and they introduce the term brain porn.

Oh, yes. Worth it right there. Right.

Excellent. Well, we will link to both of those and of course, to brainwashed on the rationally speaking podcast website and thali. Scott, it was a pleasure having you on the show. Thank you for a thank you. Thanks so much. It was fun. It's our pleasure. Well, this concludes another episode of Rationally Speaking. Join us next time for more explorations on the borderlands between reason and nonsense.

The rationally speaking podcast is presented by New York City skeptics for program notes, links, and to get involved in an online conversation about this and other episodes, please visit rationally speaking podcast Dog. This podcast is produced by Benny Pollack and recorded in the heart of Greenwich Village, New York. Our theme, Truth by Todd Rundgren, is used by permission. Thank you for listening.