13 July 2012

Semmelweis Reflex

Ignatius Semmelweis

ONE OF THE REAL BENEFITS of living in the UK is the BBC, a non-commercial network of TV and Radio stations. I'm a fan of Radio Four which is fairly high-brow in its approach to culture and science. Some years ago I learned about Ignatius Semmelweis on Radio Four.

Semmelweis was a Hungarian physician working in Vienna in the mid-19th century. His claim to fame is that he realised that doctors were spreading Childbirth Fever to women during childbirth, a disease which was frequently fatal. He recommended that doctors wash their hands in a chlorine solution before attending to each patient. In particular he made interns in his hospital who had been dissecting cadavers wash their hands before touch living patients. He obtained a definite decline in cases of Childbirth Fever and saved many lives. However, despite the clear benefits, his idea was so radical and preposterous that until Louis Pasteur established 'germ theory' in the 1870's, after Semmelweis had died, his hygienic practices were not widely taken up. Semmelweis published his findings in medical journals of the day, and wrote about this theory in a book, but made little headway. It's thought that doctors found his theory unbelievable. Trust in empiricism was still relatively new amongst scientists, and in those days doctors were not scientists. At the same time doctors were gentlemen and found the very idea that their hands were "dirty" and caused disease unseemly and unbecoming.

Today there was a magazine program which included Joanna Kavenna who published a novel, The Birth of Love, on the themes of childbirth and motherhood. Semmelweis is a character in the novel. While being interviewed on the subject of creatively she mentioned something called the Semmelweis Reflex. The Semmelweis reflex is a knee jerk rejection of a new idea because it is unfamiliar. There's a nice definition on Wikipedia:
Semmelweis Reflex (or effect) "is a metaphor for the reflex-like tendency to reject new evidence or new knowledge because it contradicts established norms, beliefs or paradigms."
It's so easy to feel that we understand things. With understanding comes a feeling of being in control, or at least not too much at the mercy of events. It has to be said that medicine is vastly improved by understanding, though modern medicine certainly has its limits. People who wish to limit the influence of science will often point out the limitations of science, though on the whole the people that I see doing this seem woefully ignorant of science and in no position to judge it's limits.
Click image to embigg
One place we might expect to find a well developed Semmelweis Reflex is in the sphere of religion. Religious people are not known for welcoming new information, especially when it contradicts there beliefs. When Darwin published On The Origin of Species in 1859 the response from Christians was a Semmelweis Reflex. Evolution continues to be the watershed issue for Christianity, especially in the United States. In the USA there is an ongoing battle to have Christian supernatural ideas given equal or better status as evolution has in the education system.

On the right is a modified version of a diagram showing a simplified version of how Christian responses to evolution have evolved over time (based on a diagram that seems to be endemic on the internet. I found it here). My version attempts to show the relative chronology vertically. In the late 18th and 19th centuries we saw several attempts to incorporate evolution into Christianity, especially after Darwin. There were those, of course, who simply refused to look at the data, refused to read On the Origin of Species, and refused to consider changing their views. What we then see is the emergence, mainly in the last 20th century a series of increasingly sophisticated approaches involving outright rejection of evolution. If the Semmelweis Reflex can be sustained over 150 years it seems as though 'reflex' is not quite the right word any more. Indeed unlike Semmelweis's case, the establishing of facts (paralleling Pasteur) doesn't seem to have initiating the overwhelming change in behaviour that it did in the case of hand washing amongst doctors.

Another classic Semmelweis Reflex can be seen in economics. Mainstream economists completely failed to predict the disastrous global financial crisis which began in 2007, and has become a depression one the scale of the 1930s. But there are a number of heterodox economists who did predict it. My favourite is Steven Keen of the University of Western Australia. He realised in 2005 that private debt was rising exponentially in Australia, with similar trends in the entire Western World. Neo-classical economic models ignore private debt, since they see credit and debit as cancelling each other out. In fact Neo-classical macro-economic models make a number of outrageous assumptions about complex systems, such as linear behaviour (the classic supply and demand graphs) and the concept of equilibrium which finds expression in the oft voiced trust that left to itself the market will find it's level. But anyone that knows anything about complex systems is that their behaviour is never linear, and never approaches equilibrium. Economists, sincere as they may be, are completely deluded about the extent to which their models fit reality. Progress in a discipline like economics comes one funeral at a time. In other words these hoary old economists are simply not going to change their minds, come what may. Our best hope it to outlive them and hope they don't cause too much damage in the mean time.

I believe that we are already seeing something similar over the issue of rebirth. I think I've done a pretty good job of outlining why rebirth is implausible, and have added some other points since publishing my blog Rebirth is Neither Plausible nor Salient (27.1.12). The case is quite strong, and those willing to consider the evidence I've marshalled on the whole seem to agree with me. But then they almost certainly already agreed and were not convinced by my arguments. At best people appreciated my enthusiasm and thoroughness. So I'm preaching to the converted, which is not entirely satisfying because it's not a real test of my argument. And it needs testing.

On the other hand as people who commented, and as discussions elsewhere on the internet, have made clear, those who disagree with me seem unwilling to examine my argument in detail and point out flaws or inconsistencies. What they do is fall back on what they know, and a literal reading of Pāli suttas. I haven't seen objections on the basis of Mahāyāna scripture, for example, though it may exist. Most of these reactions simply restate the mature theory of kamma and rebirth as they were taught it, ignoring the inconsistencies in the presentation, and say that it must be taken as a whole or not at all. In other words they are having a Semmelweis Reflex.

The point is that neither side seem to be really thinking about the issues and weighing the evidence. They're just taking sides because it fits their ideology or doesn't. Rebirth is integral to the Buddhist tradition--it is assumed at every step. The fact that it does not seem plausible on the basis of what we now know leaves us with a difficult task. I don't think anyone has really got to grips with it yet. Most rebirth deniers just seem to be dodging the issue. On the other hand I see fundamentalism as the kiss of death for Buddhism in the modern West, because it will be seen in the light of religious fundamentalism more generally. If fundamentalism continues to gain ground it will certainly alienate the mainstream of Western Society who seem heartily sick of religious dogma.

The problem needs to be addressed on two levels. We need to be clear about the facts, both from the tradition and the new facts emerging from scientific and historical investigation. But we also need to look at the level of values and salience. For the fundamentalist the tradition has enormous gravitas that affects the way that salience is assessed. Many fundamentalists have tipped the scales so far that science carries no weight. Every scholar, author and academic finds their own theory more salient than any other, though the good ones remain open to persuasion. In other words we need to try to communicate the facts, but at the same time the value of these facts. Obviously for someone like me scientific knowledge has great salience. Not only can I not ignore it, but I actively seek it out, and make it a priority to learn new things. This is not true of many religious people, and so we must frame the debate carefully.

There is also an ethical issue involved in deliberately attacking someone's belief system. One can very easily stray into violent behaviour. If someone is not receptive to us, we cannot force them to listen without doing violence to them. Making people receptive to us usually means making an empathetic connection with them first. This involves understanding and appreciating what they value and why. In order to change someone's mind we have to be able to imagine ourselves in their shoes. And very few non-religious people seem willing or able to do this.

Of course many people will prefer to stay out of the discussion. People say they are happy with their beliefs and have no desire to convince anyone of anything. Sadly this kind of cop-out see to be a modern default setting. I would argue that both religious and secular ideas are laced with an imperative to be in dialogue with others and to help other people understand your point of view. Buddhism is one of the great proselyting religions, and it's imperative is to teach other people how not to suffer. Inherent in a secular view is the betterment of humankind through knowledge. People can't better themselves if thy remain ignorant.

But this is not a call to take sides. Far from it. This is a call to empathise with your neighbour, and to treat them as you would be treated by them. Without first establishing empathy their can be no communication. Empathy doesn't need to be learned, we're all born with the ability. But we learn to suppress it with respect to outsiders and that needs to be unlearned.


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