Do Not Walk into the Dead End of Paranoia

Ignorance more frequently begets confidence than does knowledge.

— Charles Darwin, one of the founders of modern biology

In 2000, the humor science magazine the Annals of Improbable Research awarded that year’s Ig Nobel Prize in Psychology to social psychologist David Dunning of Cornell University and his graduate student Justin Kruger. The reason was a paper they published in 1999 in the Journal of Personality and Social Psychology, titled “Unskilled and Unaware of It: How Difficulties in Recognizing One’s Own Incompetence Lead to Inflated Self-Assessments.” The paper is both entertaining and scientifically valuable.

A word of explanation: the Ig Nobel Prizes are a humorous scientific event held in parallel with the Nobel Prizes. The research honored there is not nonsense; it represents genuine achievement in science, yet it has the quality of being “funny at first, then thought-provoking.”

“Unskilled and Unaware of It” studied the relationship between human confidence and competence. Dunning and Kruger designed a psychology experiment and found that the group scoring lowest in the tests rated their own standing far above their actual level, while the highest scorers rated themselves noticeably below their real performance.

Dunning and Kruger argued that such an illusion arises mainly from a deficit in “metacognition” (people’s understanding of their own cognitive processes). Those least competent in a certain field, lacking the relevant knowledge and skill, cannot recognize their own inadequacy; the ignorant are fearless and extremely confident in themselves. Meanwhile, those most competent in a field often assume that what they can do others can also do easily, and so fail to realize how exceptional they are.

The story goes that what inspired Dunning and Kruger was an absurd bank robbery that took place in Pittsburgh on April 19, 1995. That day, a clumsy robber entered a bank in broad daylight with no disguise at all, and after the robbery even smiled victoriously at the security camera.

In less than an hour, police found the “clumsy robber” from the footage. When they played the recording for him, he was astonished. He said he had covered himself all over with lemon juice — how could the camera have captured him? Locally, people believed that rubbing on lemon juice made you invisible.

I believe most people hearing this news find it unbelievable, suspecting the robber was either insane or deliberately mocking the police. In fact, the robber was telling the truth. This phenomenon naturally intrigued social psychologists, who wanted to know why people produce such cognitive bias.

We onlookers cannot help laughing at such news, yet we fail to see that in many ways we are just like this clumsy robber. In our conscious and unconscious minds there exist many similar paranoid notions. Many people, caught in these notions, suffer the “leaf blocking the eye, hiding the mountain” effect: onlookers see their problems plainly, while they themselves believe everyone else is wrong and only they are right.

I believe many people have encountered persons with paranoid personalities. Such people are hard to communicate with; they are trapped in a dead end of some prejudice. Others cannot persuade them, and they instead try to educate others into accepting the set of beliefs they themselves hold.

In the medical field I have encountered an exceptional number of people with such paranoid cognition. Some patients or families believe in one — formal or informal — recovery method almost as religious believers believe in a cult leader. They are convinced it is the best way to cure every disease and tirelessly promote it to others, urging them to abandon treatments the believer dismisses as worthless and adopt the single cure-all he recommends. There are always people who fall for it, walk into their trap, delay treatment, and in serious cases even lose their lives.

Two young patients left the deepest impression on me.

One was a 19-year-old woman with Ewing’s sarcoma, from Hunan. Her sarcoma had been shrinking under treatment and her strength was markedly recovering, but, led on by several members of a group that promoted acupressure massage and ginger-tea drinking, she joined the group, abandoned her previously effective treatment, and took ginger tea and did massage every day. Within a month the girl vomited massive blood and soon died despite treatment.

The other was also a Ewing’s sarcoma patient, a 20-year-old man from Henan, a freshman at a Project 211 university. His tumor had also been well controlled under treatment, but later, for reasons I do not know, he came to believe moxibustion could work miracles and accepted an unconventional, heavy moxibustion regimen. The moxibustion had not lasted long when he too developed massive hemorrhage and was carried straight from the moxibustion clinic to the hospital emergency room, where resuscitation failed and he died.

In my view, both had walked into the dead end of paranoia. Some patients who enter this dead end, like them, will not listen to any persuasion. Not only are they themselves trapped, but — like members of a pyramid scheme after brainwashing — they become promoters, vigorously recommending their own belief to other patients. Nowadays I keep a respectful distance from such people; I simply do not have the time and energy to hear them lecture and preach, and they have a relentless tenacity.

But some who have been brainwashed can be brought around. I once treated a breast-cancer patient who had at one point fervently believed that bian-stone therapy could cure every disease — guided by a “master” of almost supernatural reputation, she too had been sunk in similar paranoia. From the moment she contacted me, I told her that tumors easily spread through the blood, and that scraping (gua sha) readily promotes hematogenous metastasis of cancer. I told her that, if she did not believe me, she might as well have regular follow-up scans to watch her tumor change, rather than dragging things out and delaying her own treatment.

Later, as I had predicted, her tumor was not controlled but began to spread. She cut her losses in time and, on my advice, accepted a course of integrated Chinese-Western treatment — surgery, chemotherapy, endocrine therapy, plus moderate Chinese medicine. Her cancer came fully under control; she has now survived tumor-free for over six years, with no sign of recurrence so far.

This young woman’s personality was not so paranoid that she could not listen to persuasion, which is why she could fortunately cut her losses in time. Some people are paranoid to the bone; even old acquaintances, we cannot persuade. In my twenties I lived for a while near the east gate of Peking University, and I knew a young Sichuanese man a year or two younger than I, who had always been self-righteous and disinclined to listen to others.

Unfortunately, a few years ago he developed a brain tumor. He sought out some “divine healer” who, he said, had conquered cancer, swallowed the healer’s teachings, and scorned both modern medicine and other TCM doctors. He even had grand ambitions (he always did everything with grand ambition) to use his experience of making a living and doing business in Beijing (in fact, he had by then already been punished by the police and courts for bribing state personnel — hardly the story of a respectable success) to promote this great master’s life-saving formula for the benefit of cancer patients worldwide.

A mutual friend was then half-doubtful about him and asked me to help decide. I told our friend directly that this fellow with a brain tumor, crooked in his intentions and paranoid in character, would not only harm others but would destroy himself. Later the patient’s condition indeed rapidly deteriorated beyond treatment. I do not know whether he regretted it at the end.

But I know another colorectal-cancer patient who deeply regretted it before she died. She had been a bank clerk in Fujian. Bewitched by a “great master’s” boast that “those said to be untreatable have simply not met the right technique,” she sank into paranoia and would not listen to any advice. I earnestly told her one thing: multidisciplinary, standardized integrated Chinese-Western treatment offers the most chances of survival. Before she died, she contacted me to say she deeply regretted not having listened. She, who could plainly have lived five more years, reached the terminal stage in little over a year.

Well-trained doctors may not speak sweetly; some of their prognoses, which sound harsh, are hard to accept (of course, a few patients do create medical miracles and overturn a doctor’s prognosis, but large-data statistics are usually right, and doctors cannot accurately predict every patient’s outcome). They will not use smooth words to deceive patients and families into false confidence, because medical students and apprentices are repeatedly warned by their seniors: the physician must be rigorous and truthful, or he harms others and himself, with endless consequences. The reason medicine has this tradition is that there are so many bloody lessons behind it.

Medicine is indeed imperfect, but do not deny everything about it just because it is imperfect. Viewing things dialectically is always the most appropriate; only objectivity and reason bring us closer to truth.