BY KEITH MEATTO
In Act II of Hamlet, the Prince of Denmark says: “There’s nothing good or bad, but thinking makes it so.” More than four centuries later, modern science would agree –at least up to a point. In his new book, Mind Over Mind: The Surprising Power of Expectations, author Chris Berdik illustrates how our mental expectations can be self-fulfilling prophecies. A graduate of Harvard and Stanford’s journalism school, Berdik has worked as an editor at Mother Jones and The Atlantic, as a science writer at The San Diego Union-Tribune and for Boston University, and as a regular contributor to The Boston Globe. In late January, I interviewed him over burgers at the Corner Bistro, where we discussed his discoveries about the power of expectations in wine, sports, humor, sex, and parenting.
Every day our brains make subconscious decisions based on past experience and predictions about the future. What are the advantages and disadvantages of that?
Our brains use a lot of hypotheses, a lot of top-down forms to understand situations. If we didn’t have these preconceptions about how things are going to go, our daily life would become kind of hellish. The brain takes advantage of that for efficiency’s sake. Usually it’s very helpful because it allows you to focus on what’s new. On the other hand, it can blind you to experiencing the details of life and you miss some things.
How do expectations influence our perception of taste?
Most people have some inkling that they will enjoy a pricier wine just because it’s pricier. This has been established in a lot of scientific research with blind tastings where people are being told that they are drinking an expensive wine when they’re actually drinking a low-priced wine or drinking the same wine in two cups. One they’re told is pricey and one they’re told is not. It’s even been confirmed through brain scan studies where people are sipping three different wines at five different price points. People really love a $10 wine when it’s disguised as a $90 wine; then there’s a $70 wine that they hate when it’s disguised as a $5 wine –and it’s reflected in their brain scans. So what this indicates is that the preferences that we perhaps are being biased toward or steered toward by the preconception that pricey things are better is actually translated into real pleasure in your brain. You really do like the pricier wine.
So then it gets even more fun. [You say to yourself] If I’m being steered by biases and price tags and labels, I should probably just taste blind and see what I “really” like. The problem is, in studies, people who know a lot about wine who taste blind don’t know one wine from the next. You give experts six wines with two of them repeated and ask them to rate them and only 10% of them are at all consistent and those 10% are not consistent year to year. So where are we? What I found in the research is that there’s a hint, a tiny speck of possibility of finding our bedrock preferences of avoiding the biases of the reviews and the ratings and the price tags. But it takes a lot of work and you probably won’t get there.
[On the other hand,] there is a point when reality will be so much in contrast with what you’ve been expecting that your brain will say “this is bullshit.” They did this study, where independent panels of people had judged two Cabernets as “good” and “bad.” The wines were priced at three different price points and given to people who had come to a vineyard to taste. The metric was how many bottles did these people buy. And what they found was that the independently judged “better” wine sold more bottles when it was priced more expensively and the exact opposite happened with the independently judged “bad wine.”
So you have these little snippets of indications that we can really know what we like. But this avalanche of evidence that says most of the time we don’t. We are tricked and led by expectations and yet without them, we’re kind of at sea, at least when it comes to taste.
How do expectations influence what we find humorous?
One study, [by Timothy Wilson at the University of Virginia] told people they were going to look at six New Yorker cartoons. He told some of them that [other] people who had already looked at the cartoons thought they were hilarious. The others had no expectation about whether the cartoons were funny or not. The people who were told they were going to find the cartoons hilarious did. And these cartoons had actually been rated independently in some rigorous fashion [laughter] so that the first three were funny and the last three were kind of meh [unfunny]. And that is what the people that had no expectations found. The people who were told that [the cartoons] were all hilarious found them all hilarious and in fact they found the last three to be even more hilarious than the first three. It was confirmed not only in their ratings, but in videotapes. [The researchers] came up with this index of facial mirth, a measure of how much they were laughing and smiling. And it wasn’t like they were just trying to be polite…they were laughing their heads off.
How do expectations influence athletic performance?
A lot of studies show that the basis of expertise in athletics comes down to anticipation. For example, being able to hit a 95 mph fastball: The ball gets to home plate in 0.4 seconds. It takes at least half that time for the brain to decide to swing and to tell the muscles to swing –It’s just not enough time. You have to figure out that you’re going to swing right away…read the movements of the pitcher to determine whether it’s a high likelihood that they’re going to be able to hit that ball and where they’re going to hit that ball. In the book, I bring up this exhibition where women softball pitchers come in and mow down major league sluggers, they strike them out, they devastate them. And it’s not because they’re pitching any faster, they’re actually pitching slower and it’s a bigger ball, a bigger target, but the motion of the pitch is so new that the anticipation is useless to the batters. And a similar thing happens whenever you over-think and when anxiety gets involved –it kills anticipation –and that’s a lot of what leads to choking under pressure.
On the other hand, if you can do things to alleviate anxiety, you give that anticipation a glide path. This is a theory that fatigue is governed by the brain in an anticipatory manner. So if you have run a lot of 10K races, your brain knows what your body needs, how much energy it’s going to take and what pace to set and it takes a lot of things into account like how you’re feeling and whether you’re hydrated. It eventually though can put on the brakes. It’s not just that you’re running out of gas. Your brain is like “Uh-oh. You’re going to run out of gas. It’s going to be trouble for you.” So it basically induces fatigue for you ahead of time.
A lot of the tricks with sports placebos is to override that brake to squeeze a little bit extra. This is not limitless. This is not guaranteed victory or superhuman abilities. We’re talking about people winning races by hundredths of a second. And this is about achieving an extra hundredth of a second in speed. A lot of the placebo effect [research] does look at that. If I tell you you have some kind of performance booster, you will feel more at ease, your nerves will be calmed, and that may be the real mechanism of athletic placebos. It’s like having a lucky charm. It’s like wearing lucky underwear on race day.
There was a great study done about 10 years ago with top-level weight lifters. They were given a placebo steroid to train with for a number of weeks and prior to training they did baseline lifts. Then they trained for a few weeks with this placebo muscle builder. Then they did another lift to test and they were all doing about 5% better after taking the placebo. In the write-up the researchers said this could really help with anti-doping efforts because you could tell athletes: You know all the drugs you’re taking, it’s all in your head. You don’t need to deal with all the testicle shriveling. You have the ability. But in the same study these people that took the placebo steroid, half of them were told, after that second lift, that they were taking a placebo and then they trained again and took another lift and their extra strength was gone. Essentially, these guys had seen that their mind had given them more strength or had allowed them to use the strength that they had to the utmost. And yet they had no faith in it. They had faith in the chemical.
How do expectations influence our experience of medicine?
There’s a great book [The Powerful Placebo: From Ancient Priest to Modern Physician by Dr. Arthur K. Shapiro, M.D. and Dr. Elaine Shapiro, PhD.] that says that the history of Western medicine is in large part the history of the placebo. Prior to germ theory, prior to modern medicine, it was leeches, it was purgatives, it was stuff that had no real science behind it. But when it worked, one could argue that it worked because people believed in it.
Now we believe in things that we have more reason to believe in. We believe in how germs spread, we believe that surgery works, we believe in drugs. And we have good reason to believe in them, but belief enhances the effectiveness. It’s a circular thing. The effectiveness enhances the belief and the belief enhances the effectiveness. When you go to a doctor’s office, you feel like you’re in the hands of an expert –and you are – but that belief enhances their ability to treat you. And not just that belief, but when the doctor interacts with you, the way that he or she interacts with you, can influence the effectiveness of the treatment. This is not to say it rules the treatment, but it has an effect.
What did you discover about placebos?
When you’re experiencing pain, many things impinge on how painful it feels. One of those is how painful you expect it to be. The standard placebo is that I give you a pill or put some ointment on you that is inert and tell you it’s going to relieve your pain. But you could also relieve that pain by telling somebody that the painful experience they are about to experience is not that painful.
There was a study with post-operative patients recovering from lung surgery who agreed to have their morphine drip cut for four hours. For some of these people, the doctor or the nurse came in and said, OK, it’s time to cut your morphine. For other people their morphine was cut for the same period of time, but they didn’t know when (it was done by a computer and an infusion pump). The people who knew they were having their morphine cut reported double the pain. The people who didn’t know their pain intensity didn’t change. So the difference was that some people expected to feel more pain and they did.
There’s a study done by Ted Kaptchuck of acupuncturists; it’s not Western Medicine, but I bring it up because it shows the effect that context can have. He studied people who were suffering from irritable bowel syndrome who were going to see an acupuncturist. And he also had a group that was kept on a waiting list, a no treatment group. The people who were getting acupuncture actually got sham acupuncture, where the needles don’t actually go into the skin, they just telescope back into themselves…like a theater sword. So all the people who thought they were getting acupuncture only got placebo acupuncture. Some people had an acupuncturist who asked them how they were doing, asked them a lot of questions, they were very empathetic, they were very optimistic about the treatment, they exuded confidence in the treatment. And then [in the other research group] they had some people who just put the needles in you. The people who just had the needles had no improvements beyond what people on the waiting list had…The preponderance of the science when they compare real acupuncture to sham acupuncture finds that there’s no benefit to real acupuncture above the sham acupuncture.
What is the nocebo effect?
Nocebo is the tendency for people to experience pain or side effects if they are warned about them. The study I bring up in the book is that some Italian men were given medicine for enlarged prostate. And some of them were told that they were going to have all sort of sexual problems. And others were not told this. And something like 45% of the people who were warned over the course of six months did experience erectile dysfunction all the rest and 15% did not. OK, that difference could all be about people feeling more comfortable about telling their doctors after they were warned…but none of these people had a history of sexual problems.
The research is just beginning on the nocebo effect. It’s really hard to get approval to deceive people in research and it’s doubly hard if you’re going to cause them pain or suffering. But there’s some pretty strong evidence that this is a real effect.
What was the genesis of this book?
I got promoted [at Boston University] in 2007 and I negotiated for a four-day week so I could do freelance one day, because I knew I wanted to try to cook up a book idea. In the meantime I had gotten married and my wife was pregnant with twins, and it came time to fish or cut bait and I decided to fish (laughter). I quit my job a month before the twins were born which was incredible courage…on my wife’s part. And I did some freelance pieces: a piece for the New Scientist about the human sense of direction and a piece for The Washington Post about personal genomics. Then the kids were born and I went down the rabbit hole for a bit and when I emerged in 2010, I decided that I would finally do the book proposal and then try to make that happen.
What do you hope readers will take away from Mind Over Mind?
The real value of some of this research is to point out that these things we take for granted. You take for granted that you know what you like when you taste it. You take for granted that surgery is more powerful than a pill. You take for granted that you are this kind of person or that kind of person or that you’re not athletic. So many of these things are built on a foundation that’s partially in your mind. If you approach it in the right way, if you actually recognize that, you can take that solid permanent foundation, belief, and poke at it and change it to your advantage. It’s certainly not about the idea you can imagine anything and make it real. This is not The Secret. But your mind is contstantly making these self-fulfilling hypotheses. If you can recognize that’s what’s going on, try the occasional experiment, to have a more experimental approach to some of these aspects of your life and see what happens. I don’t want to tell people exactly what’s going to happen if they try to impose a placebo effect on themselves or believe they can run a 6-minute mile. This stuff is so conditional and based on so many factors, it will work for some people and it won’t work for other people, but if you don’t try, you’ll never know
How has working on this book influenced your life?
It’s made me more cognizant of how I and my wife and our families sum up our kids and say things like ‘Oh, she’s the adventurous one. He’s the silly one.” It’s all good-intentioned, they’re not like arranging their marriage. It’s just how grandparents and parents talk about their kids…I want to be really careful about essentially telling these kids who they’re going to be, either directly or indirectly through the types of activties I engage in with them or the way I steer tom toward or away from. I see that they have distinct personalities, but you can also see how much they are like lumps of clay. I think I would see that anyway being a new parent and be astounded and worried and nervous , but doing the research makes me think about it a lot more.
What’s your next project?
I’d like to get out of the brain. It’s a fascinating place to be, but’m eager to tell a human story and get out of the FMRI machine. I want to write an idiosyncractic, exploratory piece of nonfiction with a good personal narrative driven by curiosity.
Keith Meatto is editor in chief of Frontier Psychiatrist. He first met Chris Berdik in 2000 at Mother Jones magazine.