Compartment Syndrome: The Last and Best Defense Against Reason…..

How does a dedicated and highly intelligent physician practice quality evidence-based medicine and recommend homeopathy? How do they approach the decision to initiate antibiotics or to order a heparin drip scientifically, while at the same time they uncritically accept claims that magical memory water can impact the course of skin disorders like psoriasis or “boost” the immune system? The answer is compartment syndrome.

Medically speaking, compartment syndrome occurs when there is increased pressure within an enclosed space in the body. This pathologically increased pressure can lead to compression of vital structures such as nerves and blood vessels, and can ultimately lead to tissue death due to a lack of oxygenation.  I deal with this every now and then in my line of work as a pediatric hospitalist, usually when a patient has suffered some kind of musculoskeletal injury or has a serious bacterial infection involving muscle or other deep tissues, but it is fairly rare. What I encounter much more frequently, however, is more of a  mental compartment syndrome. Like medical compartment syndrome, the  psychological equivalent leads to the obstruction of reason which can result in a false understanding of reality and the subsequent acquiring of new and often increasingly untenable beliefs. And while those that suffer from it tend to incur less risk of direct physical harm compared to medical compartment syndrome, it is still something which should be taken seriously because there is the potential for disastrous results such as loss of money, relationships, or even one’s health.

All of us, even the most hardcore of skeptics*, has at least one superstition or one implausible belief that doesn’t hold up to scrutiny. This is because nobody is immune to the hardwired flaws in our ability to interpret the natural world. We see patterns where none exist. We assign undeserved causation based on our inherent susceptibility to anecdotal evidence. Our memories are imprecise and malleable with time and retellings. And we are capable of erecting these seemingly impenetrable walls around our beliefs that protect them from disconfirming information.

Why do we do this? Why do we take certain aspects of ourselves and separate them from other aspects of ourselves that are diametric, as exemplified by our fictional physician, who holds a firm belief in an absurd pseudoscience while actively supporting science-based medicine in all other areas of her practice? It all boils down to the avoidance of mental anxiety. This feeling of unease, or cognitive dissonance as it has come to be known in psychology, motivates us to take action to avoid it. This action typically comes in the form of defense mechanisms like confirmation bias and a variety of rationalizations. The fictional homeopathy-supporting medical doctor might simply ignore studies that don’t support her belief, or chalk negative studies up to undisclosed bias or the inability of “western science to study homeopathy”, all without realizing how this is a significant departure from her usual approach to the evaluation of evidence for or against a scientific claim.

Another example, and one that I’ve experienced on a number of occasions, is the defense mechanism that occurs when a parent is confronted with dissonance inducing information that calls into question choices they have made in the care of their child that have led to a poor medical outcome. I have experienced this most often with the parents of unimmunized children who have developed a vaccine preventable illness, but I have also had similar interactions with parents who have refused appropriate medical care for their ill child. The response is often one of demonizing the authority figure presenting the information, in this case me, or the medical establishment in general. The cognitive dissonance resulting from the acceptance that an irrational decision led to the suffering of one’s own child would be staggering and recovery from it would be difficult. Casting the physician as the bad guy, perhaps in the pocket of “Big Pharma”, serves as a convenient means of disregarding that information and avoiding the dissonance. The sad fact is that most people, when confronted with information such as this, dig in their heels and become further entrenched in the belief system, be it anti-vaccine paranoia or medical conspiracy theories, and the compartment walls become further reinforced.

I don’t pretend that writing posts such as this, or speaking at conferences about the benefits of practicing skeptical science-based medicine, will tear down or even weaken a solidly built mental compartment. But not every belief is as absurd, not every wall as sturdy. We all have these compartments protecting our beliefs and some of them, even in the most hardcore of believers, are just asking to be demolished. There are many people who are simply unaware of these concepts and knowledge of them might help some avoid a logical fallacy or two in the future. My goal is to help provide the dynamite to those who want to use it, and to perhaps stop construction of a wall before plans are even drawn up.

*For the longest time, when discussing this concept with others, I’ve thought myself an exception. I’m not. While watching television recently, I began turning down the volume to better hear something my daughter was saying to my wife. I watched as the volume counter descended. My television is very imprecise in this endeavor, the volume counter coasting sometimes several increments after removing pressure from the button on my remote. On this occasion it settled on the number 13. I immediately felt uncomfortable and dropped it down a little further. I then felt rather silly. Did I really believe that some calamity would befall myself or my family because of the television volume being left on the dreaded number 13? Of course not. But, then again, if something bad did happen how would I know it wasn’t because of it? Thankfully my volume counter doesn’t go up to 2012.


8 comments so far

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    Your mode of describing the whole thing in this post is truly good, every one can effortlessly understand it, Thanks a lot.

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    “Compartment Syndrome: The Last and Best Defense Against Reason.
    . Red Stick Skeptic” was truly engaging and instructive!
    In todays society honestly, that is tough to
    manage. Thx, Milan

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