The Objective Unprejudiced Observer
“But surely you need to be objective?” Miriam O’Callaghan asked Colin Davidson, the Belfast portrait painter, during an interview. If he wasn’t objective, the painter would likely impose much of his own ideas and perceptions onto the subject he was painting. (Interview link – begins about nine minutes in.) Hence, the question posed by Stephen Gaukroger in his book Objectivity: is there a difference between a photo and a painting? All of which begs the questions: can the interviewer or observer be objective and what does it mean to be objective? Likewise, what does it mean for a homeopath to take Hahnemann’s advice to be an unprejudiced observer? Objectivity and being unprejudiced are connected.
A doctor doesn’t faint while watching an operation and a nurse doesn’t become overly emotive regarding a patient’s pain because they have a professional detachment; an objectivity.
When a patient explains to a physician or homeopath that she is stressed at work because of her working conditions and the homeopath gives her a vociferous talk about rights and dignity at work etc, he is not being objective; this is his “stuff”, his own baggage, he’s imposing on the client. He is not an unprejudiced observer.
When a female patient presents to a doctor who dismisses her as “just unhappy” because she comes from a part of the world where women are dominated by men and live subservient lives, the doctor is correct. Yet the doctor’s bias has prevented her making a full and objective assessment and consequently misses a serious pathology. She is not an unprejudiced observer.
In the very first paragraph of his Organon of Medicine Samuel Hahnemann states: “The physician’s high and only mission is to restore the sick to health, to cure, as it is termed.”
He further develops this instruction in the corresponding footnote:
¹ His mission is not, however, to construct so-called systems, by interweaving empty speculations and hypotheses concerning the internal essential nature of the vital processes and the mode in which diseases originate in the interior of the organism, (whereon so many physicians have hitherto ambitiously wasted their talents and their time); nor is it to attempt to give countless explanations regarding the phenomena in diseases and their proximate cause (which must ever remain concealed), wrapped in unintelligible words and an inflated abstract mode of expression, which should sound very learned in order to astonish the ignorant – whilst sick humanity sighs in vain for aid. Of such learned reveries (to which the name of theoretic medicine is given, and for which special professorships are instituted) we have had quite enough, and it is now high time that all who call themselves physicians should at length cease to deceive suffering mankind with mere talk, and begin now, instead, for once to act, that is, really to help and to cure. (OrganonOfMedicine.com)
In other words, the physician must leave aside his own personal ideas, ideologies, theories about disease, New Age ideas about pathology etc. in order to make an objective appraisal of the patient’s disease. Hahnemann elaborates in paragraph seven:
Now, as in a disease, from which no manifest exciting or maintaining cause (causa occasionalis) has to be removed, we can perceive nothing but the morbid symptoms, it must (regard being had to the possibility of a miasm, and attention paid to the accessory circumstances, § 5) be the symptoms alone by which the disease demands and points to the remedy suited to relieve it – and, moreover, the totality of these its symptoms, of this outwardly reflected picture of the internal essence of the disease, that is, of the affection of the vital force, must be the principal, or the sole means, whereby the disease can make known what remedy it requires – the only thing that can determine the choice of the most appropriate remedy – and thus, in a word, the totality of the symptoms must be the principal, indeed the only thing the physician has to take note of in every case of disease and to remove by means of his art, in order that it shall be cured and transformed into health. (Emphasis mine)
To perceive the totality of symptoms, Hahnemann explains in aphorism six the need for the practitioner to be an unprejudiced observer:
The unprejudiced observer… notices only the deviations from the former healthy state of the now diseased individual, which are felt by the patient himself, remarked by those around him and observed by the physician. All these perceptible signs represent the disease in its whole extent, that is, together they form the true and only conceivable portrait of the disease.
So, can a physician be objective if, an unprejudiced observer, as has just been brought to the public’s attention, s/he has a list of questions for case-taking supplied by a drug company: “Doctors ‘too reliant’ on depression questionnaire designed by Pfizer, campaigners warn”? (Click here)
Stephen Gaukroger gives a synopsis of objectivity by way of introduction:
Objectivity requires us to stand back from our perceptions, our beliefs and opinions, to reflect on them, and to subject them to a particular kind of scrutiny and judgement. Above all it requires a degree of indifference in judging that may conflict with our needs and desires. (p. 1)
But Gaukroger also provides the caveat: “Objectivity, alas, is not a straightforward concept. Many difficulties are generated in the search for a definition, because ‘objectivity’ can be understood in different ways…” (p. 3)
Behavioural Economics and Bias
The relatively new discipline of behavioural economics has thrown much light on how people make biased decisions. Some examples, illustrated by Michelle Baddeley in her Behavioural Economics: A Very Short Introduction, are useful for homeopaths.
She says: “We rely on easily retrievable information instead of looking at all relevant information.” (p. 39) This is called the availability heuristic. (Similar to primary and recency effects in psychology). A heuristic is a quick decision-making tool. A homeopath’s availability heuristic might mean giving preference to polychrest remedies rather than “smaller” remedies as more information is readily available on “polychrests”.
The availability heuristic can explain our habitual behaviours. Baddeley uses the example of habitually using the same websites to book, for example, a holiday simply because I remember how to use that website.
Using the example of energy suppliers, she explains we are slow to switch unless we have a memorably bad experience, we tend to stay with what we know – because we know what we know. Similarly, homeopaths may stick to using the same repertories, materia medica, software programmes etc. because we remember how to use them which means the information is easily accessible.
We match our judgements with our knowledge of previous scenarios and stereotypes. For example, “I’ve seen this type of patient before so…”, “I’ve found remedy x good for this symptom in the past so…” Baddeley calls this the representative heuristic; we make ungrounded comparisons with other superficially similar events. This occurs because we fail to adjust prior beliefs to new information. This is part of the reason for further biases known as confirmation bias and cognitive dissonance.
Confirmation bias occurs (p. 43) when we anchor our judgement rigidly to our prior beliefs and so we interpret new information in the light of our existing beliefs. An example is when a person or group might interpret a politician’s comment to confirm their belief that the politician is a conservative and a liberal will take the politician’s statement to confirm s/he is a liberal – confirming what they already knew!
A third class of biases illustrated by Tversky and Kahnemann (who published seminal research on the subject) show insufficient adjustment. Our decisions and choices are distorted by our starting position; we “anchor” our decisions around a reference point and adjust our choices to this reference point. (The “anchor” is the tendency to rely too heavily on the first piece of information offered.) So, for example, in experiments children were asked to multiply 8x7x6x5x4x3x2x1. A second group were asked to multiply 1x2x3x4x5x6x7x8. The first group, beginning with the higher number, came up with a higher estimate.
The availability heuristic and anchoring and adjustment heuristics can overlap. Because people are resistant to change or they judge events according to how different they are to the current situation, we can display status quo bias and familiarity bias.
With status quo bias we have to make a conscious effort to change away from, for example, default settings on an airline website, as you may have discovered..!
This bias is a problem for homeopaths as most repertories will put certain remedies (usually the polychrests) in bold or italic type to emphasise them, even though remedies in small type might equally be as relevant.
Familiarity can breed contempt, we are told, but Tversky and Kahnemann discovered the opposite, Baddeley tells us. We favour the familiar over the new or novel, like a creature of habit. Homeopaths have favourite remedies or favour better known elements like Calc. carb than other calcium remedies like Calc. phos or Calc. brom., because we are more familiar with Calc. carb.
A person might choose a nutritional supplement based on hearsay or a friend’s comment rather than on facts. The positive aspect of this is being able to choose more quickly if one is highly familiar with something.
Bias and prejudice are due not only to the above heuristics but occur because of personality, emotions and visceral factors, among others. You can read this for yourself in chapter seven!
Requirements of the Unprejudiced Observer
Due to the fact we can never treat another human as an object or objectify the information they provide about themselves, since we relate as subjects, I to I (or as Martin Buber famously put it in the title of his book, I-Though and Roger Scruton explains in his recent On Human Nature), we can never relate with full objectivity. It’s a question famously raised by philosopher Thomas Nagel in his book The View From Nowhere. Here Nagel poses the question: “how to combine the perspective of a particular person inside the world with an objective view of that same world, the person and his viewpoint included,” as interpreted by Bernard Williams in his review.
Objectivity, being an unprejudiced observer, in case-taking is therefore made complex. What we are seeking is a true interpretation and judgement, an accurate representation of the patient’s story, which is only possible via objectivity, impartiality. Objectivity does not mean the same as truth, as Gaukroger explains, but it does mean not putting ourselves into the patient’s story. The practitioner needs the self-awareness to distinguish what is of him/herself and what is of the client.
Francis Bacon on Objectivity
Being of a philosophical background Hahnemann probably knew the importance of being objective. But one possible influence, if any, was Francis Bacon who also may have influenced Hahnemann’s choice of title for his manual of rational and scientific medicine, Organon of Medicine, since Bacon had used a similar title to outline, for the first time, a scientific method. Bacon called his book Novum Organum Scientiarum (‘new instrument of science’).
Francis Bacon and how to be objective is explained very clearly in A History of Philosophy: late medieval and renaissance philosophy by Frederick Copleston S.J., (pp. 302-304. Herewith quoted in full and available to view on Archive.org):
“It might appear that Bacon’s insistence on the practical ends of inductive science would itself tend to encourage the drawing of over-hasty conclusions. This was not his intention at least. He condemns the ‘unreasonable and puerile’ desire to snatch at results which, ‘as an Atlanta’s apple, hinders the race’. In other words, the establishment of scientific laws by the patient employment of the inductive method will bring greater light to the mind and will prove of more utility in the long run than uncoordinated particular truths, however immediately practical the latter may seem to be.
“But to attain a certain knowledge of nature is not so easy or simple as it may sound at first hearing, for the human mind is influenced by preconceptions and prejudices which bear upon our interpretation of experience and distort our judgments. It is necessary, then, to draw attention to ‘the idols and false notions’ which inevitably influence the human mind and render science difficult of attainment unless one is aware of them and warned against them. Hence Bacon’s famous doctrine of ‘the idols’. There are four main types, the idols of the tribe, the idols of the cave or den, the idols of the market-place and the idols of the theatre. ‘The doctrines of the idols stands to the interpretation of nature as the doctrine of sophistical arguments stands to common logic.’ Just as it is useful for the syllogistic dialectician to be aware of the nature of sophistical arguments, so it is useful for the scientist or natural philosopher to be aware of the nature of the idols of the human mind, that he may be on his guard against their influence.
“The ‘idols of the tribe’ (idola tribus) are those errors, the tendency to which is inherent in human nature and which hinder objective judgment. For example, man is prone to rest content with that aspect of things which strikes the senses. Apart from the fact that this tendency is responsible for the neglect of investigation into the nature of those things which, like air or the ‘animal spirits’, are not directly observable, ‘sense is in itself weak and misleading’. For the scientific interpretation of nature it is not enough to rely on the senses, not even when they are supplemented by the use of instruments; suitable experiments are also necessary. Then, again, the human mind is prone to rest in those ideas which have once been received and believed or which are pleasing to it and to pass over or reject instances which run counter to received or cherished beliefs. The human mind is not immune from the influence of the will and affections: ‘for what a man would like to be true, to that he tends to give credence’. Further, the human mind is prone to indulge in abstractions; and it tends to conceive as constant what is really changing or in flux. Bacon thus draws attention to the danger of relying on appearances, on the untested and uncriticized data of the senses; to the phenomenon of ‘wishful thinking’; and to the mind’s tendency to mistake abstractions for things. He also draws attention to man’s tendency to interpret nature anthropomorphically. Man easily reads into nature final causes ‘which proceed from the nature of man rather than from that of the imiverse’. On this matter one may recall what he says in his work Of the Advancement of Learning (2) concerning the introduction of final causes into physics. ‘For to say that the hairs of the eyelids are for a quickset and fence about the sight; or that the firmness of the skins and hides of living creatures is to defend them from the extremities of heat or cold; or that the clouds are for watering of the earth’ is ‘impertinent’ in physics. Such considerations ‘stay and slug the ship from farther sailing, and have brought this to pass, that the search of the physical causes hath been neglected and passed in silence’. Although Bacon says, as we have seen, that final causality ‘is well inquired and collected in metaphysics’, it is pretty clear that he regarded notions like the above as instances of man’s tendency to interpret natural activity on an analogy with human purposeful activity.
“The ‘idols of the den’ (idola specus) are the errors peculiar to each individual, arising from his temperament, education, reading and the special influences which have weighed with him as an individual. These factors lead him to interpret phenomena according to the viewpoint of his own den or cave. ‘For each one has (in addition to the aberrations of human nature in general) a certain individual cave or cavern of his own, which breaks and distorts the light oil nature.’ Bacon’s language designedly recalls Plato’s parable of the cave in the Republic.
“The ‘idols of the market-place’ (idola fori) are errors due to the influence of language. The words used in common language describe things as commonly conceived; and when an acute mind sees that the commonly accepted analysis of things is inadequate, language may stand in the way of the expression of a more adequate analysis. Sometimes words are employed when there are no corresponding things. Bacon gives examples like fortuna and primum mobile. Sometimes words are employed without any clear concept of what is denoted or without any commonly recognized meaning. Bacon takes as an example the word ‘humid’, humidum, which I may refer to various sorts of things or qualities or actions.
“The ‘idols of the theatre’ (idola theatri) are the philosophical systems of the past, which are nothing better than stage-plays, representing unreal worlds of man’s own creation. In general I there are three types of false philosophy. First there is ‘sophistical’ philosophy, the chief representative of which is Aristotle, who corrupted natural philosophy with his dialectic. Secondly, there is ’empirical’ philosophy, based on a few narrow and obscure observations. The chemists are the chief offenders here: Bacon mentions the philosophy of William Gilbert, author of De magnete (1600). Thirdly there is ‘superstitious’ philosophy, characterized by the introduction of theological considerations. The Pythagoreans indulged in this sort of thing, and, more subtly and dangerously, Plato and the Platonists.” (Quote ends)
The Myth of Scientific Objectivity by William A. Wilson