Chapter 8 Chapter 4 Testimony and Case Study Evidence - The Placebo Effect and the Amazing Randy

The scene cuts to The Oprah Show, one of the most famous TV talk shows of the past decade.Today's guest is Dr. Alfred Pontificate, Director of the Oedipus Institute for Human Potential.The doctor's new radical theory of birth order is based on the idea that an individual's life course is set by family interactions that are determined by birth order.Oprah encouraged viewers to ask questions about the theory.Discussion inevitably shifts from its initial theoretical focus to explaining important events in the viewer's personal life.The doctor readily agreed. For example, "Doctor, my brother is a relentless workaholic. He is completely indifferent to his wife and family, and puts work-related problems above all else. He has ulcers and alcohol problems, which he denies .The family hasn't had a real vacation in nearly two years. His marriage is dying, but he doesn't seem to care too much. Why would he choose such a self-destructive life?"

The doctor asked back: "My dear, what is his rank in the family?" "Oh, he's the eldest of his children." "That's right," said the doctor, "this is more common in life. We often see this phenomenon in clinical practice. The underlying reason for this phenomenon is that parents transfer their own wishes and frustrations to their parents. In the first child born. Through this unconscious process of transformation of wishes, the child internalizes these wishes and frustrations even though the parents never explicitly asked the child. Then, through this process of what I call 'expectation upspin ’ dynamic process, the transformation of parental aspirations into a child’s morbid thirst for success.”

Audiences on The Oprah Show sometimes asked pointed questions when guests challenged their beliefs, but that rarely happened when behavioral "experts" seemed to confirm the audience's conventional wisdom.There was one time, however, when the show was jazzed up by a viewer questioning a guest's claim.An eager and candid audience member was in the studio at the time, "But wait a minute, Doc," the questioner began his question, "My brother is also the head of the family. My parents sent that jerk to Harvard, and put me in a two-year specialist school where I could be a dentist. But their 'prodigy' dropped out after a year and went off to the top of a mountain in Colorado. The last time we saw him, he was Basket weaving! I don't understand what you're saying about the 'firstborn'."

The audience made the atmosphere suddenly tense, but the doctor always managed to save the day: "Oh, yes, I have seen many cases like your brother. Yes, I can often meet in my practice. to such individuals. Their 'expectation upspin' dynamic process is interrupted, generating subconscious demands to resist the expectations that their parents have translated into them. In this way, the individual's life plan develops in the opposite direction of the traditional standard of achievement .” After a moment of solemn silence, the discussion turned to the next “case.” These scenes are all too familiar to us, just another instance of the Benjamin Rush problem.The "theory" about birth order was conceived under the framework of thinking that no single instance could prove "false".Since it is an unfalsifiable theory, it is meaningless to produce more evidence to prove it, because this theory cannot rule out any possible situation.

However, our concern in this chapter is not with the theory itself, but with the evidence used to support it.When pressed to present evidence, Dr. Pontificot drew on his "clinical experience" or "case studies."This is a well-established formula in the field of media psychology.Talk shows and popular psychology books are filled with psychological theories based on the authors' clinical experience.Many of the treatments that they make available to the public through these channels are supported by nothing more than the personal testimony of those who have been treated and feel improved or cured.In this chapter we will establish a very useful principle for consumers of psychological information: case studies and testimonials are worthless as evidence for evaluating psychological theories and treatments.

In this chapter we shall demonstrate why this principle is true and discuss the proper role of the case study in psychology. The role of case studies largely depends on how far scientific exploration has progressed in a particular field.Inspiration from case studies or clinical experience may be useful in the early stages of research on a particular problem, as they can suggest which variables require further study.Case studies have played a pivotal role in opening up new fields of study in psychology.A famous example is in the work of Jean Piaget.Piaget's research raises the possibility that children's thinking is not just a simplified or low-level version of adult thinking, but has its own structure.Some of Piaget's conjectures about children's thinking have been confirmed, but many remain to be confirmed (Bjorklund, 2004; Goswami, 2004).What is more important for our discussion here, however, is not which of Piaget's ideas are confirmed, but rather to understand that Piaget's case studies, while not confirming anything, provide a basis for developmental psychologists' research. Provides an incredibly wide field.The relevant and experimental studies presented in Chapters 5 and 6 provide evidence for or against the hypotheses developed in Piaget's case studies.

The situation is very different, however, as we move from the early stages of scientific research (where case studies can be extremely useful) to the more mature stages of theory testing.Since case studies cannot be used as confirming or disproving evidence in the test of a particular theory, they are no longer valid in the later stages of scientific research.The reason for this is that both case studies and witness accounts are so-called "isolated incidents" that lack the comparative information necessary to rule out other possible explanations. Witness accounts are similar to case studies in that they are isolated incidents.The problem with relying on testimonial narratives is that if the cumulative testimonies can provide support for almost every treatment, it is impossible to support any particular treatment, since all opposing treatments have their own testimonies.Of course, what we want to know is which therapy is best, but we cannot base our decision on testimonials.As the psychologist Ray Nickerson (1998) put it, commenting on the cognitive processes we use to deceive ourselves, "Charlatans often succeed in their deception because they always find some patients who are willing to do it for them. They bear witness, these patients always tell others from the heart that they themselves have indeed benefited greatly from the treatment” (p. 192).For example, there are numerous testimonies claiming that subliminal self-help tapes (cassettes made with a signal below the threshold of hearing) can improve memory and even self-esteem, however, studies conducted under strictly controlled conditions have shown , such tapes did not produce any improvements in memory or self-esteem (Greenwald, Spangenberg, Pratkanis, & Eskenazi, 1991; Moore, 1995).

The idea of ​​"other possible explanations" is central to understanding theory tests.The goal of experimental design is to construct an event or phenomenon so that it can only be explained by a specific theory, while other theories cannot be explained.As discussed in Chapter 2, science advances only when the data we collect excludes other possible explanations.Science creates the conditions for the natural selection of theoretical ideas.Some theoretical ideas survive empirical testing, while others are eliminated, and those that remain are closer to the truth.But this is a slow process, and various theoretical perspectives must be scrutinized in order to discover which ones are closer to the truth.But there are trade-offs in this process: the data collected to support a particular theory cannot simultaneously support many other possible explanations.For this reason, scientists include control groups, or control groups, in their experiments in order to obtain comparative information.The purpose of this is to be able to rule out other possible explanations when comparing the results of the control group with the experimental group.How experimental design can do this will be the subject of later chapters.

Case studies and testimonials exist as isolated phenomena that lack the comparative information necessary to demonstrate the superiority of a particular theory or therapy.Therefore, it would be wrong to cite the results of a testimonial or case study in support of a particular theory or therapy.Those who do so are misleading the public if they do not point out that the so-called evidence they present also applies to a host of other possible explanations.In short, isolated evidence for a phenomenon is highly misleading.The example of the placebo effect will illustrate this point more clearly and concretely.

Almost every therapy born of medicine and psychology has a certain number of supporters, and always produces some people who genuinely believe in its efficacy.The medical literature records the curative effects of pig teeth, crocodile droppings, powdered Egyptian mummies, and many more imaginative things (Harrington, 1997; Shapiro, 1960).In fact, it has long been known that the mere suggestion that a treatment is being received is enough to make many people feel better. The tendency for people to report that a treatment once helped them, regardless of whether the treatment was effective, is known as the placebo effect (Christensen, 2001; Ernst & Abbot, 1999; Harrington, 1997; Kirsch, 1999; Russo, 2002; Stewart-Williams & Podd, 2004).The concept of the placebo effect is brilliantly illustrated in the film.The Fairy didn't really give the Tin Woodman a heart, the Scarecrow a brain, or the Lion courage, but they all felt better.In fact, it was not until nearly a hundred years ago that medicine developed more treatment methods with convincing evidence of efficacy. Therefore, someone once said: "Before this century, the entire history of medicine can only be said to be the history of the placebo effect" ( Postman, 1988, p.96)

We can illustrate the concept of the placebo effect by examining biomedical research.In biomedical research, all new drug research procedures must include control for placebo effects.Generally, if you are testing a new drug on a group of patients, you form a peer group with the same condition and give them an equal amount of a drug that does not contain any drug (placebo).Neither group of patients knew what drugs they were taking.In this way, the placebo effect—the tendency for patients to feel better when given any new treatment—can be controlled for when the two groups are compared.It is not enough to report that a few percent of patients are relieved by the new drug, because without data from the control group it is not known whether the patients reporting relief are due to the placebo effect or to the drug itself. The placebo effect was 29% in the treatment of depression (i.e., 29% of patients reported relief of symptoms after taking placebo), 36% in duodenal ulcer, 29% in migraine, and 29% in esophagitis. 27% (Cho, Hotopf, & Wessely, 2005).One study (Bower, 1996b) suggested that combining the placebo effect with the popular antidepressant Prozac would maximize the effect of the drug itself.The placebo effect is so potent that there have been reports of people becoming addicted to placebos (Bok, 1974; Ernst & Abbot, 1999), requiring them to take larger and larger doses of placebo to maintain their health status! Of course, in an actual study of drug therapy, the placebo control is not just a pill that contains nothing, but contains the medicinal ingredient that is currently believed to be most effective.The purpose of experimental comparison is to reveal whether the new drug is better than the current most effective drug. Every time you take a prescription drug you've been reminded of the placebo effect, the next time you take a prescription drug (if you're super healthy, look at your grandmother's pills!), take a close look at the package insert (or log on to the manufacturer's website). visit the vendor's website), you will see information about the placebo effect in the drug problem statement.For example, I take a drug called Imitrex (succinate hydrochloride) for my migraines.The package insert for the drug told me: Controlled studies have shown that 57% of patients experience relief within two hours of taking a given dose of the drug (I am one of the lucky 57%!).But the instructions also told me that the same study showed that the placebo effect in this type of migraine is 21% -- 21% of people get relief within two hours of taking the drug, even though the drug they take is neutral Non-succinic hydrochloric acid. The placebo effect is also common in psychotherapy (Wampold et al, 1997).Many people with mild and moderate psychological problems say they feel better after receiving psychotherapy.However, controlled studies have shown that a significant portion of this recovery rate is due to a combination of the placebo effect and the passage of time, often referred to as the natural recovery phenomenon.Most effective treatments are the result of some unknown combination of treatment effect and placebo effect.As Dodes (1997) points out: “Even serious diseases have periods of exacerbation and remission; arthritis and multiple sclerosis are typical examples. Even cancer can disappear inexplicably” (p. 45).He also cautions that a positive response to placebos does not mean that a patient's illness is fictional, and that, contrary to popular belief, placebos can be harmful: "The placebo effect can be demonstrated or Chronic disease is 'induced' by reinforcing imagined illnesses. Patients become dependent on non-scientific practitioners who take advantage of the placebo effect." (Dodes, 1997, p.45) In research on the effects of psychotherapy, it is often difficult to deal with the placebo effect control group reasonably.However, these complex issues are not our focus here, and it is important to understand why researchers separate the true effects of drug treatments from placebo effects and natural recovery.Gordon Paul's (Paul, 1966, 1967) work on the effects of treatment provides examples of what such findings reveal.Paul surveyed groups of students who "experience discomfort and anxiety when speaking in public."The experimental group received desensitization therapy for language tension problems, and 85% of the subjects showed significant improvement.The placebo group was given some pills, which they were told were effective tranquilizers, but were actually just a sodium bicarbonate capsule.Of this group, 50 percent showed significant improvement.The third group received no treatment at all, and still 22% showed significant improvement.It would appear that for this particular problem natural recovery was 22%, another 28% of the improvement shown was due to the placebo effect (50% minus 22%), and the true benefit of desensitization was higher Combined effect of placebo and natural recovery (85%>50%). Similar to Paul's study, other studies have shown that psychotherapy does outperform placebo alone (Hollon et al., 2002; Lipsey & Wilson, 1993; Nathan & Gorman, 1998; Shadish & Baldwin, 2005) .However, experiments using placebo controls have also shown that reporting only the percentage of people who feel better significantly overestimates the actual effect of the treatment.The problem is, getting a testimonial narrative is almost effortless.Thomas Gilovich, a psychologist at Cornell University (Thomas Gilovich, 1991), pointed out: "Human beings have bodies that heal themselves so easily that many people who seek medical help will experience positive Thus, when the rate of natural recovery is high, even worthless remedies can appear effective" (p. 128).In short, a potential placebo effect is present whenever a therapeutic intervention is used, regardless of the effectiveness of the intervention.The problem is that the placebo effect is so powerful that no matter how ridiculous a person's treatment is, if it's applied to a large group of people, there will always be some people who will be happy to testify to its effects (early morning head slaps Therapy, daily use to refresh you! Send me $10.95 and you can get this special, medically tested rubber hammer). But we really shouldn't joke about serious things like this.Giving credence to the evidence of testimonial accounts and case studies can have disastrous results.The group that developed the scientific definition of Tourette's disease as an organic disorder (Shapiro et al., 1978; see Chapter 2) pointed out that a false reliance on case-study evidence has made The persistent entanglement of unfalsifiable psychoanalytic theories of the disease hinders genuine scientific research into its pathology.Stephen Batianski (Budiansly, 1984), a Washington correspondent for the British scientific journal Nature, summed up this phenomenon in the medical field as follows, emphasizing many of the things we mentioned in previous chapters: Scientific point of view: An editorial published in the New England Journal of Medicine discusses the place of case studies and testimonial narratives in the eyes of practitioners in the medical sciences. "For example, if the journal received a paper that a patient with pancreatic cancer recovered from taking rhubarb root ... we might publish a case report, but we do not publish it as an announcement It is a new therapy and is merely recommended as a hypothesis worthy of testing in formal clinical trials. In contrast, anecdotal reports of various folk remedies (often published in popular books and journals) do not making such a claim, and the anecdotes themselves are not sufficient literature to support those efficacy." (AngeU & Kassirer, 1998, pp. 839-840). As happy as the placebo effect is to invalidate witness narratives as evidence, we must be aware that there is another barrier to understanding the issue.Social and cognitive psychologists have studied the so-called "freshness effect" in human memory and decision-making (Kunda, 1999; Ruscio, 2000; Sinaceur, Heath, & Cole, 2005).When faced with a problem-solving or decision-making situation, people will retrieve information relevant to the current situation from memory.Therefore, people tend to use information that is more easily available and can be used to solve problems or make decisions.One factor that strongly influences availability is the freshness of information. The problem is that nothing is more vivid and compelling than a personal testimony from the heart, something that happened or is true.The freshness of personal testimony often overshadows other, more reliable information.When shopping, we weigh in on different brands for a long time, only to abandon our choice at the last minute because of a friend's or an ad's recommendation for another product.Buying a car is a typical example.After looking through thousands of consumer surveys in Consumer Reports, we finally decided to buy an A brand car; after consulting several car magazines, we saw that the experts in it also recommended A A brand car, which strengthened our choice - until at a party, we met a friend who said that a friend of his friend bought a car of brand A, and it turned out to be a defective product. The repairs cost a few hundred dollars and the dude has decided he will never buy this make of car again.Obviously, such a single case should not have affected our decision to a large extent, because we have collected the survey reports of thousands of users and the judgments of many experts before deciding to buy a brand A car of.Yet how many of us can manage not to take this particular case too seriously? The car-buying example illustrates that the problems posed by living personal testimonies are not unique to the field of psychology.It is not difficult to find examples of freshness affecting people's decision-making in any field.The author Michael Lewis (1997) described how the political commentator George Will—a notorious opponent of government intervention—was witnessing an event on his doorstep that resulted in An op-ed calling for mandatory use of airbags following a fatal car accident. Imagine you read the following headline in the newspaper on a Friday morning: "Jet crashes, 413 dead."My God, you might be thinking, what a horrible accident!What a terrible thing has happened!Go ahead and imagine that on Thursday of the following week, you wake up and read in the paper, "Another Air Crash, 442 Dead." "Oh, no!" you might think. "Don't have any more disasters, how horrible, what's wrong with our airlift system?, and imagine - imagine as much as you can - the next Friday you wake up and see: "Third Air crash tragedy: 431 dead. "Not only you, but the whole country will be mad. The federal government will be asked to investigate this matter as soon as possible, all flights will be grounded, various investigative committees will be formed, and massive legal actions will be filed. "Newsweek" and Time magazine will cover it, and it will dominate the headlines of recent TV news shows. TV documentaries will dig deep into the subject. The restlessness and clamor is huge and far-reaching. This is not a fictional problem, it is real.Every week a jetliner crashes.Maybe instead of one jumbo jet, there are lots of small planes; or maybe not small planes, but small vehicles called cars.More than 350 people die in motor vehicle accidents every week in the United States (over 19,000 per year) (National Highway Traffic Safety Administration, 2004), enough people to fill a giant jetliner. We don't care about the number of people who die in car accidents on the highway every week, equal to the number of people on board a jetliner.That's because the message that "the man who fits a jetliner is dead" is not conveyed to us in a vivid form by the media.So the 350 people who die each week in auto accidents (plus the 330 killed each week by trucks or motorcycles) are not fresh to us.We don't talk about these people who died in car accidents at the dinner table the way we talk about a jet plane crashing and killing a lot of people.We don't argue about the safety and necessity of car travel, but if jumbo jets crashed every week and killed 350 people each time, we would discuss the safety of air transportation.Those 350 people who died in car accidents don't make the news because they're spread across the country and thus are a statistical abstraction for most of us.The media will not vividly represent the 350 dead for us because they did not die in the same place.Instead, the media presents us with (sometimes) a statistic (eg, 350 people per week).That's enough to get us thinking, but we don't react to it.Compared with any other behavior in our lives, driving a car is an extremely dangerous behavior (Galovski, Malta, & Blanchard, 2006; National Safety Council, 2001; Ross, 1999; Sunstein, 2002).However, there has never been a big national discussion about its risks and corresponding benefits.Is this an acceptable price for people who live in the suburbs and need to drive back and forth?We never ask such questions, because the problem has not been realized, and the reason why it is not realized is that the costs and risks are not presented to us in the vivid way like an air crash. Consider the absurdity of the following example.A friend drives you 20 kilometers to the airport because you are taking a 750 kilometer trip by plane.When parting, your friend is likely to say, "Bon voyage", and this parting message is actually sadly ironic, because your friend is at a greater risk of dying in a car accident on the 20km journey home than you are flying At 750 km the risk is three times higher (National Safety Council, 1990).This is the freshness problem, which explains the obvious irrationality of A's security blessing to B, because it is precisely A who is at greater risk (Sivak & Flannagan, 2003). Cole (1998) reported on a poll after the Trans World Airlines (TWA) crash that many people would be willing to pay $50 more for their round-trip airfare if the plane was safer.Those are the same people who refuse to pay $50 for a safety feature in a motor vehicle even though it would provide more security.Likewise, few people realize that when they drive 10 kilometers to buy a lottery ticket, they are 16 times more likely to die in a car crash than they are to win the jackpot (Orkin, 2000)! These examples are not merely hypothetical. After the terrorist attacks of 9/11, the number of people traveling by air plummeted because people were afraid of flying.Of course, people will continue to travel, not just stay at home.They just travel by other means - mostly by car.But road trips are far more dangerous than flying, and statistically more people are doomed to die by switching to road trips.In fact, researchers estimate that in the last month of 2001, more than 300 people died as a result of traveling by car rather than by plane (Gigerenzer, 2004).One team of researchers was able to convey, with a living statistic, just how dangerous driving a motor vehicle is.Sivak & Flanagan (2003) calculated that if driving a car was as dangerous as flying an airplane, then 9/11-level accidents would occur once a month! Aided by the media, freshness misleads individual judgments in other fields as well.One study (MacDonald, 1990; Cole, 1998; Radford, 2005) asked parents which risk they most feared for their children.The results showed that parents were most worried about their children being kidnapped, and the probability of this event happening was 1 in 700,000.Parents, by contrast, were less concerned about the risk of their children dying in a car accident, which was 100 times more likely than being kidnapped.Clearly, much of the fear of kidnapping is the result of media hype.The results of this study suggest that, because of perceptual distortions caused by the freshness effect, "what American parents fear is the unlikely event" (MacDonald, 1990).One researcher bemoaned that focusing on "currently popular" events tends to misdirect parents' attention, leading them to "ignore areas where they could have had more influence, such as academic performance, bad TV habits, etc. , drug use, and driving safety” (MacDonald, 1990). Author Peter Boyer (Boyer, 1999) described how pro-gun freedom lawmakers similarly fostered a false perception of danger among Americans by trying to focus public attention on "intruders" breaking down doors live cases.The subtext here is: owning a gun for self-protection will reduce your risk.Boyer (1999) points out the irony that the gun industry is trying to focus on "guns in the wrong hands" when the real statistics show that the real problem is "guns in the right hands".Criminals are not responsible for most shooting deaths in this country.Far more people are actually shot to death than shot to death.The majority of gun deaths are misfires and suicides—which is why studies have shown that bringing a gun home actually increases the risk for the family (Miller, Azrael, & Hemenway, 2002; Samuels, 2004). In the end, we worry less about the possibility of developing diabetes than about being hospitalized for a staph infection, even though the former affects 4.5 million Americans compared with 1500 a year for the latter (Fountain, 2006).This is because, personally, we can do something about the former (change our diet or exercise) but not the latter. Psychologists have extensively studied the tendency for people's judgment to be influenced by a salient example, even when more precise information is available.Wilson & Brekke (1994) demonstrate how deceptive the freshness question is and how it affects actual consumer behavior.They investigated how two types of information influenced people's choice of two different brands of condoms (Brand A and Brand B).One type of information was a survey report in the magazine Consumer Reports, and the other type was the opinions of two college students about their preferred condom brands.First, Wilson and Brick surveyed a group of participants, asking them which information they were more likely to be influenced by.More than 85 percent of the respondents in this group felt that they were more likely to be influenced by the Consumer Reports article than the opinions of the two students.The researchers then recruited a similar group of subjects in which they were told that they would be given free condoms of their choice.The subjects were told to refer to either or both of the following two types of information: one was an investigative report in the magazine Consumer Reports, and the other was the opinions of two college students.Although less than 15 percent of this group were open to the views of the two college students, 77 percent asked for both types of information.Apparently, the subjects couldn't resist the temptation to be witnessed by others, and although they didn't think they would be influenced by it, they were in fact.When participants chose to know two types of information at the same time and the two types of information conflicted, 31% more people accepted the student's recommendation than Consumer Reports' recommendation. Another example of how people respond differently to vivid anecdotal information comes from media coverage of the Vietnam War in the mid to late 1960s.As the war dragged on, the death toll of U.S. troops increased seemingly endlessly, and the media began to report the number of U.S. troops killed that week.Week after week, the number hovered between 200 and 300, and the public seemed to get used to the reporting.However, a certain magazine continuously published individual photos of those killed in the previous week in several pages.This is when the public sees very concretely the approximately 250 living lives lost in such a representative week.As a result, the move led to massive protests against the costly war. 250 photos can have an impact far beyond the weekly digital coverage.But as a society, we should overcome this tendency not to believe in numbers, to believe in things that have to be seen.Most of the complex factors that affect our society can only be captured by numbers.Only when the public learns to value abstract material expressed in digital form as much as pictorial material will the public's own position be less capricious than the latest image flashing across the screen. History repeated itself in 2004 when a TV program called Evening Online released the names and photos of more than 700 soldiers who died in the war on the first anniversary of the Iraq war.This approach is exactly the same as the show's routine of broadcasting the names and photos of the victims on the first anniversary of the "9.11" incident. At that time, the broadcast of these photos had obtained the consent of the victims' families.Still, pictures of dead soldiers sparked protests from supporters of the war.There were accusations that show host Ted Couppell was hostile to the war, but those charges were clearly misdirected, since Couppell was not opposed to the war.Instead, Cooper said, "Some of you are convinced that I'm against war, and I'm not, but that's beside the point. I'm just against the persistent illusion that war kills a few, doesn't Bringing down the rest of us" (CNN.com, 2004).The death toll did not go unreported and the news of these 700 plus deaths was in every newspaper in the country day in and day out.But both sides of the debate know that the public has not yet “processed” those numbers—the cost is not calculated because they are too abstract.Both sides knew that many people, after seeing these photos, would process the information from scratch and start to really care about the cost of war. 不仅公众受到鲜活性问题的困扰，在心理学和医学领域，有经验的临床从业者一直都在努力摆脱个别案例的压倒性影响给他们的决策带来的阴影。作家弗兰辛·卢素（Russo，1999）描述了弗吉尼亚大学的肿瘤专家威利·安德森面对的两难境地，安德森一直提倡控制实验，并会定期招募一些病人来做有控制的临床测试。但是他仍旧纠缠于自己对突出个案的反应，那些鲜活的个案对他的决策产生了影响。尽管他相信科学，但仍承认“当真实的人眼巴巴地看着你的时候，你将被他们的期望以及自己对他们期望的期望所包围，这确实非常困难”（p.36）。但是安德森知道，有时对他的病人来说，最好的办法就是忽略“看着你的那个真实的人”，并且遵循最佳证据的指示。最佳证据来自于有控制的临床试验（将在第6章表述），而不是看着你的那个人的情感反应。 评估证据的时候，鲜活性问题是一个我们都要面临的难题。并且，在这样一个充斥着媒体影像的环境中，对于社会来说，不受影像支配而基于有效的证据来解决自身的问题变得越来越困难了。作家巴瑞·格拉斯纳（Glassner，1999）讲述了一个特别相似的例子。在1995年的一场奥普拉秀中，围绕着某一次外科手术而展开讨论（这里不具体说出外科手术的名字，以免渲染鲜活性效应）。这种手术引起了一些争议，因为一些人声称在手术过程中受到过伤害。来自梅奥临床医院、哈佛大学和密歇根大学的研究证据都显示，这种手术总体上是没有危险性的。就在此时，一位声称受到过伤害的妇女从观众席里跳出来并喊道：“我们就是证明，我们这些坐在这儿的人就是结论！（Glassner，1999，p.164）。你认为哪种说法会让数百万电视观众记忆犹新——是来自梅奥临床医院的研究，还是大喊自己就曾受到过伤害的那位妇女？ 总之，过于依赖见证证据的问题一直存在。此类证据的鲜活性常常掩盖了更加可靠的信息，并且混淆视听。心理学教师担心的是，仅仅指出依赖见证证据的逻辑谬误，并不足以让人们从一个更深的层次理解这类数据的缺陷。我们还能做些什么呢？还有什么其他的方法能让人们理解这个概念吗？幸运的是，我们还有一个法宝——一种与学术方法略有不同的方法。这种方法的本质是以鲜活性来对付鲜活性，是以一种“以彼之道，还施彼身”的方法对付见证证据，让见证用自身的荒谬来击溃自己。这个方法的实践者，就是独一无二、毋庸置疑的“了不起的兰迪”！ 詹姆斯·兰迪（James Randi）是一位魔术师，并且是个多面手，他曾经被麦克阿瑟基金会授予过“天才”奖。多年来，他一直尝试着教公众学会一些基本的批判性思维的技巧。“了不起的兰迪”（Amuirig Randi，他的艺名）通过揭穿“通灵”骗术和庸医疗法来达到教育公众的目的。尽管他拆穿了很多魔术和伪装的所谓“通灵术”，但最为著名的，还是他拆穿20世纪70年代通灵术超级明星尤里·盖勒（Uri Geller）的把戏的那一回。盖勒靠吹嘘通灵术红透荧屏，他对媒体的蛊惑程度简直可以用无以复加来形容。各大洲的报纸、电视节目和主要的新闻杂志对他争相报道（盖勒仍健在，还在写书；Radford, 2006）。兰迪发现并揭露了盖勒经常表演的通灵术“绝活”其实不过是些普通和简单得令人难以置信的魔术把戏，包括使勺子和钥匙弯曲、使钟表开始走动等等，这些对于一个优秀的魔术师来说，简直就是家常便饭。自从盖勒被拆穿以后，兰迪继续将他那非凡的才智用于维护公众的知情权，他不断揭露超感官感知、生物节律、超自然力、通灵外科手术、天外来客、漂浮术以及其他伪科学的谬误，帮助公众了解真相（Randi, 1983, 1995, 2005; Sagan, 1996）。 兰迪的另外一个兴趣就是去证明，对于任何一个荒谬的事件或无中生有的言论而言，获得见证是多么地容易。他的手法就是，让人们掉进其见证所编织的陷阱里。兰迪常常使用脱口秀这一理想的美国文化载体来实现他的目的。他经常作为嘉宾出现在节目中，但不以真名示人。在几年前纽约的一个节目中，他对观众说，今天早晨开车经过新泽西的时候，他看到一个澄色的V形物体飞过头顶飘向北方。几秒钟之内，正如兰迪所说，“电台的接线总机像一棵电子圣诞树般闪烁起来”。一个接一个的目击者打电话过来证实这一奇异的景象。可他们运气不好，这一“景象”只是兰迪想象出来的，但是打电话的人提供了许多兰迪“忽略了”的细节，包括其实有多个“飞碟”飞过。这个小小的把戏证明，个体关于“某事发生”的报告是多么不可靠。 在加拿大的温尼伯市，兰迪在一个广播节目中以“星相学家”的身份出现。节目一周前，听众被要求提交他们的笔迹样本和出生日期。有三个人被甄选出来，并且进行电话连线，这样兰迪就可以“解读出”他们的性格特征。他大获成功，三位听众在1-10分的准确性量表上给出的评分分别为9、10和10。兰迪在节目的最后向听众解释了他的秘诀。他其实只是逐字逐句地读出了占星师希德尼·奥马尔在最近的一个电视节目中给三个观众的“解读”而已。 在另外一个广播节目中，兰迪揭示了另外一种伪科学——生物节律能够如此流行的原因（Hines, 1998, 2003）。一位听众同意每天都记日记，并将日记与一份特别为她准备的两个月的生物节律表做比较。两个月以后，她打回电话告诉听众：生物节律绝对不是盖的，因为节律表预测实际行为的准确率超过了90%。兰迪不得不把他的秘书所犯的一个愚蠢的错误告诉给这位听众，秘书错误地将本该发送给另外一个人的节律表发给了她，而不是她自己的。然而，这位妇女还是同意看一下真正属于自己的表格是怎样的，于是，又一份表格立即发送给了这位妇女，并且请她再打电话过来。几天后，这位妇女带着解脱感打进电话，说她自己的表格也同样十分准确——事实上更为准确。在下一期节目中，大家发现，另一个错误发生了。这位妇女收到的是兰迪秘书的节律表，而不是她自己的！ 兰迪的生物节律和占星术小把戏，其实是一种被命名为巴纳姆效应（Bamum，著名的嘉年华和马戏团的团主，提出了“每分钟都会有人上当受骗”的说法）现象的范例。这一效应曾被心理学家广泛地研究（例如，Dickson & Kelly，1985），研究者发现，大多数成年人都会认为泛化的个性总结都是准确的，并且都是对自己独特的描述。这里有一个来自谢尔默（Shermer, 2005, p.6）的例子： 大多数人都发现，这个总结是对其个性非常准确的概括，但是很少有人自发地意识到大多数其他人也同样认为它描述了他们自己！许多众所周知的语句和措辞（如这个例子）使很多人认为适用于他们自己。谁都能够将其作为一个个人化的心理“分析”提供给“顾客”，而这些顾客常常会为个人化的“性格解读”的“准确性”而感到震惊，却不知道其实每个人的解读都是一样的。当然，巴纳姆效应正是手相学和占星术的基础（Kelly, 1997, 1998）。巴纳姆效应还可以证明产生见证有多么容易，以及为何见证毫无价值。 这就是詹姆斯·兰迪运用这些小把戏努力想要达到的目的——给人们好好上一课，告诉人们见证证据是没有价值的。他不断地证实，形成有利于虚假主张的见证是多么容易。正是这个原因，用见证来支持自己提出来的特定理论是毫无意义的。检验一个主张时，只有来自于有控制的观察中的证据（第6章中将会描述）才是足够充分的。 有时候有人会说，类似刚才所讨论的种种伪科学，只不过是人们给自己找乐子的一种方式，无伤大雅。再者说，我们又何必较真呢？不就是有几个人在异想天开，而另外几个人从中赚点儿小钱吗？ 然而，对此问题进行一番彻底的考察就不难发现，伪科学的盛行对社会的危害比人们想象的要大得多。在一个复杂的、科技化的社会中，一些能够影响千万人的决策会为伪科学的影响推波助澜。也就是说，即使你并不认同这些伪科学的观念，你也可能受到这些观念的影响。例如，大银行和一些500强企业雇佣笔迹学家来做人事选拔（Sutherland, 1992），即便大量的证据表明，笔迹学在实现这一目的方面是没有作用的（Ben-Shalfhar，Bar-Hillel, Blui, Ben-Abba, ScFlug, 1989; Neter & Ben-Shakhar, 1989）。伪科学的笔迹学指标在一定程度上使雇主忽视了其他更有效的选拔标准，导致的结果是经济上的零效益和对一些人的不公平待遇。如果仅仅因为笔迹中有一个连写的“小圈圈”，就让你丧失了获得一份你很心仪的工作机会，你会作何感受？或者，你求职被拒，只是因为一个“通灵师”从你的“气场”中看到了一丝扰动，你又会作何感受？事实上，这类事情的确发生在一些人身上，一些公司会花钱请人为求职者进行“通灵分析”。例如，苏姗·金（SusanKing）是一个所谓的“通灵大师”，公司花钱请她运用“读心术”来为人事决策提供帮助。“尽管一些雇主会请她来参与最后一轮面试，或者在随后的鸡尾酒会上让她去观察一些入围的候选人”，但她宣称她甚至不需要见到这些申请者——她可以从照片或是他们的姓氏中发现问题（Kershaw，1991）。在这样一个竞争激烈的经济时代，这是你所期望的决定自己能否获得一份工作的方式吗？ 不幸的是，这样的例子绝非凤毛麟角（Shermer, 2005; Stanovich, 2004; Sternberg, 2002）。当伪科学的观念渗透于整个社会的时候，我们都以不同的方式受到影响——即使我们并不认同这些信念。例如，警局雇通灵师协助办案（Marshall, 1980），即便研究表明这一举动是没有任何效果的（Hines, 2003; Rowe, 1993）。ABC电视网络的制作人居然花钱请好莱坞的通灵师帮助他们确定节目内容，要知道电视网络可是当今社会最具影响力的通信科技（Auletta, 1992, p.114）。最令人大跌眼镜的是，有个占星师曾受雇于里根时代的白宫，专门为“总统演说的时机、穿着打扮、与州长会面、飞机的飞行时刻表甚至讨论的议题等”这类事项提供建议（Johnson, 1991, p.454）。 如今，类似占星术这样的伪科学是一项巨大的产业，涉及报纸专栏、广播节目、图书出版、网络、杂志文章以及其他各种传播渠道。星相学杂志的发行量要比很多正规的科学杂志大得多。据美国众议院老龄化问题委员会估算，浪费在医疗骗术上的钱已经达到数十亿美金。简而言之，伪科学是个油水颇丰的行当，数以千计的人靠公众的盲信盲从而获得收益。 医学领域中的伪科学话题具有借鉴意义，因为在抨击伪科学，以及把正规的与不正规的医疗实践划清界限方面，医学界的各类组织都比心理学界表现得更为激进和勇猛。下面就让我们看看由关节炎基金会出版、曾被美国众议院老龄化问题委员会所引述的一套识别不道德药品推销员的指南： 1.他或许会提供一种用于治疗关节炎的“特别的”或“秘密的”处方或设备。 2.他会做广告，用的都是“个案史”和“满意患者”的见证。 3.他或许会承诺（或者暗示）能够快速或轻松见效。 4.他也许会声称知道关节炎的成因，并且说能够“清除”你体内的“毒素”，同时促进你的健康。他或许会说外科手术、X光和医师所开的处方是没有必要的。 5.他或许会指责“医学体制”故意阻碍了进步，或者迫害了他……但是他不允许他的方法以已有的或已获证明的方法来验证。（UScongress, 1984, p.12） 这份清单同样可以作为识别带有欺骗性的心理学疗法和理论的指南。在这里，请注意第2条，这正是本章关注的焦点。同时注意，第1条和第5条论证了之前所讨论过的一个观点：科学是公开的。除了宣扬见证叙述作为“证据”，伪科学的从业人员经常以指责他人有意要压制他们所获取的“知识”，以此试图逃避“公开可证实”这一科学的标准。这样，他们就有借口带着他们的“研究成果”直接走进媒体，而不是通过正规的科学出版程序将这些成果公诸于世。通常，这种伎俩在心理学领域中更为成功，因为相比于其他科学领域，媒体通常对心理学的正常科学机制缺乏尊重。记住这一点，这很重要（在第12章中我们将会深入讨论这个问题）。媒体从来不会考虑去报道物理科学中未经证实的主张，但如果这类主张是心理学方面的，就会被当做正规的心理学话题加以报道，因为新闻记者早就被宣扬“心理学里没有规则”的伪科学洗了脑。然而，消费者必须意识到，电视和纸质媒体只要认为读者有需要，就会报道心理学领域中任何出格的主张，无论这些主张与已有证据之间是多么矛盾。最终的受害者是公众。 有关神奇疗法的宣传助长了人们的错误希望，当希望破灭时，会给人们造成心理上的致命打击。在我关于这个问题所掌握的例子中，其中最卑劣的案例之一就是一篇来自杂货店小报的文章，标题冠以“通灵师展示肓人如何通过超感官知觉看见东西”。人们可能会由于身陷伪科学的重重包围而无法获得真正科学的知识，通灵外科手术的倡导者暗中怂恿人们把钱花在骗人的疗法上，并且忽视对患者有帮助的传统的“非通灵的”的医疗手段（Angell & Kassirer, 1998）。在一个关于医疗保健欺诈行为的市民大会上，“密歇根反健康欺诈顾问委员会”的主席展示了一则骗人的、治疗癌症的小册子，上面写着“本产品不能与其他癌症疗法同时使用”（“听上去像真的”，1990）。类似案例已造成的损害是无法估算的。 心理学家越来越关注医学骗局在互联网上的蔓延，以及它对健康带来的损害。麦克斯·考皮斯（Max Coppes）博士不得不给《新英格兰医学杂志》写了一封信，警告人们注意医学中的伪科学所带来的危害（Scott, 1999）。他描述了一个9岁女孩的案例，这个孩子在经历癌症手术之后，如果接受化疗的话，将会有50%的机会可以多活3年。但她的父母找到一种未经验证的、利用鲨鱼软骨的偏方来代替化疗。小女孩在4个月后失去了生命。 当我正在讲述这个话题的时候，经常有人会针对我的演讲提出非常中肯的问题：“你不也是正在用生动的个案来阐述你的观点吗——这种做法难道不正是你所反对的吗？”这个问题问得好，并且它让我有机会详细阐述本章中包含的一些论点间的微妙之处。这个问题的答案是肯定的，我运用了生动例子来阐述观点。但是，是为了阐述观点，而不是为了证明观点。这里的关键是要区分两点：主张的提出和主张的交流。对于每个主张，我们都能问这样一个问题：它是不是基于鲜活的见证？这会产生四种可能的情况： 1.一项主张基于鲜活的见证，同时依靠鲜活的见证来交流 2.一项主张基于鲜活的见证，同时不依靠鲜活的见证来交流 3.一项主张基于证据而非鲜活的见证，同时依靠鲜活的见证来交流 4.一项主张基于证据而非鲜活的见证，同时不依靠鲜活的见证来交流 本章中的一些讨论属于第3种情况：一项主张基于证据而非鲜活的见证，同时依靠鲜活的见证来交流。例如，我引用了很多非见证的证据贯穿整章，就是为了说明：个案研究的证据不能用于建立因果性结论，鲜活的例子在人们的判断中被赋予了过高的权重，伪科学的代价巨大等等。对于这些主张中的每一项，我都标出了引证和参考文献。尽管如此，出于交流的目的，我使用了一些鲜活的案例，将注意力吸引到这些主张上，并让它们给人们留下深刻的印象。关键的一点是，支持这些主张本身的并不仅仅是鲜活的见证。比如，我曾使用一些鲜活的例子来阐述“鲜活的例子在人们的判断中被赋予了过高的权重”这一事实，但是这一主张的证据包含在我所引用的经过了同行评议的科学证据之中（例如，Kunda, 1999; Lassiteret al., 2002; Nisbett & Ross，1980; Sinaceur, Heath, & Cole, 2005）。 回到这部分的主要观点上并做个总结吧：伪科学的传播所造成的代价是巨大的。需要搞清楚哪种类型的证据能够揭示某种现象中蕴含的道理或理论是否可信，如果搞不清楚这一点，就会大大有利于伪科学的传播。由于见证叙述可以为任何主张提供唾手可得的支持，以及自身所具备的冲击力，见证打开了通往伪科学的大门。对于心理学信息的消费者来说，对它们保持警惕应当是头等大事。在接下来的几章中我们将会看到，在证实某种主张的合理性时，究竟需要哪些类型的证据。 个案研究和见证叙述在心理学（以及其他科学）研究的早期阶段是有用的，因为此时，寻找有趣的现象和待研究的关键变量很重要。虽然个案研究在早期的、理论形成前的阶段是有用的，但在研究的后期，当对理论进行检验之时，个案研究就毫无用处了。这是因为，作为一个孤立现象，个案研究的结果遗漏了太多其他可能的解释。为何个案研究和见证证据对于理论检验来说是没有用的？要想理解这一点，就需要想一想安慰剂效应。安慰剂效应是指，无论疗法是否包含了有效的成分，人们都倾向于报告任何疗法都对他们有效。安慰剂效应的存在，催生了许多关于疗效的见证叙述，致使对一种心理（或医学）疗法效果的证明成为“不可能的任务”。原因就在于，无论治疗手段是什么，安慰剂效应都会使人们提出证实其疗效的个人见证。 尽管见证证据在检验理论的时候是无用的，但心理学研究指出，由于鲜活性效应，这类证据经常被人们过分地倚重：对于更为生动、并因此在记忆中更易提取的证据，人们会赋予其过高的权重。对大多数人来说，见证证据就是一种格外生动和鲜活的信息，因此，人们在验证某一心理学主张的合理性时，会过度依赖这类证据。事实上，理论主张是否合理，是不能用见证叙述和个案研究的证据来判定的。