Depression seems especially sensitive to the placebo effect. Numerous studies have shown that genuine antidepressants account for about 25 percent of the improvement, while the placebo effect accounts for the remaining 75 percent. Believing you are getting something to help you is more than half the battle. After all, depression is marked by hopelessness, and placebos offer nothing if not hope. I always think about this when I am being given an antidepressant. I am told not to wait for an effect for at least three or four weeks—“it needs to build up.” In other words, expect no direct test of utility anytime soon, and the usual rule of regression to the mean—or, things get better after they have gotten worse—will give you all the evidence you later need. In the meantime, get with the program! The most recent meta-analysis (2010) reveals a striking (and very welcome) fact. Placebos work as well as antidepressants for mild depression, but for severe depression, there is a sharp bifurcation: real medicine shows strong benefits and placebos almost none. This, as we have noted, is a characteristic feature of self-deception directed toward others: a modest amount works, but a great deal fails to impress.
The ability to produce autostimulatory effects is nicely illustrated by work on female sexuality. Women who appear to be sexually dysfunctional in failing to respond orgasmically can be induced to greater arousal by giving them false feedback on the blood flow to their pelvis (a correlate of arousal) to sexual stimuli. They appear to be talking themselves into greater arousal, somewhat like the sight of a man’s own erection may increase his sexual desire.
There is no doubt that placebo effects operate in athletics as well. Trials have shown that cyclists respond positively to word that they have been given caffeine (without getting any) about half as well as to the caffeine itself (along with word they are getting it). Merely telling the cyclists they are getting a heavier dose of caffeine produces a stronger positive athletic response. Even that cliché of working out—no pain, no gain—has a built-in placebo effect.
One can even induce a placebo effect out of a placebo effect. That is, you can tell someone with irritable bowel syndrome that he or she will now receive a placebo—an inert chemical with no medicine in it—but then tell the person that the placebo effect is powerful, often involuntary, helped by a positive attitude, and finally, that taking the pills faithfully is critical. With this much helpful verbiage, it is not surprising that a placebo identified as such still produces benefits.
The analogy with religion is strong and tempting. Both involve strong belief. Both involve a series of conditioned associations, including common doctor or pastoral elements. And, indeed, until very recently (up to about five thousand years), medicine and religion were one and the same. You can easily imagine that regular religious attendance (especially if the music is good!) would intensify placebo and other immune benefits, just as regular visits to a caring and sensible doctor or adviser might.
A striking feature of placebo effects is that they are highly variable across a population. Typically roughly one-third show very strong effects, perhaps one-third moderate, and one-third none. This is an example of what we have emphasized repeatedly, that the deceit and self-deception system must be an evolving one, with important genetic variation for forms and degree of self-deception. We do not know how much of the variation just mentioned is genetic, but recent work shows that people with depressive disorders differ in the degree to which they show a placebo effect based on particular genes.
What else correlates with a tendency to show a placebo effect? For one thing, suggestibility, as in ease of being hypnotized, is a trait that also shows high variability, some people being highly resistant and others easily manipulated. It should hardly surprise us that ease of being hypnotized and the placebo reaction should co-vary strongly and positively. Each is a kind of self-deception requiring a third party, a hypnotist or “doctor.” When people are divided into those who are easily hypnotized versus those who are not, then hypnotizing the susceptible to concentrate only on the color in which words are printed in the Stroop test (recognizing words denoting color that are written in different colors), causes them to show no interference from the words themselves. But people who are not susceptible show no improvement on the Stroop test. This, then, is a benefit from ease of being hypnotized: greater ability to concentrate or tolerate cognitive load.
We began this chapter with the illusion of conscious control. We then moved successively into deeper and subtler forms of external control—imposed self-deception in general, torture with its disassociations, false accusations of others and of self, the placebo effect, and hypnosis. It would now be valuable to tie these kinds of conflicts into our two major social relationships: the family (Chapter 4) and the two sexes (Chapter 5). When do we impose self-deceptions on family members and on sexual partners, and when and how are these imposed on us?
CHAPTER 4
Self-Deception in the Family—and the Split Self
We usually begin our lives—the first twenty years, at least—embedded in a family, typically one or both parents and one or more siblings. This is often part of a larger extended family including grandparents, uncles, cousins, and so on. The key to the biology of all this is genetic relatedness (r). That is, family members are all related to one another in the sense that there is a chance that any given gene in any one individual has an identical copy in another by direct descent from a common ancestor. A typical gene in a parent is found in its offspring half the time (hence r to offspring = ½), while a typical gene in the offspring is also found in either parent half of the time. Siblings are related by ½ but half-siblings by only ¼ and so on. This leads to “Hamilton’s rule,” which states that the benefit of an altruistic act toward a relative times the relevant degree of relatedness must be greater than the cost suffered by the altruist in order for selection to favor the altruism. For example, if you are helping your half-sister, then (other things being equal) the benefit to her had better be greater than four times the cost to you. Likewise, selection will oppose a selfish act that harms her four times more than it benefits you. In sum, degrees of relatedness in families are high—which tends to induce investment and restrict conflict—but degrees of relatedness are far from unitary (r = 1) so that conflict is also expected between the actors. For our purposes, the key is that relatedness adds an extra dimension and logic to the kinds of deception and self-deception that will evolve.
Parents can pretend to base their actions on shared relatedness to the child (parental investment) when, in fact, it is based on the unrelated part (parental exploitation). They may be unconscious of this bias. In turn, offspring may pretend greater need in order to induce more parental investment than is optimal for the parent, and they may be more effective when they believe it themselves. And so on. Relatedness in fact leads to a series of ramifying complexities where deceit and self-deception are concerned. These have to do with misrepresentation, manipulation, and internal bifurcation. Let us look at each in turn.
Since an individual is selected to act both altruistically and selfishly toward family members, there are chances for misrepresentations regarding motivation and orientation that are deeper than those occurring toward more distantly related people. For example, there is no presumption that a person with a low r to you is programmed to act in your self-interest, but that is precisely the presumption with related individuals—and the more so the more closely they are related to you. So your relatives can pretend an interest in you that is plausible on its face, even if their real motivation is completely manipulative. A relative can also lay a claim to you. Aren’t I related to you by one-fourth, so if you are messing up in life, aren’t you messing with my quarter interest in it? Get yourself together for both our sakes.
Or consider the following. Although one is selected to invest parental care in one’s offspring, one is not selected to give as much as requested, or always to give anything at all. Hence, deeper—and, probably often, more painful—misrepresentations are possible between close relativ
es. Are you investing in a child or exploiting it? Do you love the child or not? Do you have in mind a separate self-interest in the child that you are willing to support or is the child entirely conceived as instrumental to your larger projects? It makes a whale of a difference to the offspring which of these is true, and there is plenty of scope for deceit and self-deception on the part of the parent, as well as of the offspring.
Second, with the added factor of a long period of parental investment soaked with language, there are many opportunities for conscious and unconscious manipulation, including induced self-deception, in which the parent can induce a pattern of self-deception in the offspring that serves the parent’s interests but not those of the offspring expressing the self-deception. The child may grow to believe that its parents are acting in its true interests when in fact they are not. The offspring may not be in a position to free itself of such an imposed self-deception until it no longer requires parental investment, giving an added reason for emotional turbulence in late adolescence, along with open hostility toward parents. Adults, in turn, may differ in the degree to which they suffer costly effects from earlier parental manipulation. In addition, parents are not a unit; they are a father and a mother, with different interests in offspring manipulation because the manipulation affects them and their differing sets of relatives.
Third and unexpectedly, relatedness considerations automatically split the organism into multiple selves, with differing interests, the most important for our selves being our maternal self and our paternal one. Formerly, we used to believe that an organism had a single self-interest. It had a unitary aim—to maximize its genetic reproduction. Kinship theory says this can’t be true. Different genes within us have differing rules of inheritance, and this will give them contradictory interests. For example, the Y chromosome is always passed father to son. It is not selected to have any interest in daughters. Does that mean we expect fathers to be at least slightly biased toward their sons? Not at all. The male’s X chromosome is passed only to his daughters and it is more than ten times as gene-rich as his Y, so if anything, men should show a slight genetic bias toward their daughters. No one knows whether this is true, but there is some evidence that paternal grandmothers favor their granddaughters over their grandsons according to the differing chances that their X chromosome will be found in them (½ versus 0).
The Y and the X are only small parts of the whole genome. The main genetic split within us is between our maternal and paternal halves, which are equally strong. There are a few hundred genes in us that are active only if inherited from our mother, so-called maternally active genes, and about an equal number from the father, so-called paternally active ones. Maternally active genes are selected to promote maternal interests and paternally active, paternal. This generates internal genetic conflict in which two separate genetic selves compete for control of our behavior and larger phenotype. This conflict has two important effects. We expect deception between these two halves—not directed toward outsiders but toward each other. For example, maternal genes in you may overemphasize the benefits to the organism as a whole of acting on its special relatedness to others (when these are maternally biased), while paternal genes may be selected to discount such maternal effects. Second, we also expect differences between our two halves over whom to deceive in the outside world (with or without self-deception). As we shall see below, this split in us runs deep, both from early-acting genes affecting growth and consumption of parental resources to later-acting ones affecting adult behavior.
PARENT/OFFSPRING CONFLICT
Because parents typically are related to each offspring by ½ but not by 1—and vice versa—there is ample scope for conflict between the two parties. This conflict usually concerns how much parental investment the offspring receives and what its behavioral tendencies are, as these affect its relatives. The parent is selected to maximize the number of surviving offspring it produces, but the child is twice as related to itself as to its full siblings, so it is selected to try to gain more than its fair share of resources—though not so much more that it inflicts twice the cost on its siblings as the gain it enjoys itself. Deception is an important part of the child’s repertoire, pretending greater need than is actually being experienced and manipulating the parent psychologically, sometimes against the parent’s better instincts. The parent may be selected to minimize the appearance of available resources, the better to save some for other offspring. One critical choice the parent has is whether to impose its will, insofar as it can, or opt for a fair split with the offspring. The latter, in principle, should reduce future conflict with the offspring, especially if in response it adopts a similar posture. One danger of complete domination is the turmoil that may erupt when the offspring is as physically large as the parent and is cognizant of the parental style to which it has long been exposed.
Regarding the offspring’s general behavior, it is selected to act altruistically toward a relative only when the benefit times degree of relatedness is greater than the cost to itself (B>2C for full siblings), but the parent would prefer to see altruism whenever there is a net benefit to the parent’s offspring—in this example, B>C. Thus, parents are selected to mold their offspring into being better people (more altruistic, less selfish) than they are inclined to act on their own. This may take the form of punishing behavior as being generally immoral (instead of merely counter to the parent’s self-interest).
CASES OF EXTREME ABUSE
The long period of parental investment in humans means that there are many opportunities for each party to respond to the other’s actions. One important consequence is that a child who is receiving insufficient investment or actual abuse maybe put in an awkward position where resistance is concerned. In the extreme case, resistance is likely to only make matters worse; it will provoke additional abuse and withdrawal of investment. Thus, until children reach the teen years, they may, in general, have to submit—and the more so the harsher the regime under which they live. There also are more things they need to hide from the outside world, so lack of resistance includes lack of disclosure to others, and here the evidence is clear. For abuse in general (physical, emotional, and sexual), the more the abuse is perpetrated by a close relative (or stepparent), compared to that from a more distant figure, the longer the children take to disclose the abuse, if at all. We are talking about delays of a year or more. Intervention is less likely and caregivers less supportive. And there are negative immune effects that endure into adulthood (see Chapter 6).
Here the child may be favored by natural selection to keep up a good front, which may involve self-deception, such as disassociation and selective recall. In disassociation, the mind is split into two (or more) relatively separate parts, one of which fails to recall the abuse or see it as such—perhaps the self that is usually shown to the parent. Disassociation is more common than selective recall in those who have been abused, and this disassociation compromises intellectual performance, for example, on the Stroop test (recognizing words denoting color that are written in different colors).
The notion that children completely repress memory of extreme trauma, only to recall it years later in full detail, has been shown to be unlikely in most cases, but this does not mean that amnesic factors are not at work in trauma, of which disassociation is only one example. Again, it is the closeness of the abuser that is associated with the greatest memory defects. For all forms of impairment, abuse by a caregiver induces more memory impairment than similar abuse by non-caregivers. Is this because it is inherently more offensive and in need of memory eradication or because pressure from caregivers to keep one’s silence is especially strong? It may be both. We know that the tendency to share with others is less frequent when the abuse comes from a caregiver.
GENOMIC IMPRINTING
As mentioned already, one of the most striking discoveries in the past thirty years of genetics is that we are expected not to be unitary creatures with a single self-interest, but to have a paternal g
enetic interest and a maternal one, which may differ, with each acting to promote a view of the world from its standpoint. Biologists used to think that genes had no memory of where they came from, thus they computed the average degrees of relatedness cited earlier—half chance through Mom, half chance through Dad. In the 1980s, biologists began to discover a minority of genes whose expression level depended on which parent contributed it. Often one copy was active and one inactive. So there are paternally active genes and maternally active ones. With activity limited by parental origin, these genes can act not on average relatedness, but on exact relatedness to each parent (0 or 1) and their relatives.
The first two imprinted genes described in mice tell the whole story. Igf2 (insulin-like growth factor 2) is a paternally active gene that activates growth in fetal life by increasing rates of cell division. A single active copy increases size at birth by 40 percent compared to no active copies. Why does this make sense? In competition over access to maternal investment, paternal genes in offspring are inevitably less related to siblings than are maternal genes. Multiple mating by a female for each litter or changing fathers between litters lowers paternal relatedness among the resulting siblings while leaving maternal relatedness unchanged. Thus, paternal genes will weigh effects on self relatively more heavily than effects on siblings (compared to unimprinted genes or maternally active ones), preferring faster fetal growth rates and relatively larger size at birth.
The proof is in the pudding. An oppositely imprinted gene has exactly opposite effects. Igf2r (insulin-like growth factor 2 receptor) is maternally active and, in mammals, its protein has evolved a secondary binding site to Igf2, which is carried to lysosomes and degraded. Indeed, Igf2r gets rid of 70 percent of all of the Igf2 that is produced. As a result, it lowers the fetal growth rate by about 30 percent. This is no way to build a railroad. Here are two large, costly opposing effects that virtually wipe each other out. This is not good for the individual but is exactly what you would expect if there were two opposing forces within the offspring. Evidence confirms that imprinted genes that affect early development almost always obey “Haig’s rule”—paternally active genes have positive effects on growth during maternal investment, while maternally active ones have negative effects.
The Folly of Fools: The Logic of Deceit and Self-Deception in Human Life Page 10