Excerpts for House and Psychology : Humanity Is Overrated


House and Psychology

Humanity Is Overrated
By Ted Cascio Leonard L. Martin

John Wiley & Sons

Copyright © 2011 John Wiley & Sons, Ltd
All right reserved.

ISBN: 978-0-470-94555-1


Chapter One

In the Patient's Best Interests?

Perspectives on Why We Help Others

TED CASCIO

Feeling sick? I recommend Princeton-Plainsboro Teaching Hospital. The doctors and the nurses there are exceptionally skilled. They don't save everyone, but they do have a very high success rate—even for extremely rare and difficult cases. The staff can be summarized in two words: they help. As Cameron puts it in the pilot episode, "Isn't treating patients why we became doctors?" I have to admit that there is at least one doctor on the staff who may seem a little rude and obnoxious—even cruel—but does that matter if you get better?

Actually, it does seem to matter. Although the sort of beneficence practiced by doctors is surely valuable, maybe even virtuous, helping's ultimate moral status is seldom clear-cut. We wonder. And even when we feel pretty sure, we tend to be critical. Cameron, in particular, has frequently been forced to bear criticism for her seemingly reflexive self-sacrificial tendencies. She's even been accused by House and others of having a sort of helping pathology. On their so-called date that kicked off season 3, House accurately (and in typical point-blank fashion) identifies this supposed condition as the primary basis for her romantic involvement with him:

House: You have no interest in going out with me. Maybe you did, when I couldn't walk, when I was a sick puppy that you could nurture back to health. Now that I'm healthy there's nothing in it for you.

Cameron: You are not healthy.

—"Meaning"

And yet Cameronesque fervor is clearly not a necessary precondition for helping. Most people (including House) help one another. We are psychologically predisposed to both care about and do something about the suffering of others. That is interesting, because things could have been so different. Why aren't we selfish instead? Shouldn't we all simply pursue our own self-interests? Does it really make sense to sacrifice our time, energy, money, and sometimes lives for the sake of another person's well-being? If so, why?

Psychology offers some interesting insights into these cosmic questions that you might not have thought to consider, and it challenges some prevailing assumptions. One of these assumptions is that people help out of genuine concern for other people's well-being. That assumption has been challenged. Another is that people help because they are strongly compelled by their unique dispositions to do so—or not—depending on some, usually hazy, notion of "character." Helping doesn't happen by accident; rather, it is character-driven. That assumption has also been challenged. Another doozy is that only human beings help one another or, at minimum, that human and animal helping are fundamentally and qualitatively different. This assumption has been challenged since the days of Darwin.

You will walk away from this chapter with a better understanding of the truly complex underpinnings of helping behavior. You will see why helping is not quite the pure, wholesome act it's usually depicted as. At least, that's not the whole story. This may alter your perspective on House, on your friends and family, and even on what it means to be human (as well as humane). Finally, I hope this chapter convinces you to become less self-centered and to make helping people in need a fundamental concern in your own life. We'll start with the various motives that inspire helping. When people help one another, are they actually just trying to indirectly help themselves?

Isn't all Helping actually egoistic?

Consider that doctors may help patients for many different reasons. They may help because they

1. Want to relieve the patient's suffering

2. Are simply doing their jobs

3. Enjoy the challenge of the diagnosis and the treatment

4. Are seeking fame and power

5. Hope that doing so will bring attention to their research project or their pet disease

6. Want to feel like Superman (or Superwoman)

Notice anything about this list? Only the first item reflects helping in the pure selfless or altruistic sense. In each of the other examples, the doctor helps primarily to benefit himself or herself. The patient may get better, but this is merely a side effect of a selfish or egoistic motive.

Egoistic helping is motivated by a desire to advance the interests of the person doing the helping, rather than those of the person in need. We saw House engage in egoistic helping when he becomes convinced (correctly, of course) that one of the actors on Prescription: Passion—his favorite soap opera—has a life-threatening medical condition. House decides to intervene by abducting him from the set of the show and chauffeuring him to Princeton-Plainsboro in order to be treated. When the unfortunate fellow finally realizes what is going on, House willingly admits that "I don't care if you die, but if Brock Sterling dies, Anna never finds out he's the father of Marie's baby" ("Living the Dream"). This is a classic (and pretty hilarious) instance of egoistic helping. House does this type of thing frequently. In this case, he is concerned for the other man's life only insofar as the man's continued existence is necessary to keep the story line alive on his favorite TV show. Egoistic helping at its best.

House's general assumption seems to be that people are apt to deceive themselves and others about their true motives for helping. According to House, when we say that our motive for helping another person strictly involves concern for his or her welfare, the true motive is often one that is more egoistic and likely to benefit us directly. It's no surprise, then, that House harbors suspicions about motives and generally distrusts people's claims about what inspires their helping behavior.

For example, many doctors may claim that they chose their profession because they "want to help people." As usual, however, House is not shy about proposing alternatives:

House: People act in their own self-interests. You're all here because you're happy to be here or at least because it's your best option.

Kutner: I'm here because I want to help people.

House: No, you're here because it makes you feel good to help people. Taub and Foreman are here because they've got no other viable choices, and Thirteen is desperate to make her life matter before it's over.

—"The Greater Good"

House is what we'll call an egoistic reductionist. His cynical interpretation of people's helping behavior is part of his larger philosophy about why anyone does anything. According to him, every act is ultimately in the service of self-interest. As House puts it in a conversation with Wilson:

Wilson: Apologies aren't supposed to make you feel better, they're supposed to make the other person feel better.

House: In order to make you feel better.

—"Under My Skin"

One psychological hypothesis that jibes neatly with House's interpretation of helping is called the negative state relief hypothesis. It suggests that individuals help in order to reduce the sense of guilt that they would experience if they didn't help. This is a form of egoistic helping, even if the other person ends up being benefited.

Sometimes House—and the negative state relief hypothesis—is right on target. At some point toward the end of season 5, Kutner ominously fails to show up for the morning differential (we learn later that, sadly, this is because he committed suicide). When House begins to "politely inquire" into the situation, Taub, of all people, attempts to defend Kutner by devising an excuse for him, something House naturally finds suspicious. He doesn't believe Taub would help without a direct personal incentive. House's doubts are later vindicated when it is revealed to him that earlier, Taub dishonestly claimed credit for one of Kutner's diagnostic ideas, a transgression that elicited the guilt that impelled him to come to his friend's assistance. Despite Taub's best efforts, House is never fooled. Later, sizing up the situation in characteristically cynical terms, House affirms with relish, "I thought maybe you were lying to cover for Kutner, which sounds noble, except you're doing it out of guilt instead of love" ("Simple Explanation"). This example perfectly illustrates the negative state relief hypothesis. When guilt reduction is the driving force behind our actions, any helping that might follow is egoistic in nature.

Are egoistic hypotheses such as these enough to explain all helping behavior? Probably not. A series of studies by Dan Batson and his colleagues demonstrated that altruistic helping is a real phenomenon. Imagine that you are a participant in one of these studies. You show up for an experiment on "task performance and impression projection under stressful conditions." You learn that you are participating with another person named Elaine. Your responsibility is to observe Elaine as she performs a number of tasks under stressful conditions. Stressful conditions? Yes, Elaine will be receiving mild electric shocks.

As the experiment continues, though, Elaine begins to react. The shocks do not seem so mild to her. In fact, Elaine's facial expressions and body movements clearly indicate that she is in distress. The experimenter notices this, too, and interrupts the trial in order to ask Elaine if she is doing all right. Elaine explains that "as a child she had been thrown from a horse onto an electric fence." She goes on to inform the experimenter that she suffered a bad trauma and in the future might react strongly to even mild shocks. Still, Elaine claims that she wants to continue with the study.

So, here's the problem: the experiment requires that one person receive some mild shocks while another person observes. Elaine, however, is clearly suffering. As the observer, you can see this. The experimenter asks you if you would be willing to take her place. If you had the chance to take her place, would you? In other words, would you take the shocks so that Elaine doesn't have to?

Suppose these were your only options: take the other participant's place or stay and observe her suffer. In situations like this in which escape is not an option, people usually help Elaine. After all, if you can't leave, then the only way you can reduce your distress (i.e., guilt) is to keep the other person from suffering.

Yet what if you were presented with the option to leave immediately? You won't have to watch Elaine agonize. The really interesting finding of Batson's studies is that when people have this option to leave, they still volunteer to take her place. Even though leaving would be the easiest way to relieve their distress, people pursue the less pleasant, more altruistic alternative of helping Elaine.

Still, critics (such as House) might claim that the prospect of physical escape did not seem sufficient to participants in this study because it could not have relieved their guilty conscience. Follow-up studies have ruled out this alternative. These experiments found that even when participants had options that would allow them to escape without having guilty afterthoughts (such as claiming impediments to helping or noting the inaction of others who could help), they still helped, regardless. Studies such as this specifically contradict the negative state relief hypothesis because participants do not pursue easier alternatives to helping that could just as effectively reduce their guilt. They instead pursue the more difficult and less egoistic option of genuine helping.

We can thus conclude that helping is motivated at least at times by altruistic, in addition to egoistic, motivations. Altruism seems to be real. It's important to note that we can't conclude that people never help for purely egoistic reasons, only that this is not always the only impetus for helping.

Characterless Helping: the Influence of Situations

In addition to altruistic and egoistic motives, research has demonstrated that helping is caused in part by factors that seem random, arbitrary, or both, such as our moods, whether we're in a hurry, the gender and attractiveness of the person in distress, whether other people happen to be around and are looking, and levels of ambient noise. The absurdity of some of these "situational" factors that determine helping is truly amazing. Studies show that nice weather, visualizing a vacation in Hawaii, and eating cookies all serve to increase helping.

The list goes on, but we will limit our discussion to one situational factor that seems especially relevant to House: the degree to which we feel similar to the person in need of help. Generally speaking, we are more likely to help those who are similar to us than those who are dissimilar. This is referred to as the similarity bias. It's a subtle and disquieting form of reflexive favoritism. Frequently, we aren't even aware that it is factoring into our decisions, and the criteria we use to gauge this similarity can be ludicrously superficial, such as the type of clothes someone happens to be wearing.

As rational as House is, he is not immune to this sort of influence. Take, for example, an instance involving a patient whose medical condition resulted in frontal lobe disinhibition. This ailment causes the patient to experience great difficulties in refraining from uttering all kinds of offensive opinions and attitudes; he has lost the ability to censor his true thoughts, which is greatly undermining his relationships with his family and friends. Sounds familiar, right? Sounds a lot like House. Just as we would predict in light of the similarity bias, House is more compassionate toward this patient than usual. He shows some genuine empathy. In an uncharacteristic move, House petitions Chase to perform a risky surgery in order to cure this patient's symptoms, which at this point are non-life-threatening:

Chase: You want me to help you? Tell me why.

House: Why what?

Chase: Why you care. The puzzle's solved. The guy's alive. And the odds of coming out of this surgery with that same status aren't that great.

House: My patient has a quality-of-life issue.

Chase: He says awful things. Hardly a medical condition.

House: When he leaves here, he's going to lose his family. He's going to alienate the people he works with, and if he ever finds a friend who's willing to put up with his crap, he'll be lucky. Until he drives them away, too.

Chase: I'll see what I can do.

—"The Social Contract"

House's desire to prevent this patient's long-term suffering goes above and beyond his usual level of concern. This increased compassion is presumably the result of their apparent similarities and potential for shared destinies. The situation is one main cause of House's helping, and we are all likewise subject to situational influences such as these.

So what? Who cares? Well, the fact that these random situational cues determine helping suggests that character is much less important than once thought in deciding who engages in helping behavior. It is not so much our stable personalities that lead to acts of helping, but rather the ephemeral and often arbitrary environments in which we find ourselves. Character still matters, but it has to share a large portion of the responsibility for helpful acts with factors for which we can't so readily take credit. House would have no problem admitting that he helped a patient simply because "She was hot!" Would you be comfortable admitting the same?

Our Selfish Pedigree

Finally, I will address the perspective that evolutionary biology has on helping. This train of thought begins with the idea that many, if not all, of the moral sentiments we find in human beings can also be found in animals. For example, many animals have been observed helping one another. Even feelings such as empathy and reciprocity (the compulsion to return a favor or redress an offense) are experienced by animals. It is these same very basic emotions that stimulate human helping. Thus, human helping is not qualitatively different from animal helping. When considered in this light, helping may be no more than a biologically useful behavior, despite the way it feels to us when we do it or the value we place on it in our society. We do it because it works. It helps the species. It transmits our genes.

(Continues...)



Excerpted from House and Psychology by Ted Cascio Leonard L. Martin Copyright © 2011 by John Wiley & Sons, Ltd. Excerpted by permission of John Wiley & Sons. All rights reserved. No part of this excerpt may be reproduced or reprinted without permission in writing from the publisher.
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