Wednesday, October 5, 2011

Pathological altruism...very dangerous and ubiquitous

By Natalie Angier, New York Times, October 3, 2011
Some years ago, Dr. Robert A. Burton was the neurologist on call at a San Francisco hospital when a high-profile colleague from the oncology department asked him to perform a spinal tap on an elderly patient with advanced metastatic cancer. The patient had seemed a little fuzzy-headed that morning, and the oncologist wanted to check for meningitis or another infection that might be treatable with antibiotics.

Dr. Burton hesitated. Spinal taps are painful. The patient’s overall prognosis was beyond dire. Why go after an ancillary infection? But the oncologist, known for his uncompromising and aggressive approach to treatment, insisted.
“For him, there was no such thing as excessive,” Dr. Burton said in a telephone interview. “For him, there was always hope.”
On entering the patient’s room with spinal tap tray portentously agleam, Dr. Burton encountered the patient’s family members. They begged him not to proceed. The frail, bedridden patient begged him not to proceed. Dr. Burton conveyed their pleas to the oncologist, but the oncologist continued to lobby for a spinal tap, and the exhausted family finally gave in.
As Dr. Burton had feared, the procedure proved painful and difficult to administer. It revealed nothing of diagnostic importance. And it left the patient with a grinding spinal-tap headache that lasted for days, until the man fell into a coma and died of his malignancy.
Dr. Burton had admired his oncology colleague (now deceased), yet he also saw how the doctor’s zeal to heal could border on fanaticism, and how his determination to help his patients at all costs could perversely end up hurting them.
“If you’re supremely confident of your skills, and if you’re certain that what you’re doing is for the good of your patients,” he said, “it can be very difficult to know on your own when you’re veering into dangerous territory.”
The author of “On Being Certain” and the coming “A Skeptic’s Guide to the Mind,” Dr. Burton is a contributor to a scholarly yet surprisingly sprightly volume called “Pathological Altruism,” to be published this fall by Oxford University Press. And he says his colleague’s behavior is a good example of that catchily contradictory term, just beginning to make the rounds through the psychological sciences.
As the new book makes clear, pathological altruism is not limited to showcase acts of self-sacrifice, like donating a kidney or a part of one’s liver to a total stranger. The book is the first comprehensive treatment of the idea that when ostensibly generous “how can I help you?” behavior is taken to extremes, misapplied or stridently rhapsodized, it can become unhelpful, unproductive and even destructive.
Selflessness gone awry may play a role in a broad variety of disorders, including anorexia and animal hoarding, women who put up with abusive partners and men who abide alcoholic ones.
Because a certain degree of selfless behavior is essential to the smooth performance of any human group, selflessness run amok can crop up in political contexts. It fosters the exhilarating sensation of righteous indignation, the belief in the purity of your team and your cause and the perfidiousness of all competing teams and causes.
David Brin, a physicist and science fiction writer, argues in one chapter that sanctimony can be as physically addictive as any recreational drug, and as destabilizing. “A relentless addiction to indignation may be one of the chief drivers of obstinate dogmatism,” he writes. “It may be the ultimate propellant behind the current ‘culture war.’ ” Not to mention an epidemic of blogorrhea, newspaper-induced hypertension and the use of a hot, steeped beverage as one’s political mascot.
Barbara Oakley, an associate professor of engineering at Oakland University in Michigan and an editor of the new volume, said in an interview that when she first began talking about its theme at medical or social science conferences, “people looked at me as though I’d just grown goat horns. They said, ‘But altruism by definition can never be pathological.’ ”
To Dr. Oakley, the resistance was telling. “It epitomized the idea ‘I know how to do the right thing, and when I decide to do the right thing it can never be called pathological,’ ” she said.
Indeed, the study of altruism, generosity and other affiliative behaviors has lately been quite fashionable in academia, partly as a counterweight to the harsher, selfish-gene renderings of Darwinism, and partly on the financing bounty of organizations like the John Templeton Foundation. Many researchers point out that human beings are a spectacularly cooperative species, far surpassing other animals in the willingness to work closely and amicably with non-kin. Our altruistic impulse, they say, is no mere crown jewel of humanity; it is the bedrock on which we stand.
The Christian church, at least much of it, is an incubator for "pathological altruism" and one of the most difficult skills to teach from  a pastoral perspective is the skill of asking the other, "What do you need from me?" There is a kind of  built-in automatic switch to "help" that triggers whenever one person, especially one professionally trained in medicine, or even trained in the discipline of selflessness finds another in need. Run amok, this energy literally drowns the "recipient" especially if and when the recipient is unwilling and unready.
Saint Benedict, one of the more progressive of the mendicants, reminds us never to do the work another needs to do and this is a guide that can be helpful in setting boundaries, those necessary limits to "intervention"....
We each have enough of our own "work" to do to heal from the many wounds, separations, losses, alienations and psychic injuries inflicted both overtly and covertly in our lives to keep us busy for the rest of our time on the planet. Reminding ourselves of that need to heal, and to do the work necessary to move in that direction can be another guiding reminder to attend to our own business, even when it would be so gratifying to inflict our help on another.
Just yesterday, as I coldly returned a "morning" to an unfriendly, cold, and arrogant man, he walked away laughing at me believing, I suppose, that I could not or did not hear his derision. He is derisive of everyone: the neighbour artist who "thinks her art is good" as he puts it,  the liberal whose is "soft" on hard power and the dog owner whose dog disturbs him with minimal whining while the owners are at work. Of course, I want to smack him verbally, if not physically. And of course, I am righteously indignant at his smirking, supercilious laughter.
However, that is his problem, not mine. And the less attention and energy I give to his childish insult, the less stress I put on my own psyche.
The neurologist's spinal tap was neither wanted nor needed; many of the interventions, "to help" are unsolicited, unwanted and consequently resented. It is when we ask for help, and are specific in our request, and that request goes unheard, from sources capable of assisting that we are most distressed. We have done our work; we have concluded that we cannot fix a situation alone; we have reached out for help to someone capable of helping. And when we receive a stone wall, a closed ear and door, a pocketed hand, instead of the hand-up we sought, we can be devastated.

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