Thinking About Thinking

Thinking About Thinking
by Art Ticknor

                     
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We become complete when we know what we really are. Knowing our true identity is different from the type of knowing we're familiar with, though. The knower is no longer a thing apart from what's known.

But that's not all of it. There's a state of perception where a person becomes one with everything – every thing. The best-known example of this in the West is in the autobiographical poetry of Walt Whitman. The Canadian physician R.M. Bucke wrote a book on that perceptual state, which he termed cosmic consciousness. (See Bucke's Cosmic Consciousness at Google books.) Cosmic consciousness is a blissful state and is the unwitting goal of many seekers. But it's not a permanent state – and is thus ultimately unsatisfactory. As Whitman described his own case, the cosmic conscious state came to him less frequently as he grew older and stayed for shorter durations.

When we truly know what we are, there's no longer a split between the knower and what's known – and what's known is the knower. We discover or recognize that the knower is no thing. Of course we can't imagine what nothing is. The closest the mind can come is to imagine an empty space that has no objects in it. But the no-thing that we are, at the core of our being, includes all things. So we have to resort to paradox when the mind attempts to conceive of it. We are, essentially, nothing and everything.

Maslow: hierarch of needs
Whether we're conscious of it or not, we're all striving to find completion. It's the deepest need, and therefore the deepest desire, embedded in every human organism. Most people strain to find that completion by manipulating the external world or their internal world. (Abraham Maslow's hierarchy of needs chart is a classic representation of where we try to find satisfaction.) Relatively few arrive at the point where they intuit that such completion requires certainty and that such certainty cannot come until the knower is known. Language becomes contorted when we try to think about what we are or to interpret our feelings about what we are. But thinking and feeling are the two tools in our toolbox.

Feelings are facts – not right or wrong – just as perceptions are facts. Where the error comes in is in our interpretation or thinking about observed facts. And until we get to the position where we're ready to go through the final doorway to self-knowing, we have to rely on the combination of conceptual thinking and feeling to guide us.

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At the core of our existential suffering is a feeling … a feeling that something isn't right, that we're somehow incomplete.

I heard some dialogue on a TV program recently – an episode of "Numb3rs," a series about an applied math professor who helps his older brother solve crimes for the FBI – that goes to the heart of the problem. A psychologist was counseling the older brother and gave him this advice: "If you want to feel better, take a pill. If you want to get right, face the truth."

Most of us spend our lives trying to bully or seduce the world, and attempting to twist our internal psychology when the world doesn't respond satisfactorily, to make things right. What we try to avoid at all costs, though, is facing the truth about ourselves.

Why is that? Our thinking is the source of the problem – specifically the beliefs we hold about what we are. (The line between thought and feeling becomes blurred when we look at beliefs. Beliefs are feeling-convictions that we often haven't expressed to ourselves conceptually.) In order to face the truth about ourselves, we may need to do a good bit of thinking and feeling about thinking and feeling. How do we go about that productively?

I came across a fascinating book a few weeks ago titled How Doctors Think by Jerome Groopman, a practicing physician and teacher who holds the Recanati Chair of Medicine at Harvard Medical School and is chief of experimental medicine at Beth Israel Deaconess Medical Center in Boston. Groopman is an engaging writer and someone who I get the feeling would make a good friend. He relates how the research that went into the book was instigated one morning when he was doing rounds with students and residents, when he found himself asking himself a simple question about medical diagnosis: How should a doctor think?

That question triggered others, which could be summed up as: Is there a best way to think, or are there multiple, alternative styles that can reach a correct diagnosis and choose the most effective treatment? Or from another angle, "… when and why does thinking go right or wrong in medicine?"

To find what we intuit is missing in our lives that would make us complete, all we have to do is face the truth. The truth-seeker is like a physician who is his own first patient. Is there a best way to think about the diagnosis and the treatment? Where does thinking go right – or, more importantly, where does it go wrong – in the business of truth-facing?

If you're like most physicians in this respect, you won't be surprised by Groopman's discovery: "Nearly all of the practicing physicians I queried were intrigued by the questions but confessed they had never really thought about how they think."

Why is that? Why don't we consider our thinking and make allowances for its shortcomings? The simple answer is because we're too close to it, as if we had our noses against a large-screen TV.

Another finding that shouldn't be a surprise is that the physician's mood and temperament strongly influence his medical judgment. In a study of radiologists – doctors who read x-rays and more advanced image scans – the ones who tended to be risk-takers had more false positive readings (where normal conditions are seen as abnormal) while those who were risk-averse had more false negatives (seeing abnormal conditions as normal). In between were the indecisive, who were reluctant to come to any conclusion about what they saw. Duke University's advanced imaging labs found that the average diagnosis error by their highly trained radiologists runs at 20 to 30 percent. Imagine what it is for the truth-seeker diagnosing his own situation.

Dr. James Lock, chief of cardiology at Boston Children's Hospital, whose early hero was Sherlock Holmes, said: "I keep an ongoing tap on what I know…. Epistemology, the nature of knowing, is key in my field. What we know is based only on a modest level of understanding." As he gained in maturity he realized that "Impeccable logic doesn't always suffice … there are variables that you can't factor in…." The self-inquirer, the truth-seeker who is looking to find what he really is, finds that epistemology is at the heart of his inquiry, also. The pretense of knowing what we don't know – about what we are – is what prevents us from seeing and accepting what we truly are.

Donald Schön at MIT says that a good physician "expresses uncertainty, takes the time to reflect, and allows himself to be vulnerable. Then he restructures the problem." The same could be said for the productive self-inquirer.

Jerry Katz, a physician who teaches at Yale Law School, comments on the "pervasive and fateful human need to remain in control of one's internal and external worlds by seemingly understanding them, even at the expense of falsifying the data." Accepting the truth about what we control, or don't control, is a huge stumbling block for most truth-seekers.

Stephen Nimer, a physician at Memorial Hospital in New York and researcher at the Sloan-Kettering Institute, says that specialists commonly use the phrase "it's a bad disease" privately to explain why a patient isn't responding to treatment. Nimer remarks how that shifts the burden of thinking off the specialist and acts as a buffer against the fear of failure. He also notes that a focus on possible side effects often makes people reluctant to undergo treatment. That focus distorts the risk-to-benefit ratio in Nimer's opinion and avoids dealing with the problem at hand. The self-seeker often arrives similarly at a point where he labels his ignorance as intractable in order to remove the burden of inquiry, and it's very common to see truth-seekers settle for ignorance after they have arrived at the faulty conclusion that searching for the truth of what they are is opposed to "living life."

Jeffrey Tepler, a hematologist and oncologist in private practice at NewYork-Presbyterian Hospital, notes: "It's hard to think deeply about patients at the moment when you are seeing them. You need to have some quiet time to reflect and formulate a cogent opinion." He routinely leaves his office at 8:30-9:00 PM after reading recent medical literature and thinking about his patients. Imagine if the self-inquirer considered his own condition as seriously and productively as Tepler considers that of his patients.

One of the most intriguing stories in the book was the author's description of his first night in charge of a hospital ward as a new intern. He was chatting with one of the patients who suddenly went into extreme respiratory distress. Groopman said he just stood there "with an empty head and my feet fixed to the floor." Fortuitously an out-of-town doctor who was visiting a friend walked by the room just then, examined the patient, and told the author what to do. That was Groopman's first lesson in becoming his own authority. He realized, "I needed to think differently from how I had learned to think in medical school – indeed, differently from the way I had ever thought seriously in my life."

The truth-seeker will similarly reach a point where he needs to think differently from the way he has ever thought seriously in his life. Physician, heal thyself.


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