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Imagine you are a member of a preliterate tribe on the way to invade an enemy camp. Then someone says, “Oh, man. I have a thorn in my foot. I have to turn back. Sorry guys; I can’t join the fight.” You might be skeptical. But if you both know that when he turns back, a doctor is likely to amputate his foot, you’ll have more reason to believe him.
A fascinating paper in Evolutionary Human Sciences led by Mícheál de Barra uses evolutionary game theory and mathematical modeling to describe why aversive and harmful medical treatments have been so pervasive throughout history.
The idea is that unpleasant or aversive treatments (e.g., drilling holes into skulls, amputating limbs, ingesting noxious substances, bloodletting, leeches) have been ways of making sure people are actually sick or injured. They are social technologies to make faking it more costly.
Among large-bodied mammals, humans are especially pathetic, weak, and vulnerable. We’ve had to rely on one another to survive. We are by far the most social among mammals, as well as the most physically vulnerable. Caregiving has been important for humans.
But caregiving can be exploited by deception. The range of conditions for which recipients should request care is much larger than the range of conditions for which donors should be willing to grant care.
Plainly, I might want you to care for me when I’m feeling a bit under the weather. But you might only be willing to help me if you believe I’m truly incapacitated. This gives me an incentive to exaggerate my symptoms. It allows me to save my energy while getting you to spend yours.
“There is good evidence,” the authors of the paper write, “that people harness this ambiguity in order to access caregiving which the donor would not be willing to offer had they complete information about the recipient’s disease state.”
Furthermore, it’s not uncommon for people to pretend to have illnesses or injuries.
In one survey, 30 percent of personal injury cases and 33 percent of disability and worker’s compensation cases were judged to involve deception or exaggeration. Every year, billions of dollars are lost from fraudulent claims made to insurance companies, governmental aid agencies, or charities by people who pretend to be victims.
People lie about many things. Some lie about being a victim if they can obtain an advantage by doing so.
Imagine that every time someone claimed to be ill, others unfailingly and unquestionably provided care to them. The person receives care, sympathy, kindness, food, etc., as well as an excuse to forgo their usual duties to contribute to their community. Others would reasonably respond to this state of affairs by claiming to be ill. They receive benefits while not having to pay any cost. Very quickly, there would be a community of layabouts — unless it is widely known that the treatment for being ill is unpleasant. Then people would only claim illness if they were truly unwell.
Relatedly, as I’ve discussed before, people who score high on the Dark Triad personality traits (narcissism, psychopathy, and Machiavellianism) are especially likely to engage in victim signaling. In other words, people with “dark” personalities are more willing to feign victimhood to extract rewards. Aversive medical treatments may have arisen to prevent such people from exploiting the kindness of others.
Interestingly, parents have been known to use a version of “aversive treatment.” Sometimes kids pretend to be sick to get out of going to school. Skeptical parents react by calling the kid’s bluff: “Oh, you’re sick, then I’ll schedule a doctor’s appointment.” Kids, who often hate visiting doctors, relent.
Juvenile animals also fake pain to obtain rewards. In his book about Machiavellianism, the psychology professor Tamás Bereczkei tells the story of a young male baboon who repeatedly duped adult group members. For example, the little male would see an older female digging up some nutritious roots. Then he would suddenly cry out, as if in pain. The young male's mother would then appear and think the older female was harassing her son. The mother would chase the older female away and then return to her own business. The little male would then scurry over and enjoy the roots the older female had been digging up.
Humans sometimes fake pain to receive benefits. Thus, aversive treatments arose to introduce a cost to ensure that signals are honest. Aversive treatments help caregivers to distinguish the truly ill from the pretenders. Moreover, people with symptoms that can be easily faked can credibly request care.
If you can’t see my injuries, but I tell you that I am in pain, you might be skeptical. But if we both know that the treatment for my pain is unpleasant, then you will have little reason to doubt my claims. And, thus, you’ll be more likely to help me.
Costly Cures: Harsh Treatments Appear to Uphold Social Trust
I have a very rare dual malady blood cancer, Waldenstroms Macroglobulinemia and AL Amyloidosis. I was diagnosed with the first about six years ago and the second two years later. I had a basket of weird symptoms that kept getting ignored as just general by my doctors that could not figure out what I had. I pretty much had to diagnose myself and demand the tests, and unfortunately like many times in my life where I do the hard background brain work to figure out a complex puzzle, I was right. Note that I hate being told that I was right for some reason. I get my juice from knowing I solved the puzzle... and in this case it was laterally a life vs death puzzle. I would rather people keep trying to tell me I was wrong in case there is more to the puzzle I need to try and solve. I always worry that I have blind spots... important things I am missing. Not because I fret about being wrong, but I don't want to make any bad mistakes in judgement.
But because my doctors kept telling me I was just dealing with general symptoms, my wife started to think I was going through some post mid-life crises that manifests in hypochondria. She suggested that age might be the reason I was feeling these symptoms. I might have bought that explanation had my decline not been as precipitous after being normally health, fit, athletic and energetic. She also joined my doctors in admonishing me for going my own medical research to try and diagnose myself.
Poor thing was devastated when the tests came back positive. My doctor was sheepishly apologetic. Both are now my champions in assistance with care.
For me I though... that is the way these things need to be... because otherwise the care-craving people (I am not... I have a tendency toward independence... in fact, to a fault) would be constantly self-diagnosing every twitch to get more from their doctor. If the symptoms are bad enough the average person should be motivated to become a stronger advocate for their care.
During rounds of subsequent infusion treatments where I would sit in a comfortable recliner at the top floor of the facility with windows over-looking the city... with attention from several very sweet and friendly nurses. I noted myself looking forward to those sessions simply because of the care/attention these professionals routinely administered... I started to become friends with some of them... asking about their life and family, and them about mine.
It bothered me that I looked forward to the sessions. I knew why.
Some things we crave are not good for us. It is why the Puritans would hang their chairs on a peg on the wall when not being used for meal time. Self-awareness, emotional intelligence, about the things we think we need, but generally just want or crave... throwing out the bad and focusing on the good... that is the stuff that optimizes our choice inventory and improves the odds that we have a successful, long and happy life.
If I craved the attention of the nurse care in the infusion center and pushed my doctors for more treatment than necessary, I would take space away from someone else that needed it and increase the risk from the drugs injected into my system.
I see clearly this similar human weakness at play in society today. More people injected into their adult life unable to care enough for themselves, and/or stuck in a childish pursuit of attention. They have not developed the skills of self-determination and self-awareness of this attention-craving behavior that is childish and explained by the need for survival as the human child is one of the most helpless big-headed hazardous blobs of flesh in the animal kingdom. Social media "likes" has reinforced this problem and we have grown a population of vulnerable narcissists (loved the explanation of this from a previous post by Rob). Not only are these people heat-seeking cravers of attention, but they are resentful and angry when they don't get enough... and it is never enough.
Frankly, too many are weak, soft and needy... and got this way because they never had to struggle for their lower-rung psychological needs. They enjoyed a relatively easy life compared to the historical standard for what the human animal evolved to cope with. Without that struggle they are incomplete and have a sort of societal Munchausen syndrome... seeking an identity of a societal victim and demanding more care for it. They are adult-age underdeveloped people... still children.... but with advanced degrees that they use to wield as a cutting tool to punish society for not giving them enough attention.
I keep thinking that what they really need is defined by what my father used to say to me in administering the needed tough love: "You want me to give you something to really cry about?"
Not buying it.
These unpleasant treatments may have as a beneficial side-effect of discouraging malingerers, but I doubt that is the reason they were invented.
No evidence is provided for this hypothesis, only a very theoretical argument as to why it would have been a good idea to do so.
But people of all ages and fitness do get sick or hurt, and it can happen to anyone, even doctors and healthcare workers and parents, and when it happens to you or a family member, you want the most efficacious and less unpleasant treatment possible, and that is what everyone would have been looking for, even in the distant past, the possibility of preventing malingering being very far from anyone's priorities, imo.
Not one of the better offerings here.