COMMON SOURCES OF ERROR

The Influence of Language and Persuasion Strategies

T

^wo COMMON SOURCES of error involve use of language and the influence of social-psychological persuasion strategies. Clinicians use words to describe people and events, to describe relationships between behavior and events, and to express evaluations. Language is used in posing and

"thinking" about clinical questions and in processing material read in profes- sional books and articles. Although considerable attention has been devoted to problematic use of language on the part of clients, less attention has been devoted to exploration of how common sources of error influence clinicians in their daily practice. The words clinicians use not only shape their own experi- ences and actions but those of their clients as well. The tendency of clinicians to say "Yes, I know this" without becoming knowledgeable about the specific ways language and persuasion strategies influence clinical decisions is an obstacle to avoiding these sources of error. Here, too, as with other sources of error described in this book, having a name for a fallacy highlights its unique- ness, and may help us to recognize and plan how to avoid it.

THE INFLUENCE OF L A N G U A G E

Many critical thinking skills involve recognition of the ways in which lan- guage may affect decisions (Halpern, 2003; Johnson, 1946). Language plays an important role in clinical practice. Discussions between clients and practition- ers and the nonverbal reactions that accompany these are a key component in most practice frameworks. Use of language is also integral to decisions made during case conferences and in court presentations, as well as in interpreta- tions of clinical records. All writing in the professions and the social sciences can be viewed as rhetorical in that a position is advanced and a point of view is presented that is then reviewed for its soundness (Edmondson, 1984). The term rhetoric has varied definitions: (1) "the art of using words effectively in

speaking or writing; now, the art of prose composition (2) artificial eloquence;

language that is showy and elaborate but largely empty of clear ideas or sin- cere emotion" (Wehsterk Nezu World Dictionary, 1988). It is in the latter sense that the term is in ill-repute. It is not unusual, for example, to hear someone say "we need less rhetoric and more straight facts." When rhetoric is defined in its broader sense, as in the first definition above, it is an important area of study and skill, especially in helping professions that rely heavily on the spo- ken and written word.

Three basic reasons that language may compromise the quality of decisions include carelessness, lack of skill in writing and thinking, and deliberate intent on the part of a speaker or writer. The many functions that language serves complicate understanding of spoken or written statements. One function is description. Description of clients, procedures used, and progress achieved is an integral part of clinical records. The aim of descriptive statements is to in- form (for example, "Mr. Larkin has been hospitalized three times."). We can find out whether they are true or false. Another function is to persuade others to believe or act differently Clinicians attempt to persuade clients to act, think, or feel differently in problem-related situations by talking to them. Use of language is a critical influence when considering the evidentiary status of different assessment or intervention strategies, whether talking to oneself or to colleagues. A third function of language is purely expressive-to express some emotion or feeling or to create such a feeling without trying to influence future behavior. Other statements direct or guide us, as in "Call the parental stress hotline." A given statement may serve several functions; not only may a speaker or writer have more than one purpose in mind when making a state- ment, but the listener or reader also may have more than one in mind, which may or may not match those of the speaker. The context is used to interpret the speaker's or writer's purpose. Language also has presymbolic functions, such as affirming social cohesion (as in "Isn't it a nice day?"). Lack of understand- ing of this function may result in naive assumptions about the triviality of con- versation, as Hayakawa (1978) notes in his "Advice to the Literal-Minded (p. 85). Only if we correctly understand the motive behind a sentence may we translate it correctly

Words differ in their level of abstraction. At the lowest level are definitions in extensional terms. The extensional meaning of a word refers to what it points to in the physical world; it is what the word stands for. A psychiatrist could point to the disheveled clothes of a person admitted to an emergency psychiatry unit, or to the behavior of pushing a nurse. Many words have no ex- tensional meaning-that is, there is nothing we can point to. In operational definitions, a rigorous attempt is made to exclude nonextensional meaning, as in the definition of length in terms of the operations by which it is measured.

The intentional meaning of a word refers to what is connoted or suggested.

Clinicians may act toward people, objects, or events in accord with the inten- tional (affective) connotations associated with a name. For example, reactions

t o terms such as "sociopath" or "welfare recipient" m a y go far beyond the ex- tensional meaning o f these terms without recognizing that this is happen- ing. Definitions describe our linguistic habits; they are statements about h o w language is u s e d . T h e higher the level o f abstraction, the less the utility o f re- ferring t o a dictionary definition to capture meaning, especially intentional meaning.

FALLACIES RELATED T O L A N G U A G E

Problems related to use o f language that influence the quality o f clinical decisions are described in the following, together w i t h suggested remedies.

This list is b y n o means exhaustive, and readers are referred t o other sources for greater detail (e.g., Halpern, 2003; Hayakawa, 1978; Thouless, 1974). Care- lessness is o f t e n responsible for foggy writing and speaking-not taking the time and thought to clearly state inferences and reasons for them.

Predigested Thinking This term refers t o the tendency to oversimplify complex topics, issues, or perspectives into simple formulas that distort content, such as describing Freudian theory as reducing everything t o sex or describing behavioral theory as favoring mechanistic stimulus-response connections.

Stereotyping is a f o r m o f predigested (oversimplified) thinking. Perhaps one o f the most striking examples o f oversimplification is the assertion that a w i d e variety o f problems are caused b y "chemical imbalances i n the brain." T h e brain is very complex. Compared w i t h what there is "to know"; w e k n o w little about it, contrary to claims such as: " W e have found .

. ."

"This shows that

.

. ."

" W e n o w k n o w . .

."

W h a t is a "chemical imbalance"? H o w does this relate t o electricity i n the brain? H o w d o different chemicals interact? Oversimplifica- tions o f complex views and topics may lead t o errors and get i n the way o f further research. Varieties o f oversimplifications o f complex concepts include u s e o f words that obscures the differences between different entities, words that suggest that some phenomenon is unchanging w h e n it does change, and words that suggest differences that d o not exist.

Analogues used to simplify material m a y result i n a disregard for the real complexity o f concerns; for example, development o f hallucinations or a se- vere phobia. Consider a diagnosis o f social anxiety based o n reports o f a cli- ent-that she is fearful i n social situations and avoids them. Describing this as a "mental disorder" (assuming that such concerns are caused b y brain dis- eases) and prescribing medication, ignores the environmental context in which such reactions develop and are maintained that, i f changed, m a y de- crease related distressing reactions. It m a y misrepresent or ignore interaction among variables, and as W o o d s and Cook (1999) note, create "a false sense o f understanding and inhibit pursuit o f deeper understanding" ( p . 152). Simpli- fyingstrategies d o not always help u s to solveproblems, although overall, they m a y d o so as discussed in Chapter 9.

Referring to hundreds of different behaviors, feelings, and thoughts as

"mental disorders" (diseases) is an oversimplification; for example, it ignores the continuous nature of the vast majority of related behaviors, such as drink- ing alcohol or anxiety. Consider shyness. Eighty percent of people are shy in some situations. Are certain forms of "social anxiety" a "mental disorder"?

(see DSM IV-TR, 2000). Another example of a common oversimplification is reflected in the following answer of a doctoral student during a discussion of twin studies: "We know the environment was the same because the twins were raised in the same home." Is it the same home for each of these individuals?

Research suggests that it is not, that even twins have different environments.

As Lewontin (1991,1995) suggests, we each construct (not adapt to) our envi- ronments. Clinicians are sometimes guilty of reducing an answer to a simple formula, such as "rapists will rape again." A practitioner who does not believe that evaluation of client progress can be done in a way that is meaningful may say "evaluation is mechanistic," or "it trivializes concerns," or "it does not rep- resent the true complexity of human problems." Such views overlook the fact that evaluation can be carried out in an irrelevant or relevant manner. The lat- ter requires skill in working together with clients to select important, feasible, and sensitive progress indicators. Such views also overlook resources for deal- ing with the complexity of evaluating client progress in terms of identifying measures that accurately reflect progress (or its lack). (See for example de- scriptions of assessing quality of life.)

Another example is the statement that "a scientific approach to clinical ques- tions offers trivial answers:' What is the meaning of "a scientific approach here? What is a "trivial answer"? Predigested thinking in the form of slogans may be used to encourage actions, such as "support community care." The his- tory of the community mental health movement reveals that such slogans were used often, despite the minimal available community care for patients (Sedg- wick, 1982). Slogans are easy to remember and so are readily available to influ- ence us at an emotional level. The use of predigested thinking obscures complexities and so may encourage inaccurate inferences. This kind of think- ing is common because of indifference, lack of information, and idleness, and the fact that it often offers a practical guide for life. The tendency to simplify complex matters may help to account for ignoring the undistributed middle (substituting all for some) and the readiness to accept an extension of a position.

We can guard against predigested thinking by avoiding mental idleness, which encourages us "to accept mental food well below the limits of our di- gestion" (Thouless, 1974, p. 164). The remedy is to consider the actual com- plexity of the issue at hand as needed to arrive at accurate accounts.

Recognizing the complexities related to a question may increase tolerance for other positions. The emotional appeal of predigested thinking and the fact that it often provides a practical guide for daily life make it difficult to chal- lenge. For example, a clinician may object to the oversimplistic presentation of Freudian theory that "everything is related to sex." The other person may

protest that the objections raised are too "learned:' that "nothing will con- vince him that art, romantic love, and religion are just sex, which is generally agreed by everybody to be the teaching of Freud (Thouless, 1974, p. 161).

Note the reaffirmation of the original position (begging the question) and the appeal to consensus. As Thouless notes, if this is a discussion with other people, the user of predigested thinking can usually rely on "having their sympathy, for his opponent will seem to be a person hying to make himself out to be too clever and who makes serious argument impossible by throwing doubt on what everyone knows to be true" (pp. 161-162). The only recourse here may be to state an argument so clearly that the inadequacies of a position are quite obvious. So, challengers of predigested thinking who wish to take a more careful look at a point under discussion should be prepared that some people may not like this; negative reactions can be avoided by posing inquiries in a tactful manner and by emphasizing common interests, such as helping cli- ents achieve outcomes they value.

Pseudotechnical Jargon/Bafflegarb Jargon can be useful in communicating in an efficient manner if listeners (or readers) share the same meaning of techni- cal terms. However, jargon may be used to conceal ignorance and "impress the innocent" (Rycroft, 1973, p. xi; see also Tavris, 2001). Consider the earlier dis- cussion of misleading oversimplifications, such as claims that problems are due to "chemical imbalances in the brain." An economic incentive may per- petuate obscure writing; for example, highly specialized jargon in the legal profession increases the need to hire lawyers who can understand it. We tend to be impressed with things we cannot understand. Professors tend to rate journals that are hard to read as more prestigious than journals that are easier to read (Armstrong, 1980). Of course, it is possible that the more prestigious journals discuss more complex subjects that require more difficult language.

This possibility was tested by Armstrong. Portions of management journals were rewritten to increase readability without changing the content; unneces- sary words were eliminated, easy words were substituted for difficult ones, and sentences were broken into shorter ones. A sample of 32 management pro- fessors were asked to rate as easy or difficult versions of four such passages and also rate them on a scale of "competence" ranging from 1 to 7. They knew neither the name of the journal nor the name of the author. Versions that were easier to read were considered to reflect less competent research than were the more difficult passages.

Obscurity may be desirable in some circumstances, such as when exploring new possibilities. However, in most situations that arise in clinical practice, obscurity is not an advantage; it is often a cloak for vagueness. Examples of pseudotechnical jargon include psychic deficiencies, structural frame of reference, and generational dysfunctions. The proliferation of terms adds to pseudojargon in psychotherapy. Consider, for example, terms that Firestone and Seiden (1987) present as similar to "microsuicide."

indirect suicide parasuicide

masked suicide slow suicide

partial suicide chronic suicide

hidden suicide embryonic suicide

installment plan suicide

Who has not suffered from "bureaucratese"-turgid, unnecessarily complex descriptions that yield only to the most persistent of readers (or listeners)? Examples include "mumblistic" (planned mumbling) and "profun- dicating" (translating simple concepts into obscure jargon; Boren, 1972). The remedy is to simplify and clarify. Examples of rules suggested by Orwell (1958) include the following:

1. Never use a metaphor, simile, or other figure of speech which you are used to seeing in print.

2. Never use a long word when a short one will do.

3. If it is possible to cut a word out, always cut it out.

4. Never use the passive when vou can use the active.

5. Never use a foreign phrase, a scientific word, or a jargon word if you can think of an evervdav En~lish _,

-

eauivalent.

6. Break any of these rules sooner than say anything outright barbarous.

(p. 143)

The potential for obscure terms to become clear can be explored by ask- ing questions such as "What do you mean by that?" "Can you give me an ex- ample?" Asking such questions when reading case records and practice- related literature is a valuable rule of thumb (see list of Socratic questions in Exhibit 3.5).

Obscure language often remains unquestioned because of worries that the questioner will look ignorant or stupid. The risks of lack of clarification should be considered, as well as the risks of revealing a lack of knowledge. Writers and speakers should clarify their terms, bearing in mind appropriate levels of abstraction. If they don't, it may be because they cannot. They should be thank- ful that someone cares enough to want to understand their position and that lack of clarity is discovered. Not all people will be open to questions, espe- cially those who use vague language to hide aims or lack of knowledge they would rather not reveal. "The great enemy of clear language is insincerity.

When there is a gap between one's real and one's declared aims, one turns as it were instinctively to long words and exhausted idioms like a cuttlefish squirt- ing out ink" (Orwell, 1958, p. 142). Some people will become defensive and try to put others down for asking simpleminded questions, perhaps using their prestige to do so. They may share Humpty Dumpty's attitude: "When I use a w o r d Humpty Dumpty said, in a rather scornful tone, "it means just what I choose it to mean neither more nor less." "The question is," said Alice,

"whether you can make words mean so many different things." "The question

is," said Humpty Dumpty, "who is to be master, that's all." (Lewis Carroll, 1946, Through the Looking Glass, p. 229). A question could be asked in such a straight- forward manner that if the person still cannot understand it, his own lack of astuteness is revealed (Thouless, 1974).

Use of Emotional or Buzzwords or Images Professionals, as well as advertisers and politicians, make use of emotional words and images, as illustrated in the letter to the editor, National Association of Social Workers (NASW) News:

Example

The conspiracy of silence continues to state implicitly that social workers, because of their training and clinical expertise, cannot possibly be impaired by alcohol and drug abuse. As long as this conspiracy exists, impaired social workers will be afraid to seek help and to come out into the open about their addiction, just as I am ("Letter to the Editor," 1986, p. 15).

Comments

The term "conspiracy" is highly pejo- rative, as is "impaired." No evidence is offered that there is a "conspiracy of silence," or for the assumption that the "conspiracy" stops social work- ers from disclosing their "addiction."

No evidenceis offered for the assump- tion that people assume that social workers "cannot have a substance abuse problem because of their train- ing and expertise." It is assumed that substance abuse is "an addiction."

Emotional terms are rife in the turf battles between psychologists and psychi- atrists: Consider the opening sentence in an article in the Psychiatric Times:

"Clinical psychology is in a war for survival against American psychiatry"

(Buie, 1987, p. 25). Research regarding the role of emotions on our behavior lies in many fields, including social psychology, learning, and clinical psy- chology Our emotions offer rapid, often automatic information linked to fight-or-flight reactions. Our emotional reactions influence our decisions and how we respond to new material, or if we seek out certain material (Slovic, Fin- ucane, Peters, & MacGregor, 2002). Emotions and perceptions may precede thoughts; associated cues, which are automatic in nature (they occur without our awareness) influence behavior (Gilovich & Griffin, 2002). Indeed, auto- matic perceptions and associative responses comprise two of the three pro- cesses for making judgments (see Chapter 9).

Proverbs, similes, or metaphors that have emotional effects may be used to describe or support a position. They may be of great value in developing new ideas about how to solve problems. On the other hand, they may obscure rather than clarify a problem or issue; they may create a feeling of under- standing without an accompanying increase in real understanding. Points against a disliked (and perhaps misunderstood) position may be referred to as ammunition, and points in favor of a preferred position referred to as rea- soned and humanistic considerations. Clinicians who do not believe that clini- cal practice can be evaluated may refer to such efforts as mechanical, and may