
Look at yourself objectively - myle
http://www.aaronsw.com/weblog/semmelweis
======
tptacek
Semmelweis is a favorite "management science" topic; there's even a pop-psych
phenomenon called the "Semmelweis Reflex"; the Wikipedia article on it
recapitulates much of what Aaron wrote here. The Gladwell formula of using
Semmelweis' personal narrative to articulate a frailty of human reasoning was
employed to great effect in Ayres _Super Crunchers_; the Semmelweis section
is, for instance, noted prominently in the NYT book review.

Aaron has oversimplified the Semmelweis story in some material ways:

* Semmelweis didn't institute "handwashing" in Vienna hospitals. Contrary to the conventional wisdom, which suggests that doctors in the 1840s were sticking horse-manure-covered hands into the exposed wounds of patients, handwashing was apparently already a norm. What Semmelweis did differently was to use lime to wash hands.

* Semmelweis' actual theory of the cause of childbed fever was wrong, and it was wrong in ways that made his recommendations hard to take seriously. Semmelweis' contention was that "cadaveric particles" were making their way into patients, and that those particles could only be removed by lime. But doctors observed cases in which no contact with either cadavers or injected or symptomatic patients lead to the same cluster of illnesses. It was thus difficult for Semmelweis to make a "scientific" case for why the lime worked; it obviously didn't help that he was wrong about why it did (his work predates the germ theory of disease, which would have taught him that rather than lime being effective at removing specific particles, it was instead effective at killing bacteria).

* Aaron's story (and Ayre's) has a heroic Semmelweis pleading for doctors to simply wash their hands in a specific way to save lives. But that's not necessarily what Semmelweis was arguing. Instead, the case he could have been making, loudly, was for an actual, specific, _incorrect_ cause of childbed fever.

* Semmelweis himself was, apparently long before he lost his post, a notorious asshole. It did not help his cause that instead of carefully reasoning about the actual evidence, he instead seized on a single explanatory theory of childbed fever and then demanded (often by barging into hospital wards and berating the staff) that his peers adhere to it.

The point is not that Semmelweis didn't make an important discovery, or that
we shouldn't be mindful of warped-sounding new knowledge that contradicts our
existing theories. Of course we should be objective when considering facts
that threaten our existing theories. But there's a reason John Snow and Joseph
Lister [and Pasteur] are better known in the development of the germ theory of
disease, and there's more to learn from the Semmelweis story than how the
audience to a new theory should behave.

~~~
acqq
That he named the things that were killed by lime "cadaveric particles" and
not "bacteriae" at the time nobody knew that bacteriae exist can't be
considered wrong.

How he named them was irrelevant. His explanation was good enough -- there WAS
something on the hands of the doctors that was small enough and not visible
that lime was able to destroy. Why was it hard to take it seriously then?
Certainly not because others knew better -- nobody had "bacteria" in their
language. He had to call that what was neutralized somehow.

~~~
tptacek
You're rationalizing what Semmelweis said with a modern understanding of
medicine. Of course, today, it's obvious that thoroughly clean hands help
eradicate pathogens, and so it seems obvious that to note in 1840 that
handwashing in chlorinated lime lowers death rates is to come immediately to
the crux of the problem.

In fact, doctors in the 1840s were well aware of the concept of contaminants.
They had already assumed a regime of handwashing. Moreover, Semmelweis himself
was not content to lobby attendants to wash their hands. He was instead
fixated on the idea of cadaverine particles, going so far as to invent new
vectors for their creation in cases where no contact with dead bodies could
have occurred. Semmelweis wasn't even correct about the mechanism of action in
cleaning hands; he believed the chlorinated lime more thoroughly removed
particles, when in fact the key was to kill the pathogens.

A simple way to sum the problem up: Semmelweis advocated handwashing... _for
staff who had been conducting autopsies_. Semmelweis was on to something, but
he himself seems to have missed it by a wide margin. Things could have been
different if Semmelweis himself stuck with the evidence, rather than seizing
the first bit of it that confirmed his theory and running away with it.

~~~
acqq
I hope you recognize that when you say "A simple way to sum the problem up:
Semmelweis advocated handwashing... for staff who had been conducting
autopsies" you also confirm that there were _actually_ the doctors that did
autopsies who didn't disinfect their hands. So he was obviously right. You can
just claim that he set his goals too narrow, but even that much was not
accepted by others.

~~~
nl
_So he was obviously right._

Not at all. Semmelweis thought something associated with _death_ was what was
killing people (eg, he chose chlorinated limes _which he found best removed
the stink of death_ ).

I suspect the focus on _death_ and _dead people_ meant people focused on that,
and "proved" to themselves he was "wrong".

I can imagine scenarios where doctors dealt with one woman who had a good
birth experience, didn't use the Semmelweis handwashing method (because the
first woman didn't have the death particles) and then the next woman got
infected and died. To many (unfortunately), that would prove his theory was
wrong.

~~~
acqq
Citation needed, since you claim that doctors actually used the results of
experiments to disprove him but at the same time didn't heed to the results of
the experiments that showed that using lime was obviously beneficial.

~~~
nl
_Citation needed_

No it isn't.

 _you claim_

No I didn't. I was very careful to make clear this was my opinion only ("I
suspect" and "I can imagine scenarios").

As I noted, lime wasn't _obviously_ beneficial, because Semmelweis claimed it
removed the "cadaveric particles", and yet people were still dying when there
should have been no "cadaveric particles" around (ie, no one had died).

It's like the story of how scurvy started happening again in the early 20th
century with Scott in the Antarctic[1]. In the 18th century scurvy had been
defeated by drinking (fresh) lime juice on long sea voyages, without a correct
understanding of the mechanisms involved.

Read the linked article about how it happened.

[1] <http://idlewords.com/2010/03/scott_and_scurvy.htm>

------
iSnow
While overall, I like this article, there is real danger in advice like this:

>Look up, not down. [...] to do that you need to look at the people who are
even better than you.

While this is great for those who exaggerate their skills, I doubt those would
even read this piece. For people with self-esteem problems and a tendency
towards depression, however, this is about the worst advice you can give,
because they tend to look at the top 1% already and therefore experience their
life as a complete failure.

>But people will feel more comfortable telling you the truth if you start by
criticizing yourself, showing them that it’s OK.

In theory this is fine, but if you start seriously criticizing yourself in
front of others, you anchor this critique in the minds of your listeners.

~~~
msluyter
Cordelia Fine, in "A Mind of Its Own," makes a similar point:

 _Fine says, "that your unconscious is smarter than you, faster than you, and
more powerful than you. It may even control you. You will never know all of
its secrets." So what to do? Begin with self-awareness, Fine says, then manage
the distortions as best one can. We owe it to ourselves "to lessen the harmful
effects of the brain’s various shams," she adds, while admitting that applying
this lesson to others is easier than to oneself. Ironically, one category of
persons shows that it is possible to view life through a clearer lens. "Their
self-perceptions are more balanced, they assign responsibility for success and
failure more even-handedly, and their predictions for the future are more
realistic. These people are living testimony to the dangers of self-
knowledge," Fine asserts. "They are the clinically depressed."_

~~~
bobwaycott
Is this merely a correlation, or are you (or Fine) attempting to posit
causation here? That is to say, is this merely pointing out that viewing "life
through a clearer lens" is seen in connection with higher frequency of
clinical depression, or is the inference here that this clearer lens _causes_
clinical depression?

I find it a hard case to make the latter statement, and the former statement
doesn't imply (to me) that one ought to eschew the clearer lens. I wonder if
there is some analysis that digs into what mental processes, emotions,
thoughts, etc. occur in the wake of viewing the world through the clearer lens
that might lead to clinical depression?

I _feel_ like there could be some not-so-weak element of not having as
balanced a view/method of how to respond to one's failures that would lead
toward depressive thought patterns. I don't think self-esteem issues are
_caused_ by viewing oneself more objectively and rationally, but instead by
placing unwarranted weight on the (potentially errant) _conclusions_ one draws
from a more objective view of oneself. That is, if one has a more balanced and
nuanced objective view of the world, but has an equally unbalanced and un-
nuanced view of oneself--say, that one's abilities or potential for
improvement are strictly circumscribed and not easily changed--I would hedge
my bets toward that person having a greater likelihood for depression than
someone who does not draw such conclusions.

I think I tend toward viewing myself and others fairly objectively, and
actively work to do so. I also compare myself to others I subjectively and
objectively find better in some ways. But then I respond by improving the
parts of me that I have found to be weaker than those who are a level above my
own. I don't experience depressive thoughts (that I am aware of). (shit,
that's just anecdotal and can be dismissed. nevermind.)

[edit: typo and calling out my own anecdotal evidence that is unhelpful]

~~~
msluyter
I'm not really asserting any sort of causal effect; I just thought it was
interesting. Here's a bit more detail on the topic:

[http://biasandbelief.pbworks.com/w/page/6537201/Is%20Bias%20...](http://biasandbelief.pbworks.com/w/page/6537201/Is%20Bias%20Beneficial)

~~~
bobwaycott
Thanks a bunch. I didn't think you were asserting causality; just thought you
might know if Fine was instead.

------
Jun8
This is a well-written and useful article. If a lot of people are against you
you may be onto something big, or you may be just wrong.

I wonder if Aaron will discuss the furor caused by his JSTOR activism
([http://bits.blogs.nytimes.com/2011/07/19/reddit-co-
founder-c...](http://bits.blogs.nytimes.com/2011/07/19/reddit-co-founder-
charged-with-data-theft/) also see the many discussions on HN, e.g.
<http://news.ycombinator.com/item?id=2781615>). The case here is not as clear
cut as, say, the case of Semmelweis. I am also undecided (hate the greedy
closed magazines, don't quite approve the sneaking in part) on it.

I would really know what his objective analysis of the situation is unless
he's already done a post that I've missed or if he can't talk about a court
case.

~~~
hansef
I'm fairly sure that the federal case against Aaron is still being litigated
(<http://en.wikipedia.org/wiki/Aaron_Swartz#JSTOR>), which means that he
almost certainly can't discuss details publicly.

------
ChuckMcM
I've always told people that many of the best conversations with folks have
started out with "Chuck I think you are wrong and here's why ..." This is
especially useful when you are "important" (like someone's boss) because
getting honest feedback when you are the boss can be nearly impossible at
times.

Steve Bourne (yes _that_ Bourne) told me once that you should try to cultivate
people who could give you a different view on the world, That is helpful stuff
but you do have to also get people to be honest. That is hard to do if they
think you're 'hot headed' or likely to shoot the messenger.

------
Evgeny
_saying “You were right, I was wrong.” It didn’t destroy her reputation; it
rescued it. [...] Wayne Hale took full responsibility: “The bottom line is
that I failed to understand what I was being told…I am guilty of allowing
Columbia to crash.” He was promoted. When JFK admitted the responsibility for
the Bay of Pigs fiasco was “mine, and mine alone,” his poll numbers soared_

I would guess that the survivorship bias is at play here. How many people we
will never hear about took responsibility and were demoted, fired or
prosecuted?

~~~
pdonis
Not only that, but Aaron seems to be skating perilously close to the position
that admitting that you screwed up is, in itself, sufficient reason for you to
be promoted. It's not.

------
BCM43
I think the biggest challenge of this is finding friends that will tell you
when you are wrong. And no wonder, it's really hard.

A friend of mine sent me a short story that they wrote not to long ago, and it
was not very good. But I could not bring my self to say that, instead I made
some little criticism and did not comment on the writing as a whole.

Anyone have tips on how to do this better?

~~~
dpkendal
The tricky aspect here is that most people believe that taste, and the
'quality' of artistic work, is mostly a subjective matter, but when they make
criticism of art they treat their views as objective truth. Thus when you
criticise a friend's work, or vice versa, the temptation is to think of it as
"(Your|their) work sucks!" instead of "Oh well, (I|you) didn't like it, maybe
someone else will."

Semmelweiss, on the other hand, had no subjective matter. He had the
statistics showing that as soon as doctors started washing their hands, infant
mortality went way down. It was just the doctors' pride which made them think
he was accusing them of regularly killing newborn babies.

Of course there _is_ bad art which everyone agrees is terrible, and telling
people that truth is hard. In the end, though, it's better to be honest
because it's probable that your friend would respond with a determination to
do better next time. The trick is to be tactful.

~~~
finnw
It's easy to criticise a minor detail of a friend's work, but harder to say
"you don't have the talent for this, give up."

~~~
ryanmolden
>It's easy to criticise a minor detail of a friend's work, but harder to say
"you don't have the talent for this, give up."

I would question whether most people honestly have the expertise to make a
judgement like 'you don't have the talent for this, give up'. I think people
routinely overestimate their own abilities and discernment. Taking a
hasty/faulty analysis and then telling someone to 'give up' seems like a
terrible idea.

------
iandanforth
While this, on its face, looks like good, morally sound advice, I worry about
the practicality of it for a certain class of individuals.

The people I see in leadership positions are far more likely to be
narcissistic sociopaths than reflective mediators.

If you're not in a position of power / individual freedom, this is excellent
advice to make sure that you can, and are seen to, play nice with others. It
will probably help your blood pressure and promotion prospects. I'm just not
convinced that this strategy is one that leads to the top more often than
brutal myopia and conceit.

~~~
bstpierre
I don't think he meant "top" meaning (necessarily) leaders of a hierarchy. I
think it meant more like look to people who are performing "better" than you
-- for whatever thing you want to measure.

------
Alex3917
Just wanted to add that there is another interesting article here that links
the Theory of Contagion to sympathetic magic:

[http://laphamsquarterly.org/essays/very-
superstitious.php?pa...](http://laphamsquarterly.org/essays/very-
superstitious.php?page=all)

Apparently the idea that diseases can spread through contagion is a prime
example of something that was previously considered to be magic that later
came to be accepted by science.

~~~
saraid216
Sympathetic magic was one of the first forays into actual science. It sought
explanatory power for phenomena. That they did this ass-backwards and
propagated through superstition and rumor is why it's not _actually_ science,
but when you start talking about controllable and manipulable mechanisms,
you've taken the first important step.

"Magical thinking" doesn't refer to this. It refers to an utter ignorance of
the mechanism, leaping from observation to conclusion without isolating any
variables experimentally.

------
jblz
Really good stuff. I'll try to take it to heart.

Thanks for sharing :)

Small gripe: 30em-wide text is pretty tough (for me, at least) to read on a
high-res display

~~~
BryanB55
agreed. I hate when people have anything less than 14pt font now. Luckily I
have a readability for chrome installed.

------
etruong42
>"people will feel more comfortable telling you the truth if you start by
criticizing yourself, showing them that it’s OK."

I disagree with this assertion. Some people criticize themselves in hopes that
their listeners will contradict them. For these self-criticizers, affirming
their critical statements greatly upset them. I have not found much
correlation in my personal life between people who criticize themselves and
their ability to listen to criticism. There are other attributes which I have
found correlations, such as being easygoing and thoughtful. I still often try
to gauge a person's willingness to listen to criticism by starting with very
small criticisms and working my way up.

------
limist
A bit of observation, of self or others, will quickly show we all exhibit the
Semmelweis Reflex at some time or another:

<http://en.wikipedia.org/wiki/Semmelweis_reflex>

------
naner
_This is what we’re taught: make five compliments for every criticism,
sandwich negative feedback with positive feedback on each side, the most
important thing is to keep up someone’s self-esteem._

 _But, as Semmelweis showed, this is a dangerous habit. Sure, it’s awful to
hear you’re killing people—but it’s way worse to keep on killing people!_

Semmelweis did exactly what you're advocating and he was marginalized for it.
Maybe he would have fared better if he was more conscientious of their
feelings?

------
ozim
That was what I hated about my previous work. Damn management was so
protective that you could feel good about yourself, so there was no negative
feedback and there was no way you could improve. I think they wanted us to
work for them for low wage and never get better job. But in the matter of
facts we sucked badly at that job, I felt this, and I felt it when I was going
to interviews, I got new job and we'll see how it will turn out.

------
astrofinch
Great post. Whenever I remember, I try to thank people who criticize me, so
they'll be willing to do it again. They really are taking a risk.

------
ilaksh
The thing about new ideas being rejected (better/different hand washing)
reminds me of how everyone thinks that a web page or web application UI must
to be hand coded.

I think that is very stupid and eventually we will use graphical tools to
create the UIs for web pages and web applications and look back at the days
when every single web page had to be hand coded in HTML and CSS and laugh.

------
incision
I'm always up for an Ignaz Semmelweis [1] reference. I read his story for the
first time when my woman was taking a Microbiology course. Incredible stuff.

1: <http://en.wikipedia.org/wiki/Ignaz_Semmelweis>

------
di
> Force students through an embarrassing initiation to take a class, and
> they’ll insist the class is much more interesting.

Does anyone know which experiment he is referencing here?

~~~
jeremyjh
There are so many studies like this it is hard to say which one specifically
he may be referring to. There is a mountain of literature on the topic; as
usual, Wikipedia is a good place to start:
<http://en.wikipedia.org/wiki/Cognitive_dissonance>

~~~
mistercow
It frustrates me a little when people conflate cognitive dissonance with
effects caused by dissonance reduction, like in this article. Cognitive
dissonance is simply the uncomfortable experience of believing two conflicting
things. Dissonance reduction is the class of biases that we use to reduce that
discomfort.

------
MattSayar
Semi OT, but I signed up for email alerts at the bottom of the previous
article in this series, and haven't received an email since. Am I alone with
this?

~~~
joshmlewis
Maybe email him and let him know?

------
krat0sprakhar
I've started loving this new series started by Aaron. Thanks a lot, Aaron.
Keep 'em coming!

~~~
evmar
These posts have been reminding me of Malcom Gladwell, in the unfortunate way:
an collection of interesting anecdotes that together would make an interesting
story instead are blown up into a broader statement that doesn't seem to
follow.

~~~
barking
I agree. There is also a bit more to the Sammelweis story than simply doctors
refusing to be self-critical.

From the wikipedia article on Sammelweis
(<http://en.wikipedia.org/wiki/Ignaz_Semmelweis>):

"It has been contended that Semmelweis could have had an even greater impact
if he had managed to communicate his findings more effectively and avoid
antagonising the medical establishment, even given the opposition from
entrenched viewpoints."

~~~
HarryHirsch
> It has been contended that Semmelweis could have had an even greater impact
> if he had managed to communicate his findings more effectively

This is the point. Anyone who is properly introspective is already following
the good advice given here. But how about the total ramrods one has to deal
with on occasion, those people who are crazy and deluded, whose self-
confidence totally exceeds their grasp of the subject matter? Blessed is the
man who can say to his line manager "I won't deal with N.N. any longer, he is
incompetent and unaware of it." But sometimes the constraints of work do not
permit not dealing with some people, or the boss is the crazy one. What to do
in such situations?

------
lectrick
This anecdote, holy crap.

