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.
Maybe a better illustration would be Peter Pronovost's efforts to get hospitals to use checklists. His studies show that using a checklist for routine procedures like inserting a catheter dramatically reduces infection rates, saving lives and money. It's such a huge win that you'd think checklists would take the medical world by storm, but that hasn't happened. Convincing doctors to use a checklist requires overcoming their self-image of competence; it's too easy for a doctor to think, "I know I have to wash my hands before inserting a catheter, I don't need some nurse with a checklist to remind me."
Of course, Pronovost's story is less dramatic than Semmelweis. Pronovost has been more carefully about drawing conclusions from his observations, done a better job of presenting his ideas, and been more successful—hospitals are adopting his methods, if slowly and sometimes grudgingly. He's not likely to die alone in an asylum. To my mind, though, that makes a better illustration of Aaron's thesis.
Aren't you supposed to regard empiricism above all else in science? While holding to that rule would force Semmelweis to alter his theory as well, the observation of the highly reduced mortality rates should have forced the medical powers that be to reconsider things also - the burden is on them to make a scientific case for why lime had nothing to do with the decreased mortality rates.
I agree there were probably other reasons they fired him, but I think that only helps Aaron's points.
Semmelweis went "on tilt" with his hypothesis. Even after doctors adopted a regime of disinfecting hand washes, hospitals still saw a significant rate of childbed fever. Semmelweis demanded of the scientific establishment that they recognize cadaverine tissue as the cause, going so far as to suggest that tissues in the mother were occasionally being crushed during childbirth, and later becoming gangrene, and thus mothers were infecting themselves.
Again: my point isn't that Semmelweis didn't make an important discovery, or that the scientific establishment of the time didn't miss a critically important opportunity; my point is that there is more to the story than the missed opportunity of Semmelweis' detractors.
I don't much care about the injustice of Semmelweis losing his post at a hospital in the 1840s. I am, on the other hand, fascinated by how poor framing and communication, close-mindedness, and overall bloody-mindedness prevented Semmelweis himself from becoming the godfather of the germ theory of medicine.
After all, it's relatively easy to be objective when the facts are overwhelming and communicated by a sensible and rational messenger. Under these circumstances, only the most pig headed caricature would cling to preconceived, faulty, notions.
However, it's much harder to take seriously criticism that originates from a volatile and unpopular source. Doubly so if their own theory or notion is flawed. Under this circumstance, it's extremely easy to avoid self-observation.
For instance, in this case it should not have mattered too much that Semmelweis's theory was demonstrably incorrect. What should have mattered was the clear causality linking disinfectant hand washing and a reduced rate of labor mortality. They had an easy out, and they took it. That reaction is all too common.
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.
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.
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.
No it isn't.
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. 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.
His peers, instead of investigating further, chose to just disregard it completely, and keep killing women.
This history is a perfect example about how being correct doesn't mean you're right. It's the difference between being logic or wise. Sadly, I see this reaction all too often.
All knowledge in the world is worth nothing if people can't reason, use intuition, be empathic and remove the ego out of the equation. Western-culture prides itself about scientifical feats and economical progress, but still has much to evolve about developing human beings. That was in 1800, but can easily happen today - just look at global warming theory.
See Einstein: his findings started as hunches and creative exercises. Nobody though about light being a particle-wave, or combining space and time, because they were limited to preconceived notions ("it's either a particle or a wave", "time as conceived by Newton").
It's often necessary to start from intuition to get to new places.
>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.
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."
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]
And yet that piece of advice is situated quite firmly in the midst of other practices that are intended to help balance drawing such erroneous conclusions--reverse your projects, take the outside view, etc.
These bits of advice really work in tandem with one another. They're not a "if you could do just one thing, pick something from this option list" set of prescriptions. Reversing your projections includes reversing your projections about yourself, as well. Especially when they are non-objective projections. How do you find these non-objective projections? By taking the outside view of yourself. How can you possibly get toward a better objective view of yourself from the outside? By criticizing yourself for your non-objective conclusions, finding honest friends, etc.
> 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.
This strikes me as a relatively dubious assertion. Is there some citation that shows this happens with significant frequency to be wary of it? I've never experienced such anchoring (consciously) toward others who are self-criticizing (in an objective, non-deprecating way).
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... 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.
It does occur to me, though, that a post of his about legitimate self-critique might actually be somewhat related to regrettable past deeds such as you mention.
Or, I could be wrong. Who knows?
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.
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?
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?
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.
In hindsight, we can see that he was right and it doesn't matter why. But there are also plenty of other stories where acting too soon, before having a real, theoretical understanding of what's going on, would have been a lot more detrimental in the long run.
Could not agree more. I have design based startup where we do digital home staging for real estate clients and this is our most difficult problem, getting past the subjectivity of interior design.
It's funny to see the exact same furniture used for various different clients and see the wide range of feedback we get from "I love it" to "that looks terrible" and usually the negative feedback is always expressed as definitive comments like "that does not work" or "this NEEDS to be changed". Someone recently even went so far as to say that a mug should be next to a coffee machine instead of a cup.
Even though we state that we are appealing to the majority of home buyers and not individual preferences I have yet to find a good way to get past design subjectivity. I think it is just human nature to inject our preferences into artistic things and express them as if it is the other person's work that sucks.
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.
With that said, I've critiqued writing I've not liked, but I rarely say, "I didn't like this", but rather I point out everything I think needs improvement, with at least one specific example to back up my point. As giving vapid criticism is easy, and producing works is typically much harder, I attemtp to put some effort into my feedback.
And always be aware that there's a good chance that what you might view as an improvement may not be. I'm no more offended that one doesn't incorporate a given piece of my feedback than I'd expect them to be in getting the feedback.
- Benchmarking (to a peer group)
- Clarity (what does/does not come across)
- Technical (pro-tip: this is how to fix)
Of course, some of the onus is on the submitter on how s/he selects the reviewer. This will be a function of how serious they are, and what their purpose is.
An expert reviewer will typically benchmark you to an attainable but more advanced peer group. A lay-reviewer is usually useful for feedback on clarity, direction, or purpose. If something is truly lacking, a reviewer may ask about the intended goals of the project. This typically segues to a discussion on a sub-section of the work that has some merit (hopefully) . Maybe an idea, concept, example. This is still useful, and the reviewer/s avoid painting the whole thing with a broad brush.
Edit: Just wanted elaborate, re: Benchmarking.
For creative work, typically, an exchange is "This part is strong. This part needs work." And the you are referred to somebody elses work:..."Take a close look at what these guys are doing [list XYZ]". It then falls on the reviewee to follow up. And this is where the real feedback takes place. Where you see just what is expected of you and you get a sense of how hard/easy the next step is. But the act of direction, support, and (hopefully) inspiration is what leads to the success.
* Critique the story, not the writer.
* Remember that it's your *opinion*, and phrase it as such.
This, of course, assumes that your friend specifically asked for a critique when sending you the story.
The only thing I can think of is to make a concerted effort to be honest. Not too honest. I have noticed that if you're too honest it comes off as rude and abrasive even if it's true. Hopefully that will encourage my friends to be honest with me which is the kind of honesty I value the most from all the people I know in life.
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.
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.
"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.
Thanks for sharing :)
Small gripe: 30em-wide text is pretty tough (for me, at least) to read on a high-res display
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.
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?
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.
Does anyone know which experiment he is referencing here?
I suspect it falls into this general realm: http://en.wikipedia.org/wiki/Effort_justification
edit: Specifically I believe I recall this (from the linked Wikipedia page) in Thinking Fast and Slow:
One of the first and most classic examples of effort justification is Aronson and Mills's study. A group of young women who volunteered to join a discussion group on the topic "Psychology of Sex" were asked to do a small reading test to make sure they were not too embarrassed to talk about sexual-related topics with others. The mild-embarrassment condition subjects were asked to read aloud a list of sex-related words such as "prostitute" or "virgin". The severe-embarrassment condition subjects were asked to read aloud a list of highly sexual words (e.g. "fuck", "cock") and to read two vivid descriptions of sexual activity taken from contemporary novels. All subjects then listened to a recording of a discussion about "Sexual Behavior in Animals" which was dull and unappealing. When asked to rate the group and its members, control and mild-embarrassment groups did not differ, but the severe-embarrassment group's ratings were significantly higher. This group, whose initiation process was more difficult (embarrassment = effort), had to increase their subjective value of the discussion group to resolve the dissonance.
The cited study is: Aronson, E., & Mills, J. (1959) The effect of severity of initiation on liking for a group. Journal of Abnormal and Social Psychology ,59, 177-181.
I don't have specific cites, but I do recall reading this in various psychology texts.
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."
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?
He isn't exactly making controversial points here, but rather trying to raise the awareness of such ideas.
He also isn't trying to sell you a pop-intellectual book.