Paradigms can have phenomenal longevity

A paradigm refers to a framework of ideas, beliefs, and assumptions that forms a particular worldview or approach to understanding and interpreting a specific subject or phenomenon. Over time, a paradigm can become the dominant perspective or worldview that shapes the way individuals and communities think about and approach a particular subject.

This is not intrinsically problematic, but paradigms have a way of enduring much longer than they should. The existence of a standard framework for thinking about a topic is not the problem, it is when the standard framework itself is never reconsidered or assessed that problems arise and persist. Paradigms are helpful, but thinking about thinking about paradigms is essential.

Often, it is the most revered exponents of a paradigm who entrench it as the dominant framework, regardless of its actual efficacy. The more that the leaders of a paradigm are perceived as elite and superior, the more likely the paradigm they defend will be unquestioningly assumed to be true—no matter how far removed from the truth it may actually be.

One of the reasons that Galen, the second century physician to Roman emperors, was so trusted and his teaching so revered as true was the strength of his confidence. He did not suffer from doubt and his belief in his assumptions was robust enough to survive any number of head-on collisions with reality. He said of one potion:

All who drink of this treatment recover in a short time, except those whom it does not help, who all die. It is obvious, therefore, that it fails only in incurable cases.

The obvious confirmation bias in Galen’s statement is typical of the priests of paradigms who enthusiastically perform the rituals and ordinances of the paradigm without ever questioning their own assumptions about its efficacy. This self-assuredness tends toward blindness as to the deficiencies of the paradigm while increasing the sense of importance of those who lead it. Galen said of himself:

It is I, and I alone, who have revealed the true path of medicine.

And what was this “true path” of medicine? One of Galen’s most enduring errors was the belief that fevers are caused by an excess of blood—an assumption devoid of even the slightest connection to reality. The treatment was self-evident: remove the excess blood of the afflicted. “A patient with a fever should be bled twice a day, the second time to the point where they fainted. (Galen’s belief in blood-letting was extreme—He even recommended it as a cure for blood loss.)“^[1]

What is astonishing about the paradigm of blood-letting as a cure for sickness is not only how utterly wrong it is, but for how long it persisted. Sir William Osler, a founding professor at Johns Hopkins University and later the Regius Professor of Medicine at Oxford, on pneumonia:

To bleed at the very onset in robust, healthy individuals in whom the disease sets in with great intensity and high fever is good practice.

He was writing in 1920, almost two millennia after Galen.^[2] How many people were harmed (and even killed) because of this bankrupt paradigm that persisted for twenty centuries? Tetlock recounts a well-known example:

When George Washington fell ill in 1799, his esteemed physicians bled him relentlessly, dosed him with mercury to cause diarrhea, induced vomiting, and raised blood-filled blisters by applying hot cups to the old man’s skin. A physician in Aristotle’s Athens, or Nero’s Rome, or medieval Paris, or Elizabethan London would have nodded at much of that hideous regimen. Washington died.^[3]

Tetlock then makes a very important observation about why practitioners of a paradigm often get stuck in that paradigm:

One might assume that such results would make physicians question their methods but, to be fair, the fact that Washington died proves nothing about the treatments beyond that they failed to prevent his death. It’s possible that the treatments helped but not enough to overcome the disease that took Washington’s life, or that they didn’t help at all, or that the treatments even hastened Washington’s death. It’s impossible to know which of these conclusions is true merely by observing that one outcome.^[4]

Meaning: as long those in the paradigm only attempt to answer their questions and solve problems from within the paradigm, they will never recognize the intrinsic deficiencies of the paradigm itself. It is only when they begin to question the paradigm itself—thinking about thinking about the paradigm—that the possibility for breaking through to new understanding of the truth becomes possible.

#paradigms #metacognition