P A R T O N E The Good: Unlimited Vicodin COPYRIGHTED MATERIAL ch01.indd 5 8/8/2011 12:38:52 PM ch01.indd 6 8/8/2011 12:38:52 PM In the Patient’s Best Interests? Perspectives on Why We Help Others TED CAScIo eeling sick? I recommend Princeton-Plainsboro Teaching Hospital. FThe doctors and the nurses there are exceptionally skilled. They don’t save everyone, but they do have a very high success rate—even for extremely rare and difficult cases. The staff can be summarized in two words: they help. As Cameron puts it in the pilot episode, “Isn’t treating patients why we became doctors?” I have to admit that there is at least one doctor on the staff who may seem a little rude and obnoxious—even cruel—but does that matter if you get better? Actually, it does seem to matter. Although the sort of beneficence practiced by doctors is surely valuable, maybe even virtuous, helping’s ultimate moral status is seldom clear-cut. We wonder. And even when we feel pretty sure, we tend to be critical. Cameron, in particular, has frequently been forced to bear criticism for her seemingly reflexive self-sacrificial tendencies. She’s even been accused by House and others of having a sort of helping pathology. On their so-called date 7 ch01.indd 7 8/8/2011 12:38:52 PM 8 T E D C A S C I O that kicked off season 3, House accurately (and in typical point-blank fashion) identifies this supposed condition as the primary basis for her romantic involvement with him: House: You have no interest in going out with me. Maybe you did, when I couldn’t walk, when I was a sick puppy that you could nurture back to health. Now that I’m healthy there’s nothing in it for you. Cameron: You are not healthy. —“Meaning” And yet Cameronesque fervor is clearly not a necessary precondi- tion for helping. Most people (including House) help one another. We are psychologically predisposed to both care about and do something about the suffering of others. That is interesting, because things could have been so different. Why aren’t we selfish instead? Shouldn’t we all simply pursue our own self-interests? Does it really make sense to sacrifice our time, energy, money, and sometimes lives for the sake of another person’s well-being? If so, why? Psychology offers some interesting insights into these cos- mic questions that you might not have thought to consider, and it challenges some prevailing assumptions. One of these assump- tions is that people help out of genuine concern for other people’s well-being. That assumption has been challenged. Another is that people help because they are strongly compelled by their unique dispositions to do so—or not—depending on some, usually hazy, notion of “character.” Helping doesn’t happen by accident; rather, it is character-driven. That assumption has also been challenged. Another doozy is that only human beings help one another or, at minimum, that human and animal helping are fundamentally and qualitatively different. This assumption has been challenged since the days of Darwin. You will walk away from this chapter with a better understanding of the truly complex underpinnings of helping behavior. You will see why helping is not quite the pure, wholesome act it’s usually depicted as. At least, that’s not the whole story. This may alter your perspective ch01.indd 8 8/8/2011 12:38:52 PM I N T H E P AT IE NT’ S B ES T I NT E R ES T S ? 9 on House, on your friends and family, and even on what it means to be human (as well as humane). Finally, I hope this chapter convinces you to become less self-centered and to make helping people in need a fundamental concern in your own life. We’ll start with the various motives that inspire helping. When people help one another, are they actually just trying to indirectly help themselves? Isn’t All Helping Actually Egoistic? Consider that doctors may help patients for many different reasons. They may help because they 1. Want to relieve the patient’s suffering 2. Are simply doing their jobs 3. Enjoy the challenge of the diagnosis and the treatment 4. Are seeking fame and power 5. Hope that doing so will bring attention to their research project or their pet disease 6. Want to feel like Superman (or Superwoman) Notice anything about this list? Only the first item reflects helping in the pure selfless or altruistic sense. In each of the other examples, the doctor helps primarily to benefit himself or herself. The patient may get better, but this is merely a side effect of a selfish or egoistic motive. Egoistic helping is motivated by a desire to advance the interests of the person doing the helping, rather than those of the person in need. We saw House engage in egoistic helping when he becomes convinced (correctly, of course) that one of the actors on Prescription: Passion—his favorite soap opera—has a life-threatening medical con- dition. House decides to intervene by abducting him from the set of the show and chauffeuring him to Princeton-Plainsboro in order to be treated. When the unfortunate fellow finally realizes what is going on, House willingly admits that “I don’t care if you die, but if Brock Sterling dies, Anna never finds out he’s the father of Marie’s baby” (“Living the Dream”). This is a classic (and pretty hilarious) instance ch01.indd 9 8/8/2011 12:38:52 PM 10 T E D C A S C I O of egoistic helping. House does this type of thing frequently. In this case, he is concerned for the other man’s life only insofar as the man’s continued existence is necessary to keep the story line alive on his favorite TV show. Egoistic helping at its best. House’s general assumption seems to be that people are apt to deceive themselves and others about their true motives for helping. According to House, when we say that our motive for helping another person strictly involves concern for his or her welfare, the true motive is often one that is more egoistic and likely to benefit us directly. It’s no surprise, then, that House harbors suspicions about motives and generally distrusts people’s claims about what inspires their helping behavior. For example, many doctors may claim that they chose their pro- fession because they “want to help people.” As usual, however, House is not shy about proposing alternatives: House: People act in their own self-interests. You’re all here because you’re happy to be here or at least because it’s your best option. Kutner: I’m here because I want to help people. House: No, you’re here because it makes you feel good to help people. Taub and Foreman are here because they’ve got no other viable choices, and Thirteen is desperate to make her life matter before it’s over. —“The Greater Good” House is what we’ll call an egoistic reductionist. His cynical inter- pretation of people’s helping behavior is part of his larger philosophy about why anyone does anything. According to him, every act is ulti- mately in the service of self-interest. As House puts it in a conversa- tion with Wilson: Wilson: Apologies aren’t supposed to make you feel better, they’re supposed to make the other person feel better. House: In order to make you feel better. —“Under My Skin” ch01.indd 10 8/8/2011 12:38:52 PM I N T H E P AT IE NT’ S B ES T I NT E R ES T S ? 11 One psychological hypothesis that jibes neatly with House’s interpretation of helping is called the negative state relief hypoth- esis. It suggests that individuals help in order to reduce the sense of guilt that they would experience if they didn’t help. This is a form of egoistic helping, even if the other person ends up being benefited. Sometimes House—and the negative state relief hypothesis—is right on target. At some point toward the end of season 5, Kutner ominously fails to show up for the morning differential (we learn later that, sadly, this is because he committed suicide). When House begins to “politely inquire” into the situation, Taub, of all people, attempts to defend Kutner by devising an excuse for him, something House natu- rally finds suspicious. He doesn’t believe Taub would help without a direct personal incentive. House’s doubts are later vindicated when it is revealed to him that earlier, Taub dishonestly claimed credit for one of Kutner’s diagnostic ideas, a transgression that elicited the guilt that impelled him to come to his friend’s assistance. Despite Taub’s best efforts, House is never fooled. Later, sizing up the situation in characteristically cynical terms, House affirms with relish, “I thought maybe you were lying to cover for Kutner, which sounds noble, except you’re doing it out of guilt instead of love” (“Simple Explanation”). This example perfectly illustrates the negative state relief hypothesis. When guilt reduction is the driving force behind our actions, any helping that might follow is egoistic in nature. Are egoistic hypotheses such as these enough to explain all help- ing behavior? Probably not. A series of studies by Dan Batson and his colleagues demonstrated that altruistic helping is a real phenomenon.