Gatekeeper Syndrome

If the original Milgram obedience experiment weren’t scary enough, in the 1960s a researcher named Hofling did a variant in which nurses were ordered to give twice the maximum dose of a certain drug. The drug was not on the hospital’s approved list, the order was given by phone, and the nurse didn’t know the doctor giving the order. Yet 21 out of 22 nurses obeyed. (They were stopped just before giving the drug.) Hofling concluded that of the several intelligences that might have been involved in the situation, one was absent.

I thought of this research when I learned about a remarkable case of anaesthesia dolorosa. Anaesthesia dolorosa is a condition where you lose sensation in part of your face and have great pain in that area. It’s rare; it’s usually caused by surgery. In 1999, Beth Taylor-Schott’s husband had an operation for trigeminal neuralgia that left him with this condition. In the ensuing years, all sorts of pain medications failed to solve the problem. Then he had another operation:

In January of 2008, David underwent a gamma knife procedure to ablate the sphenopalentine nerve bundle. Before the procedure, we were told that 16 other patients had had the procedure, and that all of them had experienced either complete recovery without drugs or an 80% reduction in pain. So we were optimistic going in. It was only after they had done the surgery that the doctors admitted that they had never done it on someone with AD before and that all those other patients had had atypical facial pain. The surgery had no effect as far as we could tell.

Shades of my surgeon claiming the existence of studies that didn’t exist. But that’s not the point. The point is this: After reading Atul Gawande’s article about mirror therapy for phantom limb pain, she and her husband tried it. “Within 2-3 days, his pain was down to zero.” It stayed there so long as they continued the mirror therapy. Soon after this they were able to eliminate his pain medication.

I asked Taylor-Schott what the reaction of her husband’s doctor was. She replied:

David’s actual pain doctor wrote back a single word, if I remember correctly, which was “fantastic.”

Wow. An incurable debilitating pain condition quickly and completely eliminated without drugs or danger or significant cost and . . . a pain doctor isn’t interested. Let’s call it gatekeeper syndrome: lack of interest in anything, no matter how important to your work, that doesn’t involve you being a gatekeeper.

I said that showed remarkably little curiosity. Taylor-Schott said that was typical. I agree. After I lost 30 pounds on the Shangri-La Diet, my doctor expressed no curiosity how I had done so. A friend of mine showed his doctor some data he had collected highly relevant to how to treat his condition; his doctor wasn’t interested.

Curiosity is part of intelligence. Not measured on IQ tests — a serious problem with those tests. To lack curiosity is to be just as brain-dead, in a different part of the brain, as those too-obedient nurses. Taylor-Schott speculated that curiosity was beaten out of doctors in medical school. Or perhaps much earlier. Curiosity doesn’t help you get good grades in college.

In my experience, college professors have their own problems along these lines. UC Berkeley has a fantastic selection of talks, year after year. I almost never saw a professor at a talk in a department different from his own — no psychology professor (other than me) would attend a talk in nutrition, for example. At statistics talks, I almost never saw a professor from another department. Curiosity had been beaten out of them too, perhaps. Professors who lack curiosity produce students who lack curiosity . . . it makes sense. It sort of explains why Berkeley professors had/have a such a narrow view of intelligence; to them being smart means being good at what college professors do. It also explains why the lack of measurement of curiosity on IQ tests is so rarely pointed out.

And it explains why Taylor-Schott and her husband learned about mirror therapy from a magazine article rather than from one of the many pain doctors they consulted.

9 Responses to “Gatekeeper Syndrome”

  1. dilys Says:

    Just one more iteration — a friend’s brother, after about a year on the Paleolithic Diet, had a blood test in which the tech and the doctor agreed they had never seen such high scores of “good cholesterol.”

    Neither one was interested in what he was doing that might have caused this.

  2. Andy McKenzie Says:

    Seth, instead of assuming that all of these things (med school, college, doing conventional research) reduces or “beats out” creativity, why not just make the simpler assumption that most people just don’t have this curiosity in the first place? It didn’t help them get there, but it probably wouldn’t have hurt either.

  3. Aaron Blaisdell Says:

    @Andy, There may be some truth to what you say. I try to spark curiosity in the pre-med students taking my seminar in Animal Cognition. Usually a few of the 20-30 students show lasting curiosity week after week. The rest don’t show much expression so I don’t know what they’re actually thinking. Perhaps just what will be on the next quiz or test so that they can study to get an A in the course. Same with my comparative psychology course which usually enrolls about 80-100 students, most pre-med psychobiology majors. a handful will show genuine interest and ask intelligent (by which I mean creative and interested) questions, but a good majority of the students hardly make a peep in class. Of course absence of evidence isn’t necessarily evidence of absence (of creativity or interest), but I know where I’ll bet my money.

  4. seth Says:

    Andy, because young children are curious. All of them. In a world without schools, that’s how you learn. That’s the first reason. The second reason is that there are examples where a facility that isn’t used or encouraged or rewarded goes away. The obvious example is language, where distinction not used in the language are no longer heard. A less obvious example is the urge to decorate. For a long time in Communist Croatia, to decorate your house was forbidden. When Communist control subsided, it took a long time for the urge to come back.

    Aaron, I found my Berkeley students were intensely curious about stuff related to what they wanted to do after they graduated, like be a nurse. But yeah, I remember when I was a grad student at Brown, a lot of the students in my statistics section (I was a TA) couldn’t see the point of anything that wasn’t going to be on the test.

    I think it’s normal to be interested in stuff related to what you do for a living and not be interested in other stuff but what these pain doctors seem to be saying to the Taylor-Schotts is what they do for a living isn’t alleviate pain but make money. Since mirror therapy doesn’t involve them making money, they’re not interested in it.

  5. Nathan Myers Says:

    My wife’s grandmother spent a year on doses of Tegretol so strong she couldn’t walk safely, prescribed for trigeminal facial neuralgia. (She said it felt like electric shocks to her cheekbone.) I finally persuaded her to talk to a specialist, and it turned out that a simple procedure, essentially inserting a spacer between two nerve fibers, completely cured the problem. Her doctor hadn’t been interested enough to find out about the treatment, or to refer to her to someone who knew, and just prescribed stronger doses.

    My wife’s grandfather died of prostate cancer, which it now turns out is caused by a virus, XMRV, the same virus that appears to cause Chronic Fatigue Syndrome. For a long time anyone presenting with CFS was referred to the psychiatrists. Arguably what actually did him in was the radiation treatment, which entirely transformed him in just a few weeks; afterwards he was just waiting to die.

  6. epistemocrat Says:

    I’ll chime in as that (recent) pre-med student. The process does not foster curiosity. It punishes creativity and curiosity in many ways. To make it into and through medical school, residency, etc., students have to ‘put their heads down’ and just go (don’t look left, right, or back)–it’s the most effective way to jump through all the hoops set up by academia. Deviating too far from this path is counterproductive in terms of gaining admission, excelling on standardized tests, and receiving accolades.

    Unfortunately, this approach is flawed philosophically and does not necessarily translate into future physicians who practice medicine effectively, with insatiable curiosity. I had to create my own major to pursue my curiosity–that was not recommended in terms of looking good on medical school applications. I did it anyways; my path was much more valuable that way for me. When I elected to do my Master in Health Administration degree following undergraduate, instead of go straight to Medical School, on of my friends at UCSF Med School asked, “Why would you do that? Do you like studying that stuff?” Every medical decision is an economic/financial/policy decision, I thought, and I pursued my curiosity further. Experienced physicians praised me for foresight, but I still penalized myself in terms of jumping through the mainstream hoops most successfully.

    Our educational system focuses on the known, not the unknown. Curiosity helps children interact with the unknown. After awhile of schooling that teaches them the grand importance of the known, that curiosity starts to go dormant, unfortunately.

    The more you standardize education, the more you drown our curiosity.



  7. seth Says:

    “The more you standardize education, the more you drown our curiosity.” Yes, I think that’s exactly right.

  8. Alex Chernavsky Says:

    Perhaps lack of curiosity is a factor here, but I think there are other reasons for the type of behavior that Seth described. There is a book that sheds considerable light on this issue. The book is called, “Mistakes Were Made (But Not by Me): Why We Justify Foolish Beliefs, Bad Decisions, and Hurtful Acts”, by Carol Tavris and Elliot Aronson. Here is the Amazon page:

    This is the best book I’ve read in the last year. You’ll recognized relatives, friends, and co-workers on every page (and perhaps yourself, if you are honest).

  9. Darrin Thompson Says:

    Maybe you’ll nuance this a bit in time? (black-and-white, mmmm?) ;-)

    I’m curious enough about self experimentation to read about others’ results, even try out some of their finds, but not enough to invest time measuring every day.

    I’m curious enough about Deming’s methods and Lean to read library books and popular bookstore books about the subject, but not enough to pay $40 or $hundreds for more expensive training materials.

    I was really curious about the technical details of creating a story. I was half tempted to try and scrounge up $600 and airfare for McKee’s seminar. Lucky for me, I found he authored a bookstore priced book. That was one of my best finds last year. Story is a fabulous read.

    Note, I’m a computer programmer. I’ve made a habit of trying to study outside my field and it’s amazing what I’ve found. Here’s _why_ agile works, according to Deming. Here’s what Lean manufacturers do. Did you know that “waterfall” never worked anywhere? Anywhere? We didn’t “borrow” it from anywhere. No one does it and sees it work.

    So I’m definitely living out the curious thing, but I have my limits.

    Your professor friends who don’t attend each others’ talks are truly missing out on half the excitement of their jobs. You get go to the presenter and breathlessly tell them how what they just said relates to your field, or even the other way around. Did you know … ?!