Assumptions And Beliefs

By Gerrit Van Wyk.

There is a God. No, wait, there isn’t.

The German philosopher Immanuel Kant argued we can’t know anything without starting off with some basic assumptions. Kant’s time was dominated by Newton’s physics and Leibniz’s mathematics so he thought as a minimum we must make assumptions about space, time, how things are connected and affect each other (cause and effect), and mathematics, or numbering things to compare them. What Kant didn’t realize was he assumed Newton and Descartes’ clockwork world is how our world and reality is and works.

Today we have quantum physics and non-Euclidean mathematics describing a different perspective of space and time, hence we are more likely to describe the resulting complexity in terms of probabilities and predictions and the likelihood of our predictions to be true, and the cause and effect of for example Singer’s multiple factor recursive causality is entirely different from what Kant had in mind.

Believers believe there is a God based on their belief scriptures inspired by God is true. Scientist believe one cannot design an experiment proving there is a God, therefore God doesn’t exist. Arguments of this kind become heated and in my opinion are meaningless because they start from different premises or assumptions, in terms of which both conclusions are true. Unless you start from the same assumptions, you can’t have an argument about whether a different outcome is true. Which means it becomes an argument about whose assumptions are true. Assuming the contents of a book is true is a belief, and beliefs are not facts. At the same time, assuming things that cannot be proven experimentally don’t exist or are meaningless, is also a belief and not a fact.

You now have a problem arguing about whose beliefs are true. Belief means accepting something is true and includes faith, opinion, conviction, and judgment. Most beliefs are not based on proven facts; instead we find evidence to support what we believe, and based on that evidence believe it is true.

Beliefs are part of the image we have of ourselves, hence when I challenge your beliefs, I also challenge your self-image, which often becomes threatening. We dig in and defend a belief, not because it is true, but because admitting it isn’t cause what Festinger calls cognitive dissonance, or mental stress in simple terms. It means we are obliged to find alternative facts to support the belief under siege, or must change the belief causing the discomfort. As a rule, we will try to find new supporting evidence rather than change the belief, because changing the belief also means changing a bit of who we believe ourselves to be, and that is the difficult part. Changing the sanctity of being a believer or hardcore scientist is a big deal.

Beliefs form quickly and unconsciously, we judge others on their beliefs, accept the beliefs of people we know, trust, or belong to our group, and reject those of outsiders, foreigners, or if we don’t understand an argument. We automatically share the beliefs we grow up with; ones picked up from peers, educational cohorts, nationally, etc. Challenging collective beliefs challenges the norms and ideologies of collectives or groups, which we resist collectively for the same reasons we do so individually. Beliefs create stability and changing them instability. As Kuhn pointed out, we only change them when the contradictions they create become too big to ignore.

In short, you can’t change people’s beliefs by arguing with them or presenting them with facts.

I believe one of the keys to changing health care is acknowledging its complexity which means starting from a different set of assumptions. The problem is, all decision makers, planners, politicians, ministerial staff, consultants, physicians, nurses, etc., operate on the belief the industry is simple by assuming it works like a clockwork. Trying to convince them of the fact it isn’t fails for obvious reasons; beautifully constructed logical arguments and reams of carefully selected evidence stand no chance against pre-existing beliefs. And yet, that is the key to solving our growing problem.

There is one way to change this. When people work together on a problem during which they are mentored, they begin to see the facts for themselves and often change their beliefs based on that. In other words, learning from acting on real world issues and observing the outcome.

The opposite of belief is doubt, which in the pragmatist tradition is the trigger for starting to ask questions why things no longer are, or work as I believe, come up with explanations that may explain why, or may fix things, and trial it to see if it works. If it works, the problem is solved and I have a new belief but if not, inquiry and experimenting continues until I find a solution.

Until now we looked at official inquiries and reports, or consultants and planners with smart plans to fix health care. It hasn’t worked and we are worse off than before. The pragmatic approach I propose works bottom up rather than top down, is inexpensive to implement, and low risk, and there is therefore no reason why we can’t try it.

The immovable rock in its way is the beliefs of politicians, leadership, and decision makers in health care. Like Sisyphus, they keep heaving the rock up the same mountain which dooms them to repeating the same mistake They would do better looking for something other than a rock and a mountain to heave against.