Drugs again

[Tim_Carey]

[From Tim Carey (971223.1010)]

I'm back.

I've joined the recent posts on "Drug Happy" together because there are
parts of all of them I'd like to respond to.

To begin with I'd like to restate my main point. We are _not_ able to
comment intelligently _from a PCT_ perspective about the effects of drugs
at the moment ... _any_ drugs. My current understanding is that drugs are
used by professionals at the moment to treat the _actions_ of a person.
When we say a person is now doing better on drugs, what do we mean? Are
they producing actions that we, as professionals, like to see (sounds a lot
like what Skinner did) ... or are they able to control more effectively
perceptions that are important to them? My answer to this is, at the
moment, WE DON'T HAVE A CLUE .... control isn't even being considered.
Perhaps clients are doing better on drugs
because the drugs knocked out the references that were _really_ important
to them (which may have been what all the crazy, or psychotic, or depressed
actions were about) and left them in a state of having references that
are easy to control but relatively unimportant (from their own subjective
perspective). Maybe because of the drug they're not even aware of that
happening.

Current drug treatments are evaluated with respect to their ability to
modify actions. Is this what PCT is about? A lot of the discussion here
seems very linear ... "give them _this_ drug, for _these_ actions"

This conversation seems amazingly parallel to the one on reinforcement that
was on the net a while ago. I seem to remember someone (I think it was
Rick) saying that from a PCT perspective reinforcement does not exist.
There seems to be a lot of people applying PCT jargon at the moment to
stuff that _is not_ PCT. We could, if we were game, interpret Skinner's
research in terms of PCT, but it wasn't, and never will be PCT research. We
can describe what happens in a reinforcement paradigm from a PCT
perspective but that doesn't make it PCT. I've seen lots of kids in lots of
classroom "get better" through the use of reinforcement ... ie they
produced the actions that the teacher wanted to see when they were given a
particular thing. If we throw a bit of PCT-talk in here to explain what's
going on, does that make the reinforcement program PCT .... I think not. I
think the same applies to drug therapy. In fact it almost seems that
reinforcement programs and drug treatment approaches are the applications
of behaviourist and cognitive theories respectively. If person A gives
person B a drug so that person B will produce different actions, and person
B does indeed produce different actions ... can we talk about this person's
life being better from a PCT perspective? Did we identify any controlled
variables in person B's life before the drug treatment ... are we
investigating them now? If not, I don't understand how we can talk about
the effects of drug treatments on a person's life from a PCT perspective.

Allow me to illustrate:

        [From Bill Powers (971222.0535 MST)]

        These drugs are more than "recreational." They are destroyers of
        organization. And I think the same is probably true of every psychoactive
        drug, no matter how benificent the short-term effects may appear to be.

Tim:
Maybe they are destroyers and maybe they aren't (although I suspect they
are), how do we know, what do they destroy in terms of the PCT model, what
aspects of control do they interfere with?

        [From Bruce Gregory (971222.1100 EST)]

        You may be allowing your use of the word "drug" to tar very
        different kinds of chemistry with the same brush. The SSRI's
        work in very different ways from traditional drugs and have
        quite different consequences.

Tim:
But do they have anything to do with control??

        Bruce G:

        You are assuming that
        the SSRIs work against reorganization but you really have little
        evidence to support your claims. A better case can be made
        that they facilitate reorganization.

Tim:
What better case? Who's researching this? I would say _both_ cases have
exactly the same amount evidence ... zilch!

        [From Rick Marken (971222.0830)]

        The fact that Kay still had problems
        that could now be approached in a normal way does nothing to remove
        my doubts about the problem being "hardware".

Tim:

From memory, this is a self report from Kay. So when he is up to his

eyeballs on liquid Prozac and he reports that he can now approach problems
in a normal (whatever that is) way, do we take his word for it? Is a man
who is medicated in this way in a normal state? What were Kay's problems
before? What are they now? When I say problems, I'm speaking of PCT
problems ... problems of control.

        [From Bruce Abbott (971222.1135 EST)]

        When the loss of neurons crosses a
        threshold, the motor tremors and muscular rigidity that are characteristic
        of Parkinson's disease begin to develop, because the loss of inhibition in
        the basal ganglia effectively raises the gain in the motor system to the
        point of oscillation.

Tim:
How do we know it raises the gain Bruce? Has there been PCT research done
on this or is this a guess (even though it sounds like a pretty good
guess)?

        Bruce A:

        I agree whole-heartedly with your message that "recreational" drugs can
        and do serve to short-circuit normal modes of functioning, allowing the
user
        to substitute taking the drug for other actions that would normally be
        required to achieve similar phenomenal effects.

Tim:
By this do you mean that they are taking the drug in an attempt to more
effectively control perceptions that are important to them? How do you
know? You say "allowing the user to substitute taking the drug for other
actions" is taking the drug an action or a consequence of action?

        Bruce A:

        I also agree that simply
        prescribing a drug as the avenue of first resort (the quick fix) is to be
        avoided unless there is some immediate crisis for which the drug provides
        an immediate, though temporary solution (e.g., a person living with
        overwhelming dread may be so distracted that he or she simply cannot
        attend to therapeutic interventions such as the method of levels).

Tim:
For whom is the drug an immediate though temporary solution ... the
therapist or the client? What is it a solution to? Is it solving the
problem of problematic output or input?

        Bruce A:
        But I also understand that some conditons can be dealt with effectively
(at present) in no other way, and in such cases the benefit may greatly
outweigh the risks.

Tim:
What do you mean by effectively? More able to effectively control? What is
the benefit? Benefit to whom?

        Bruce:
        I don't think anyone here is recommending the cavalier prescription of
        psychoactive drugs as the "quick fix" for every problem, but it must also
be recognized that this pharmacological arsenal does have its appropriate
        applications for some clients as part of a carefully conducted and
        monitored program of intervention.

Tim:
Bruce, I think it is far more important to realise (particularly for people
who subscribe to PCT) that we do not have ANY IDEA of how to apply drugs
appropriately at the moment if we think of the person in front of us as a
living control
system.

        Bruce:

        There has also been a tremendous number of lives saved or bettered by it;
        one must not forget that either. As always, one must carefully
        weigh the potential costs and benefits in each individual case, and then
        hope that the decision made was the correct one.

Tim:
How have their lives been bettered? How many come off the drug at a later
stage and are able to control better than they did before? Is keeping
someone on drugs for the rest of their life making their life better? What
potential costs and benefits?

I realise I've just taken on practically the entire PCT establishment but I
am really trying very hard to learn this stuff and I think if we want the
rest of the world to get it, we've got to first make sure we've got our
message right. Consistency is very important to me. I may be way off base,
and if so, I want to know ... as I said I'm here to learn.

I dream about the day when the problems of humanity will be approached from
a PCT perspective and I see the large scale drugging of sections of our
population as one of the problems of humanity. I don't know about the
situation in the U.S. but the ease with which kids can be medicated in
Australia for ADD is frightening. I actually find it amusing in a perverse
kind of way, that when kids are little we teach them to take pills whenever
there is a problem and then when they become teenagers we complain because
they start to "self-medicate"!!!

Again, my main point is: if PCT is an accurate conceptualisation of a
living organism, then current conceptualisations of living organisms are
_wrong_. This means that the way we currently conceptualise psychological
disorders is _wrong_. We, therefore, can't have any sensible discussion
about the pros and cons
of drug use for problems until we know what the problems are. Maybe then we
can start to use drugs appropriately, intelligently and responsibly. And
maybe then we will discover that we don't need to use drugs after all .....

Cheers,

Tim

[Bill_Powers1]

[From Bill Powers (971223.0550 MST)]

Tim Carey (971223.1010) --

To begin with I'd like to restate my main point. We are _not_ able to
comment intelligently _from a PCT_ perspective about the effects of drugs
at the moment ... _any_ drugs. My current understanding is that drugs are
used by professionals at the moment to treat the _actions_ of a person.
When we say a person is now doing better on drugs, what do we mean? Are
they producing actions that we, as professionals, like to see (sounds a lot
like what Skinner did) ... or are they able to control more effectively
perceptions that are important to them? My answer to this is, at the
moment, WE DON'T HAVE A CLUE .... control isn't even being considered.
Perhaps clients are doing better on drugs
because the drugs knocked out the references that were _really_ important
to them (which may have been what all the crazy, or psychotic, or depressed
actions were about) and left them in a state of having references that
are easy to control but relatively unimportant (from their own subjective
perspective). Maybe because of the drug they're not even aware of that
happening.

I think you've put your finger on a basic lack of communication here. PCT
is about controlling perceptions; no conventional approach is about that.
To speak of controlling perceptions is not just a roundabout way of saying
"behaving." In the conventional view, behaving is doing things that _other
people_ can perceive. But other people can't see each other's perceptions;
they see only each other's actions. This means that if drugs are observed
to have some effect on behavior, they are affecting actions in a visible
way (what people say and do), but are having an unknown effect on the
ability to control perceptions.

I think this is the basic point about PCT that we fail to communicate
clearly to those who are still thinking of behavior in conventional terms.
It's too easy to hear the term "control of perception" and instantly
translate it into "actions that I can observe." The very term "behaviorist"
means an interest in _observable behavior_, and NOT controlled perceptions.
The behavioral illusion is not just an interesting phenomenon: it's the
very core of the difference between conventional psychology or psychiatry
and PCT. The conventional approach is to study the effects of environmental
manipulations (including drugs) on observable actions. The PCT approach is
to study the effects of both environmental manipulations and observable
actions on _controlled variables_, which are the key to inferring
_controlled perceptions_.

Your post had an effect for me like the lifting of a fog. What a difference
it makes to have fresh points of view in this conversation!

I can see now that my difficulty has been that I've been trying to get the
PCT view across but letting the conventional view set the terms of the
discussion. By whose evaluation is the effect of a drug beneficial? If we
allow only the evaluations based on external observations of a person's
actions, we get assessments of value from the standpoint of other people
who are affected by irrational, neurotic, psychotic, or "abnormal" actions.
But we are left in the dark about the ability of the person to control his
or her own perceptions.

And as you suggest so clearly, nobody has a clue as to what the abnormal
actions were intended to control -- it's as though that just doesn't
matter. What matters is getting the person to act normally, meaning more
like the average person who doesn't have the same problems of control. When
conventional psychologists get the person to desist from the actions that
they consider unusual or bizzarre, they say that behavior has returned to
normal. But if those actions were an attempt to control some perception of
which the observer knew nothing, are those perceptions now magically under
control? Or has the person simply given up on controlling them, or had the
the whole control process, as you suggest, suppressed or removed by the
action of a drug, or ECT, or relentless social pressure?

One of the problems in this whole discussion is that psychology (much more
than psychiatry) _does_ concerned itself with the individual and the
individual's viewpoint. But it's torn between the external and the internal
points of view. On the one hand, we have talking or insight therapies, in
which the important thing is that the client understand and develop new
perceptions and ways of controlling them. But on the other hand, the lack
of a good model has made these methods relatively ineffective (people still
argue about whether psychotherapy has any measurable effects at all). This
leads psychologists to want to use the methods of medicine; for years,
psychological associations have tried to obtain the right for psychologists
to prescribe and administer drugs. So we can have the same psychologists
insisting on the benefits of interactive therapies and at the same time
adopting the medical arguments that basically scoff at the idea that you
can cure a person of anything just by talking.

Keep it up, Tim. You're brought some clarity into this dicussion.

Best,

Bill P.

[R_Marken]

[From Rick Marken (971223.0745)]

Tim Carey (971223.1010) --

I realise I've just taken on practically the entire PCT establishment
but I am really trying very hard to learn this stuff and I think if
we want the rest of the world to get it, we've got to first make
sure we've got our message right. Consistency is very important
to me. I may be way off base, and if so, I want to know ... as I
said I'm here to learn.

What can I say about this gem of a post that Bill Powers
(971223.0550 MST) hasn't said already? I don't feel "taken on";
rather, I feel pleasantly _reminded_. You are, indeed, learning
PCT, Tim, and teaching us (including Bill and me) in the process.
The main thing you teach me (remind me, really) is how much
intellectual leverage I get by ignoring the noise of conventional
cause-effect psychology and keeping in mind -- always -- that
the behavior of living organisms _really is_ what Bill Powers
showed that it is in his landmark book: behavior _is_ the control
of perception.

Thanks

Rick

···

--
Richard S. Marken Phone or Fax: 310 474-0313
Life Learning Associates e-mail: rmarken@earthlink.net
http://home.earthlink.net/~rmarken

[David1]

If drugs result in a person being more functional as well as feeling
better, it seems to be that the person must be controlling better.

I remember one woman patient of mine, who was experiencing an episode
of depression with psychotic features, did a tracking task before and
after she took some medication for the condition. She did so much
better in the tracking task after the medication. I believe I spoke to
Bill Powers about this case.

I wish I had saved the data! The case is, in principle, repeatable.

Now that I think about it, it is well known that people diagnosed with
Schizophrenia show deficits in pursuit eye movements. Maybe I could
find out if someone has done a before and after study of this.

···

From: David Goldstein
Subject: Re:Drugs again
Date: 12/24/97

[Bill_Powers1]

[From Bill Powers (971224.0654 MST)]

From: David Goldstein
Subject: Re:Drugs again
Date: 12/24/97

If drugs result in a person being more functional as well as feeling
better, it seems to be that the person must be controlling better.

I remember one woman patient of mine, who was experiencing an episode
of depression with psychotic features, did a tracking task before and
after she took some medication for the condition. She did so much
better in the tracking task after the medication. I believe I spoke to
Bill Powers about this case.

Yes, I remember it. But you're overgeneralizing. An improvement in tracking
ability doesn't necessarily imply an improvement in higher-level
functioning. If there's some higher-order system with a problem, it may
well interfere with other systems that use the same lower-order control
processes. If you solve the problem at the higher level, the result might
well be better tracking performance. But if you just chemically extirpate
the whole higher system, that could have the same effect on tracking skill.
Eliminating the capacity to have the problem is not the same thing as
fixing the problem.

A prefrontal lobotomy can solve many personality problems, leading to
better behavior in the eyes of other people. Of course this results in loss
of whatever high-level control processes the isolated lobe was performing,
but that's not a problem any more -- there's nothing left to have the problem.

Now that I think about it, it is well known that people diagnosed with
Schizophrenia show deficits in pursuit eye movements. Maybe I could
find out if someone has done a before and after study of this.

Don't bother -- it wouldn't mean anything. Pursuit eye movements are not
what are causing the schizophrenic's problem.

Curing the symptom doesn't mean you've cured its cause.

Best,

Bill P.

[David1]

Bill Powers wrote(12/24/97)

An improvement in tracking
ability doesn't necessarily imply an improvement in higher-level
functioning.

As her therapist, I am here to tell you that there was improvement at a
higher level.

Bill said: >But if you just chemically extirpate

the whole higher system, that could have the same effect on tracking skill.

As her therapist, she became much more functional in everyday life
which suggests that this theoreticical possibility was not happening.

I am finding the anti-drug posts, including yours, annoying. People
are making ignorant statements and dressing it up in PCT language. I
hope that the people who are making these statements never have to face
the issue in a personal way. On a very practical and nontheoretical
level, psychotrophic drugs have enabled some people to function outside
of institutional settings, engage in a more normal life style than they
would have, and have resulted in a reduction of uncomfortable symptoms.
They are not everything and they are not nothing. They can be one part
of a total treatment approach which is oriented towards helping the
person become more functional, which I interpret to mean controlling
his/her life better.

···

From: David Goldstein
Subject: Re: Drugs again
Date: 12/24/97

[Bill_Powers1]

[From Bill Powers (971225.0835 MST)]

From: David Goldstein
Subject: Re: Drugs again
Date: 12/24/97

Bill Powers wrote(12/24/97)

An improvement in tracking
ability doesn't necessarily imply an improvement in higher-level
functioning.

As her therapist, I am here to tell you that there was improvement at a
higher level.

Fine. Then I would agree that there had been a higher-level problem and
that reducing it allowed better tracking to take place. But would you then
recommend that others use tracking data to see if higher-level problems had
been overcome? As the therapist, you used _other_ information, didn't you?

I am finding the anti-drug posts, including yours, annoying. People
are making ignorant statements and dressing it up in PCT language. I
hope that the people who are making these statements never have to face
the issue in a personal way. On a very practical and nontheoretical
level, psychotrophic drugs have enabled some people to function outside
of institutional settings, engage in a more normal life style than they
would have, and have resulted in a reduction of uncomfortable symptoms.

Haven't I been acknowledging that drugs are sometimes the only answer we have?

Nevertheless, I also maintain that drug therapy, as it is done today, is
itself based on ignorance. It's a purely pragmatic approach. Even when some
aspect of a drug's action can be explained in terms of biochemical effects,
only one or two steps of the process are dealt with: the "what's wrong?"
question then is abandoned in the rush to treatment.

The problem as I see it is that the human biochemical system is just that,
a _system_, in which you really can't affect just one thing with a drug.
Even if a drug could be found that had one and only one local chemical
effect, arbitrarily changing one variable in a system will inevitably
result in affecting others. The biochemical state of the system is as it is
because of countless interactions, including the effects of interactions
with the outside world and the organization of the perceptual, comparison,
and action processes in countless control systems at many levels. If there
is a chemical "imbalance," then something created that imbalance as part of
doing something else. When you step into this whole system and make
arbitrary changes in the middle of it, with no understanding of the larger
organization, you may deal with some immediate (apparent) problem and at
the same time assure that other, larger, problems will never be dealt with.

The psychotrophic drug industry is far larger and richer than can be
accounted for by pointing to extreme cases where drug treatment got
somebody out of an institution or an emergency situation and restored the
person to a comparatively better life. We're talking about a hundred
billion dollars in sales, and hundreds of millions of pills being consumed
every day. This is far from the picture you present, of careful
dispensation of drugs based on individual evaluations and careful attention
to side-effects, as the last resort when less intrusive methods have
failed. There aren't enough doctors in the world to handle this volume of
drug-taking with the kind of care that you seem to claim is routinely taken.

What we have is society gone drug-crazy, with understanding of the human
system being pushed aside in favor of an empirical shotgun approach aimed
at getting immediate results, and to hell with understanding what went
wrong so it can be prevented in the future. The attitude people have toward
drugs is that they're "medicine" which will fix whatever is wrong, from the
depression of a failed love affair to the grief of having a loved one die
or to the discomfort of a hangnail.

They are not everything and they are not nothing. They can be one part
of a total treatment approach which is oriented towards helping the
person become more functional, which I interpret to mean controlling
his/her life better.

I don't fault anyone who settles for this. Helping is better than not
helping. But I see a future in which the approach to human problems will be
very different; where we can understand the whole system, and predict the
effects of chemical treatments on the whole system rather than one
attention-getting symptom. And also, I see future in which nonintrusive
methods will become far more effective than they are today, as components
of therapy that actually do nothing very useful drop out and new methods
are found that actually help people solve their problems without
arbitrarily altering their biochemical organization. To the extent that you
defend the virtues of the present state of affairs, you're arguing against
any substantial changes that would lead to the future I want to see. Can't
you see that today's medicine and psychotherapy will some day be viewed as
laughably primitive? Why overvalue them and defend them against change,
when you know they will be superceded?

Best,

Bill P.

[David1]

Bill said:

But would you then
recommend that others use tracking data to see if higher-level problems had
been overcome? As the therapist, you used _other_ information, didn't you?

No, I am not making this recommendation. Yes, I did. It would be nice
if there were a complete set of control tasks which would quantify how
well a person was controlling at each of the levels of perception. I
know that the pursuit tracking task does this for the relationship
level. I simple used it out of curiosity. I was surprised by how poorly
she performed before the medication. Her verbal skills and social
skills did not reflect the degree of impairment. When I started to
question how she was really doing, she started to admit the severe
sleeping difficulties and the visual/tactile hallucinations of rats
crawling over her body and the delusions of men looking into her window

Haven't I been acknowledging that drugs are sometimes the only answer we have?

Yes you have. The problem is that your criteria for when you would be
willing to use drugs is probably higher than many people who are
suffering could tolerate.

Bill said:

you may deal with some immediate (apparent) problem and at
the same time assure that other, larger, problems will never be dealt with.

This is possible. But it does not necessarily have to be the case.
Most people are happy to have some relief of symptoms and are willing to
work on the real issues.

If a person is "superficial" and only wants symptom relief, are you in
favor of withholding it from him/her?

Bill said:

What we have is society gone drug-crazy, with understanding of the human
system being pushed aside in favor of an empirical shotgun approach aimed
at getting immediate results, and to hell with understanding what went
wrong so it can be prevented in the future.

Managed care is in the process of reducing therapy services to very
brief therapy. Drug therapy will become even more dominant. The
patient, let us understand the problem approach is becoming less
accepted or tolerated. Insurance companies rule. People want to go to
Dr. Mctherapy and be fixed, whether by magic substances or magic words.

Bill said:

To the extent that you
defend the virtues of the present state of affairs, you're arguing against
any substantial changes that would lead to the future I want to see. Can't
you see that today's medicine and psychotherapy will some day be viewed as
laughably primitive? Why overvalue them and defend them against change,
when you know they will be superceded?

I think you are misreading me. I am taking a more pragmatic view.
Perhaps you are undervaluing what they mean to some people. Not every
one is as strong as you.

···

From: David Goldstein
Subject: Re:Drugs Again; Bill Powers (971225.0835 MST)
Date: 12/25/97

at nighttime. Bill said:

[Bill_Powers1]

[From Bill Powers (971225.1530 MST)]

From: David Goldstein
Subject: Re:Drugs Again; Bill Powers (971225.0835 MST)
Date: 12/25/97

It would be nice
if there were a complete set of control tasks which would quantify how
well a person was controlling at each of the levels of perception. I
know that the pursuit tracking task does this for the relationship
level. I simple used it out of curiosity. I was surprised by how poorly
she performed before the medication. Her verbal skills and social
skills did not reflect the degree of impairment. When I started to
question how she was really doing, she started to admit the severe
sleeping difficulties and the visual/tactile hallucinations of rats
crawling over her body and the delusions of men looking into her window
at nighttime.

Yes, it would be nice, but there isn't such a thing. On the other hand, you
can view all that a person does as a control task, and see what is going on
as a test of how good the control is.

It's interesting that this person could so successfully conceal from you
major things like nightmares and hallucinations. I would expect that if the
pure MOL had been used from the start, such things would inevitably come
out sooner or later, and maybe sooner.

Bill said:

Haven't I been acknowledging that drugs are sometimes the only answer we

have?

Yes you have. The problem is that your criteria for when you would be
willing to use drugs is probably higher than many people who are
suffering could tolerate.

I think that like you I would put the alleviation of suffering before
theoretical correctness. But if you had a nonintrusive method that would
eliminate the immediate suffering rather quickly, as the MOL often does,
wouldn't you prefer to use it instead of drugs? I have seen more than a few
people who seemed deeply distressed or apathetic completely change their
moods in the space of 15 seconds, just from going up one level. They may
not have solved all their problems, but this kind of immediate relief
certainly would make it easier to go on -- the same argument you offer for
drug treatments.

Most people are happy to have some relief of symptoms and are willing to
work on the real issues.

True. But I think that most people, if offered a choice between a temporary
fix and a permanent one, would choose the latter. I think that most people
on chronic drug treatments would prefer to find a different way to resolve
their problems, if it were available and didn't produce worse side-effects.

If a person is "superficial" and only wants symptom relief, are you in
favor of withholding it from him/her?

No. If I've explained what I think about short-term and long-term benefits
and the person wants the quick fix, it's not my place to substitute my
judgment for theirs.

Bill said:

What we have is society gone drug-crazy, with understanding of the human
system being pushed aside in favor of an empirical shotgun approach aimed
at getting immediate results, and to hell with understanding what went
wrong so it can be prevented in the future.

Managed care is in the process of reducing therapy services to very
brief therapy. Drug therapy will become even more dominant. The
patient, let us understand the problem approach is becoming less
accepted or tolerated. Insurance companies rule. People want to go to
Dr. Mctherapy and be fixed, whether by magic substances or magic words.

I'm afraid you're right. This is all the more reason to put some effort
into exploring the MOL, which might prove to work faster and thus be more
attractive to the bottom-liners.

Bill said:

...Can't
you see that today's medicine and psychotherapy will some day be viewed as
laughably primitive? Why overvalue them and defend them against change,
when you know they will be superceded?

I think you are misreading me. I am taking a more pragmatic view.
Perhaps you are undervaluing what they mean to some people. Not every
one is as strong as you.

My strength is as the strength of one. Anyone.

It's the pragmatic view that I'm arguing against, not because it's
valueless, but because it's squeezing out the systems view and usurping
financial and institutional support that would, in the long run, be far
better devoted to improving theoretical understanding. Someone famous said,
"There's nothing as practical as a good theory." My objection to the
pragmatic approach is that it's so terribly inefficient. All you know is
what seems to work -- you don't know why it works, or why it doesn't work
when it doesn't. You don't know what parts of the things you do are
effective, and what parts are irrelevant or even detrimental. The
witch-doctor doesn't dare leave anything out of his brew because he doesn't
know what the essential ingredient is. If he knew that only the bark of the
quinona tree is effective in treating malaria, he
could leave out the bat's eyes, the toadstools, and the tears of the
pregnant woman. The pragmatic approach is really a prescientific way of
dealing with the world. It works, but it works at a snail's pace.

Best,

Bill P.