Correcting Traditional Psychology’s Error Within Health Value Assessments & PROs.

Self-Identity as a Percept, Not as a Profusion of Concepts.

When working to understand health and well-being, as well as the value treatments offer, it’s important to get the point of view of the patient—the so called patient-centric approach. This contrasts with the approach of an assessment of our health done by a caregiver. After all, who knows us better than ourselves, right?

Turns out we don’t know ourselves very well. Scholarly and lay publications in the field of behavioral economics, the Nobel Prize winning science behind how and why we make decisions—the predictably irrational as well as the good ones—acknowledges that both sides of our brain evaluate the world differently. According to Gazzinaga’s (1989) research with patients who have had the two sides of their brain surgically separated, the right side of our brain accepts experience and reports on it more realistically—the facts, just as they are. The left side of the brain functions to interpret events, accepting a conceptual gist and filling in any gaps with plausible fabrications. In my own writing, I’ve suggested a slight change in the behavioral economic terms (Kahneman, 2011) used to describe these two ways we process information (i.e., the right-side’s experiential processing or the “experiencing self” & the left side’s rational-cognitive processing or the “remembering self”) to the “perceptual self” and “conceptual self,” respectively, in keeping with Epstein’s two selves theory that underlies behavioral economics. Notably, all humans are (literally) of two minds that never come to agreement. Neither is right. Until switched out, one may predominate for a while, as the other carries on as a persistent annoyance.

People are unique, not categorizable, yet words are used to describe us. Few seem to realize that words/ concepts cannot get below the level of a category to specify any unique thing, including us. It’s an inherent problem with language. When the word “cup” is used to describe the specific cup in front of us, we’re only stating its category. Even a modifier like “blue” only narrows the category but does not describe the unique thing itself. There are many blue cups in the world. To this point, I’d like to argue that that specific cup is indescribable because it’s a unique perception—what comes to us through our sense perceptions before it’s transformed into a (categorical) concept through the transformation by language. Just because it cannot be conceptualized does not mean it does not exist or demean it in any way. The problem originates within language, not within the cup.

Because everything is unique, including us humans, at our root we’re all percepts—existing before words try to put us into categories. We first know the entire world exclusively through our sense perceptions. The sight of blueness, the sound of a trumpet, the smell of a rose, the touch of a feather on the skin, the quality of a thought (not the thought itself) in the mind, and the taste of an apple all cannot be conceptualized. Words correlated to them can be uttered but no word can say what each is. Because of this, it’s intolerable to me to be described not as a unique individual, but as a category. I am most happy being a percept, inexpressible and unique. Though I have taken on the concept of “writer” for the moment, I’ll drop it and go back to being a percept when this task finishes up.

Through the distortive transform of language, humans mistakenly accept themselves as concepts (e.g., teachers, egos, cancer survivors) and answer questions, say, about their perceived health status (e.g., pain is a percept often accompanied by a worry-filled conceptual component) from those viewpoints using conceptual terms. Depending only on the concepts aligned to or not, patients may report consistent levels of perceptual pain as being greater or lesser. If health researchers want a bit more truth and far less variability in the answers they receive from respondents, use of “experience sampling” or “day reconstruction” methods, which tap into present moment perceptions, appear to provide very acceptable solutions. To better understand the value of a drug or other treatment this method can be used in real-world evidence (RWE) databases, such as medical records or surveys, as much as it can within the context of a clinical trial using smart phones and IoT devices. Those who rely on value dossiers to buy drugs and other health care treatments will notice the difference and so benefit.

I’m a percept and you are, too. As a challenge, reflect on behavioral economics theory and try on this alignment and see if it fits. Determine for yourself how much less your authenticity and your health outlook vary when you hold to this unwavering center. Further, if you’re a health researcher, ask yourself whether or not whether access to the patient’s perceptual view also needs your attention. My sense is that it does.

Copyright Steven Pashko, Ph.D. (2017)

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