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Commentary

Sometimes, the Why Really Isn't Crucial
Sally Satel, MD, The New York Times, 12-19-06

Satel, a senior fellow at the American Enterprise Institute, explains why patients suffering from drug and alcohol addiction don't need to unravel the psychological roots of their problems before embracing meaningful life changes.

Reconstructing the story of one's life is a complicated business for other reasons. What scientists call hindsight bias kicks in when we try to figure out the causal chain of events leading to the current situation. We may well come up with a tidy story but, inevitably, it will contain large swaths of revisionist history. It's not that we bias ourselves deliberately; it happens because the mind tends to make events in the past appear comprehensible and orderly. We forget the uncertainties that might have beset us as we struggled in real time. Narratives are shaped also by a natural tendency to focus on information that confirms theories we already hold. These theories—for example, that molested children are likely to grow up to have sexual compulsions of their own#151;may be imbibed from the media, self-help books or therapists.

If our own accounts of our actions are often so slanted and embellished, is composing them simply a misbegotten quest? Surely not. To a therapist, the attempt signals that patients are aware that they have a problem worthy of attention. And the narratives themselves can help them make sense out of confusion. This, in turn, can diminish anxiety and exaggerated guilt. Such relief might be sufficient in and of itself for some, or, depending on the goals of therapy, it could embolden a patient to make further healthy adjustments.

But the grail-like search for insight can also backfire when it becomes a way for patients to avoid the hard work of change.



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