Black and white thinking, for those readers unfamiliar with cognitive distortions, refers to the tendency to reduce complex ideas and situations into simple, dichotomous, and mutually exclusive categories.
Think of good or bad, yes or no, all correct or all wrong, acute pain or chronic pain, neuromatrix or peripheral mechanisms, cure the pain or manage the pain.
It’s a way of simplifying arguments or decisions that can work well when the situation requires very fast decision-making, or where the options are very limited.
It doesn’t work at all in the messy and complicated worlds of clinical reasoning, theory development, or in discussions to broaden understanding.
I’m pondering this because of the way various aspects of pain management and the science of pain are misrepresented as opposed to each other, when maybe it’s not quite so simple.
I hope (crossing fingers and toes) that I’m not doing prone to doing it too often on the pages of this blog, or elsewhere for that matter!
There are multiple strands of research into pain at present.
There are the reductionists who focus exhaustively on smaller and smaller elements of biology to explain the processes involved in nociception and transmission from noxious input to the perception of pain and back to the responses as a result.
There are the phenomenologists who focus on the ‘lived experience’ of the individuals who have pain.
There are those who are furiously investigating laterality and cortical processing.
There are others feverishly working on ways to abolish all pain, and those who are equally enthusiastically researching why so many people are unbothered by their pain even though it’s severe.
Can you see all those opportunities for opposing views? for argument and debate? It’s common for any of us to think mainly in terms of our own orientation, and there are many factors in human cognitive bias and group decision-making that get in the way of us working towards consensus – or even hearing each other. And that can lead to trouble within teams, especially multi- or inter-disciplinary teams.
I wonder if it’s time to apply some of the cognitive techniques we can use with patients to ourselves as clinicians. Let’s take a quick look at some of the basics.
Firstly, why do we use black and white thinking? Well, it simplifies things. If we’re feeling a little bit sad, we’re more likely to tell a loved one that we’re feeling “terrible”. We don’t mean to exaggerate, we’re aiming to get empathy from the person we’re talking to, so we unintentionally use dichotomous language – we think in terms of feeling “amazing” vs feeling “terrible”. Humans like to identify patterns, and to group similar things together so we can generalise. We like to reduce an argument into “either – or”. And when we do this, once again because of our tendency to look for information that confirms our own position, we often fail to recognise other alternatives, or information that doesn’t fit with our own views.
What we can do is step back and carry out some metacognition – thinking about our own thinking.
Some questions we can use to challenge our own position are:
- How did I come to that conclusion?
- What’s the evidence for the other position?
- Is it possible to use “and” instead of “either/or”?
- What are the other options?
- Are there parts of my argument that can’t explain something the other position can explain?
- This idea is only an idea – not my personal possession
- Consider saying things like “at the moment my position is…”, “I’m attracted to this idea currently…”
I’ve personally found it useful to relax a little and recognise that in the end, the data will speak for itself. So, for example, I was initially not keen on mirrorbox and laterality training for CRPS. The studies, especially in the early stages, weren’t carried out in people with the degree of chronicity and complex psychosocial background that I saw. Over time, and as the evidence has been gathering, I’ve changed my position. I don’t mind acknowledging this change – in the end, it’s not my ego that’s important, nor “my” ideas – it’s what helps this person at this time with this particular problem.
Having said this, developing critical thinking skills, and in particular, being able to unpack and delve into how a study has been conducted and whether the conclusions drawn are supported by the data is vital. Cherry picking, or selecting studies that support one view or another while ignoring or failing to account for studies with conflicting findings, just doesn’t do – again I try to relax a little, because in the end the balance of evidence does fall one way or another. Or, in the case of chronic pain management, maybe there is so much to learn that what we know now is not even beginning to find answers.
If you’re keen to learn more about how to develop critical thinking, Foundation for Critical Thinking has a wealth of information.