Escaping the loop

Q J Med 2004; 97:59–60 doi:10.1093/qjmed/hch001

Coda Escaping the loop This is a story about intuition and its relation to logic. A mother came to see me recently with her nineyear-old son, who wets his bed. She wanted me to write a letter to the council to support the family’s application for a bigger flat. The boy apparently has two elder brothers who share his bedroom. They are fed up with the smell of his urine and want another bedroom. When she made this request, I tensed up. I felt caught in a double bind. If I said no, I would probably lose any chance of helping the boy with his enuresis. If I said yes, I would effectively be offering an incentive for his behaviour. Like most doctors when faced with this kind of dilemma, I found a solution intuitively. But afterwards I analysed what I had done and realized that it conformed rather well with formal logic and communication theory. This was a relief, as I was in the middle of preparing a seminar on this topic for a group of clinicians, and beginning to have my doubts about whether it fitted real life. I will tell you about my solution later, but let me go into a little bit of the theory first. When Russell and Whitehead wrote their Principia Mathematica at the beginning of the last century, they proposed a Theory of Logical Types. A central argument of that theory was that a category ‘cannot belong to itself’. To use the annoying language that philosophers love, the category of ‘cats’ is not itself a cat. More important, from the point of view of logic, the category of ‘categories’ is not itself a mere category. It is at a higher level of abstraction. What this means in ordinary language is that categories of ideas or things have to nest inside each other like Russian dolls. They cannot ooze into each other like pseudopodia, or suddenly leap to another level like excited electrons. At first sight this may seem obvious or seriously uninteresting, but it matters in philosophy because it helps people to identify and disprove certain errors of logic. A generation after Russell and Whitehead, the theory was taken up by the biologist Gregory

QJM vol. 97 no. 1

!

Bateson. He suggested that logical typing is a natural as well as a mathematical phenomenon. He argued that mammals, including humans, seem to display in their communications an intuitive understanding of logical levels. They particularly show evidence of this in the ways that they respond to the same stimuli in different ways according to different contexts. One example is the mock fighting that occurs among young animals. Cubs of many species can bite each other in ways that look just like real fights, but because they give out signals of a ‘higher level of context’ that this is only play, no-one gets hurt. If the signals about context get confused, no-one knows which is the higher one, fighting or playing. The situation then gets frightening and nasty. You can see this logical confusion when children of a certain age are practising their aggression but then lose control. Another example is humour. Bateson argued that humour is often the consequence of an intentional confusion of context levels. We recognize this as a logical trick even though we may not quite understand how it works, and we find it amusing. (For instance, I once looked at a Japanese print of an elephant and commented that I didn’t think that there were elephants in Japan. ‘But this isn’t a real elephant’, the owner quipped. ‘It’s only a print of one!’) Bateson’s ideas about logical typing in nature were taken up in their turn by communication theorists. They looked at conversations, and found that these tended to be harmonious if everyone shared the same assumptions about which context had the higher authority in any situation. However, things could become dysfunctional if this wasn’t the case. So if one partner in a couple thinks that arguments are fine because there is an overarching commitment to work things out, while the other partner believes they define a relationship as a failing one, there will be trouble. (On more mundane territory, most doctors will know of the discomfort they feel when patients respond to friendliness with intrusive personal

Association of Physicians 2004; all rights reserved.

60 inquiries. The patients are reacting to what they believe are the ‘context markers’ of an informal social situation. The doctors by contrast think that they are only being friendly as part of another, higher context—the courteous professional encounter—and they feel aggrieved.) Returning now to my own difficult consultation, it is clear that there were two contexts vying for supremacy. One was ‘the doctor as healer ’ and the other was ‘the doctor as patient’s advocate.’ Whichever context I chose, I would automatically disqualify the other, and therefore fail in a legitimate part of my job. In communication theory, this is called a ‘strange loop’. Intuitively, I managed to get myself out of the loop. I said I was happy to write the letter but not yet. I wanted the boy first of all to attend the local

Coda enuresis clinic, and the family to make a serious attempt to engage with the treatment offered. If this failed, I would certainly back their application. The mother agreed at once. My guess is that the solution appealed to her in the context of ‘the mother who wants a healthy child ’. She was now able to set this above the alternative context of ‘the mother who wants better accommodation’ without having to let go of it altogether. Of course the lure of better housing may lead the family in the end to sabotage any treatment, but I hope it will not. When there are strange loops around, disentangling them will often produce relief. Logic and intuition have converged. Could they possibly be the same thing anyway? John Launer