Thursday, September 1, 2016

Science Communication and The Impostor Syndrome

"Why scientists are losing the fight to communicate science to the public" is the title chosen by Richard Grant for his editorial on science communication, published on The Guardian of August 23.  At the same time, Pediatrics, the official journal of the American Academy of Pediatrics, published the results of a US wide survey among pediatricians focusing on parents' refusal to vaccinate their children. The surveyed population was a population already surveyed in 2006, so allowing a temporal comparison.

Results are appalling, in a decade the proportion of pediatricians reporting parental vaccine refusals increased from 74.5% to 87.0%. Pediatricians reported that parents are increasingly refusing vaccinations because parents believe they are unnecessary, moreover a total of 75.0% of pediatricians reported that parents delay vaccines because of concern about discomfort, and 72.5% indicated that they delay because of concern for immune system burden.  Brief, not only ten years of public health communication aiming to increase vaccine acceptance have not achieved this goal - at least in the US -  but there is even the suspect that they have  been counterproductive.

Richard Grant mentions two main reasons why scientists are losing the fight to communicate science, first because scientists tell people how to live their lives and second, because they don't listen to people. Commenting Grant's article, Ian Mackay, in his Blog The Virology Down Under, adds a third, may be deeper, reason: scientists are usually "supercilious".  Of course, among scientists there are people of all kinds, disdainful and humble, arrogant and unpretentious. That's right, but what Mackay means is a bit subtler than a naïve psychological profile of the average scientist.  Mackay argues that "imposter syndrome for an academic can drive the need to sound just as supercilious as our peers". The "impostor syndrome" is a term that describes the peculiar condition of successful individuals who, notwithstanding their successes and despite their true competence, fear of being considered impostor. Although they are truly high-achieving, they have the inner sensation of being deceivers. In other words, to Mackay scientists are arrogant as far as they need to reassure themselves. Arrogance is their way to say "I'm part of the (scientific) tribe, I'm not a fraud".

Mackay's argument is sound and, as a psychiatrist, I would tend to agree with him. Yet, I would like to go a bit further. During my clinical practice, I happened to meet patients suffering from delusional beliefs.  In a dialogue with someone who is suffering from delusions, one could try to keep the conversation far from delusional contents, at least during the initial interview and the early treatment.  Yet, this strategy cannot be followed forever, soon or later the moment arrives in which one has to discuss patient's delusions.  When this occurs, it is not rare that the patient poses a simple question, "do you believe me?" We all know that questions are never simple questions. Yet, questions are also simple questions and psychiatrists should avoid playing the old, ridiculous, game to interpret questions or to answer with another question. Answering questions is a matter of professional honesty and respect for the patient.

When a delusional patient asked me whether I believed in his narrative, I used to reply him "No, I think you are wrong. Said so, I'm aware that there are more things in heaven and earth than are dreamt of in my science. So, at least inside this room, I'm suspending any definitive judgment and I will listen at you without too many preconceptions.  I will accept the, theoretical, possibility that you are right". Was it only a rhetoric expedient? No, it wasn't.  Of course, there was  a lot of rhetoric in my statement, yet it would not work if it were only rhetoric. At the end of the day, either the psychiatrist truly accepts the risk of becoming insane with his patient, or he will be forever precluded from a real understanding of the patient's inner world.

Similarly, scientists involved in science communication should sincerely accept the possibility that they are wrong, this is the only hope they have to change people's mind.  Is there any prerequisite to adopt this strategy? Yes, there is. You should feel yourself solid enough in your knowledge and your world-view in order to accept a true, actual, challenge. Finally, this is the implicit, reassuring, message that you give to someone else when you accept his extreme challenge. 

So, arrogance is not only the reason why scientists often dictate rules and don't listen to people, it is also the sign that they are not as confident in "their" science as they pretend being. Is this only due to the "impostor syndrome"? 

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