REFERRALS AND THE NORMALCY BIAS
By Dr. Ben Lerner, BSN, MSPSY, DC
On her first patient appointment, Clara, an emphysema sufferer, stood in the parking lot with her oxygen tank, tubes going into her nose, and in the available face hole that was left, smoking a cigarette. We can see the same thing at every restaurant, movie theater, theme park, grocery store, 7-11, and county fair – people who have even extremes of weight or health problems continuing to pour on the abuse.
Chronic disease, obesity, and extremes of suffering are not enough to stop them from consuming super-sized sodas, Slurpees, fries and candy along with popcorn buckets, fried Oreos, caramel lattes, and anything else for sale that spends a moment on the lips and a lifetime on the hips (and arteries). After my mother’s stroke, 100% confirmed by tests to have been caused by smoking, she could not wait to get out of the hospital to start smoking.
This seems completely ludicrous, but there is a known psychological phenomenon that describes this behavior. One mental theory on how people ignore statistics like these and continue to act in ways that put their lives at risk is the normalcy bias.
It is a powerfully influential problem. In Florida, where I have lived the last 25 years, we have hurricane season. Unlike the holiday season, most Florida residents welcome hurricane season with fear and trepidation. Although hurricane and holiday season do have a few things in common. The joke is that similar to the holidays, during hurricane season, the stores are packed, you stock up on food, you leave home to visit relatives, and eventually there’s going to be a tree in your house.
Some years, it becomes clear that a coastal city is going to take a direct, dangerous, and devastating hit. With today’s technology, meteorologists can provide information to local government with ample time to make sure people secure their homes or in the case of the bigger storms, EVACUATE!
In spite these warnings and even if law enforcement demands an evacuation, a fascinating and disturbing phenomenon occurs. Many people stay and do nothing. Often with catastrophic consequences. This psychological phenomenon is often due to what is called a “Normalcy bias.”
Psychologists and sociologists have found normalcy bias to be an unfortunate part of human nature. It is generally seen as a state of denial many people exhibit when their life is in peril, there is impending danger, or are confronted with a disaster. Even in the face of clear evidence and overwhelming proof to the contrary, people will continue on expecting everything to continue to be OK or return to normal. A disaster warning that harm is about to displace what was their familiar and comfortable existence is interpreted and inaccurately reframed as non-serious and with a positive outcome.
Why we continue to behave the way we do when the outcomes are so apparently going to be unpleasant is complex. But normalcy bias certainly appears to be a huge factor. It is like the Boiling Frog metaphor. The story of the boiling frog posits that if you put a frog in a pot of boiling water, it will instantly jump out. But, if you put the frog in a pot of cold water and slowly turn up the heat, the frog will not do anything at all to improve its condition and eventually boil to death. The moral to the story is that people do not notice or respond appropriately to incremental change going on around them or even clear and present danger until it is too late.
Like the Florida hurricane scenario, there is story after story of people who sit frozen rather than running or taking cover during tornados, terrorist attacks, and when there are only moments to remove themselves from the plane or car after an accident. Experts believe that those people need to be jolted, yelled at, smacked, or shocked into somehow waking up and jumping out of the pot that is about to boil so they can save themselves.
Ask your patients to drag, grab by the collar, pull by the ear, smack, scream, and yell at their friends and family if necessary to get them in. People are fast asleep and need to be awaken if we’re going to save their lives.
