Author: Jonah Lehrer
BOOK CONTENTS
How do we make up our minds? How do we decide between options? What is the secret behind decision-making? In this book, the author explores what he terms ‘…one of the oldest mysteries of the mind…’ (page 9). He started by tracing the philosophical foundations of decision-making with reference to people such as Plato, René Descartes, and Francis Bacon. He reviewed the psychological aspects of decision-making, recognising the influence of the psychologist William James on our understanding of how we think (page 26-27).
A prominent feature of the book is its detailed exploration of the anatomical and biochemical underpinnings of decision-making. The orbitofrontal cortex for example is ‘… responsible for integrating visceral emotions into the decision-making process…’ (page 18), and the dopamine system helps to ‘… incorporate the lessons of the past into our future decisions…’ (page 39). The author explored the functions of other brain areas such as the dorsolateral prefrontal cortex, the ‘rational’ center of the brain (pages 100-104), and the amygdala which evokes negative feelings (page 106).
The running theme throughout the book is the role of reason and emotion in decision-making (page 9). Contrary to conventional wisdom, the author makes the case that emotion is as important as reason in decision-making. He argues for example that ‘…the emotional brain…has been exquisitely refined by evolution… so it can make fast decisions based on very little information’ (page 24-25), and ‘…if it weren’t for our emotions, reason wouldn’t exist at all’ (page 13). He referred to the neuroscientist Antonio Damasio whose patients, having lost the emotional parts of their brain, became incapable of making any decisions. The author brings examples from different spheres of life to show the influence of feeling on decision-making and summarises the influence of emotion when he says ‘…a brain that can’t feel can’t make up its mind’ (pages 14- 15).
Intuitive decision-making is however not infallible, and the book examined the circumstances when feelings lead to mistaken decisions. A typical situation is in the prediction of random events, a process that relies on patterns such as the hot hand and the winning streak which have great influence in sports and the markets (pages 63-64). These patterns are however flawed and the author says ‘…we trust our feelings and perceive patterns, but the patterns don’t actually exist’ (page 65). He explained why this happens with a quote from Read Montague which says: ‘when the brain is exposed to anything random… it automatically imposes a pattern onto the noise’ (page 67). Decision-making is also influenced by several biases which the book discussed. These include loss aversion (page 76), negativity bias (page 81), perceptual narrowing (page 98), cognitive dissonance (207), cultivated ignorance (page 209), and the certainty bias (page 217).
The book is packed with anecdotes, and the most dramatic ones illustrate decision-making in completely novel situations. An example is the story of Firefighter Wag Dodge who came up with the brilliant idea of burning a patch of ground to use a refuge against an approaching raging forest fire (pages 93-97). Another story is of Pilot Al Haynes who, disregarding his instincts and using reason, successfully landed a malfunctioning DC-10 passenger aircraft (pages 120-132). The author says such novel ideas ‘… are merely several old thoughts that occur at the exact same time…’ (page 130-131).
The book offers several suggestions to guard against making wrong decisions. The author advises against completely relying on reason when making choices; he says ‘… when the rational brain hijacks the mind, people tend to make all sorts of decision-making mistakes’ (page 140). He urges the use of executive control; this is choosing the rational brain when the emotional brain is leading to a bad decision (pages 115-116). The author explores other decision-making strategies for example when he says ‘… the best decisions emerge when a multiplicity of viewpoints are brought to bear in the situation…’ (page 254). The book discusses other concepts important to decision making such as metacognition and emotional regulation (page 107). It however emphasises that ‘…there is no secret recipe for decision-making…’ (page 250).
OPINION
This is probably the most exhaustive and accessible book on decision-making available. It is clearly written and full of illustrative anecdotes. The book explores the psychological and scientific foundations of decision-making, and highlights the ways we make wrong decisions. The author, a journalist, had his career blemished by allegations of fraud, but there is very little to criticise about his excellent book. A note of caution however, the book is also published as The Decisive Moment.
OVERALL ASSESSMENT
Decision-making is a core function for patient safety, and this book details how good and bad decisions are made. There are excellent tips on making better decisions which I recommend to all doctors.
BOOK DETAILS
- Publisher, Place, Date: First Mariner Books, Boston, 2009
- Number of chapters: 8
- Number of pages: 302
- ISBN: 978-0-547-24799-1
- Price: £1.11 (used)
- Rating: 5 stars
The Doctors Bookshelf 