This book is about the disadvantages of unlimited choice, what the author calls the ‘darker side’ of the freedom to choose. The driver for the book is the premise that ‘we now face a demand to make choices that is unparalleled in human history’ (page 43). It explores the impact of unregulated choice on almost every human activity, ranging from mundane tasks such as shopping for groceries and gadgets, to significant choices, such as deciding on schools for children, and which health institutions to patronise (pages 9-33). The book argues that having an abundance of options ‘contributes to bad decisions, to anxiety, stress, and dissatisfaction‘, and this leads to a situation whereby ‘choice no longer liberates, but debilitates‘ (pages 1-3).
The book’s key them is that, ‘in a world that provides unlimited choice’, people are more prone to be dissatisfied with the choices they make, and to blame themselves when they make the wrong choice (page 208). The over-abundance of choices makes individuals feel more responsible when they make wrong decisions, a prospect that may even intimidate them into not making any choice at all (pages 20 and 29). The author illustrated this with buyers remorse (decision regret), the idea that ‘the more options you have, the more likely it is that you will experience regret’ (pages 147-148).
The author admits that ‘choice is fundamental to well-being’, and he accepts that ‘every choice we make is a testament to our autonomy‘. He however points out that ‘more choice may not always mean more control‘, and he warns that ‘there comes a point at which opportunities become so numerous that we feel overwhelmed‘ (pages 3, 101-104). This ‘tyranny of choice’ is illustrated by the authors personal experience of buying a pair of jeans, an experience that became ‘a complex decision in which I was forced to invest time, energy, and no small amount of self-doubt, anxiety, and dread‘. The book shows that the consequences of unlimited choice extend to more serious aspects of life such as healthcare, where ‘the prospect of a medical decision has become everyone’s nightmare’, where the shift in responsibility for decisions means ‘doctors are now merely instruments for the execution of our decisions’ (page 32-33).
The book covers an astonishing array of subjects related to choice. These include trade-offs, opportunity costs, decision conflicts, inferior alternatives, deferred decisions, choice justification, and choice reversibility (pages 120-146). The author also explores diverse concepts such as choice responsibility (page 151), upward and downward counterfactual thinking (pages 152-154), regret aversion (page 157), hedonic adaptation (page 166-169), hedonic treadmill (page 172), the curse of discernment (page 183), the curse of high expectations (pages 185-187), the curse of social comparison (page 187), and positional competition (page 193). We also learn of the three gaps of satisfaction and the ‘peak-end’ rule of pleasure (pages 49 and 183). The book also reviewed the influence of heuristics and biases on choice, giving a detailed exploration of availability, anchoring, risk aversion, loss aversion, sunk costs, and the endowment effect (pages 56-73).
The author makes several recommendations to protect against the harsh psychological consequences of choice overload and the tyranny of small decisions (pages 6, 18, and 21). For example, he advises people to ‘learn to be selective in exercising choices’, and to focus mainly on things that really matter (pages 4 and 104). He recommends techniques such as distraction, and discourages rumination and social comparison (page 197). He offers practical tips to limit choices such as making decisions non-reversible (page 228), embracing an attitude of gratitude (page 229), and learning to love constraints (page 235). He also advocates close social relationships which nurture happiness by their inherent capacity to limit freedom, choice, and autonomy. He notes the paradox in this because ‘what seems to contribute most to happiness binds us rather than liberates us’ (pages 106-108).
The author supports his arguments with academic evidence from the psychology of decision-making. For example, he refers to the work of Daniel Kahneman on the mismatch between expected and remembered utility; this implies that people don’t always know what they want, and this sets them up for disappointment with their choices (pages 51-52). He refers to work by Herbert Simon on maximizers, people who ‘are determined to make only the best choices’, and satisficers who fare better because they ‘settle for something that is good enough‘ (pages 4 and 78). The book refers to the work of David Myers and Robert Lane on how the rules and routines of social ties ‘make life more manageable’ by limiting the decisions we can make (page 114).
This is an excellent book, full of wisdom and built on solid research. The huge number of psychological concepts in the book belies its relatively small size. This author, a renown psychologist in this field, highlights the clear consequences of unlimited choice, and does so with a clear and simple writing style. He illustrates his arguments with several examples, and many of these are related to health and lifestyle decisions.
Choice is increasingly taking a key role in health care decisions, and this is driving many health policies. It is therefore important that policymakers and healthcare practitioners know about the significant consequences of unconstrained choices. This book is an insightful review of these negative effects, and I highly recommend it to all doctors.
- Publisher, Place, Year: Harper Perennial, New York, 2004
- Number of chapters: 11
- Number of pages: 265
- ISBN: 978-0-06-000569-6
- Star rating: 5
- Price: £8.99