musingsonwomenshealth.com

Reflections on 40 years as a doctor in Women's Health

Life is like a game of cards. The hand you are dealt is determinism; the way you play it is free will.


When my kids were small, there was often an argument brewing about things they didn’t want to do. I went through the same phase when I was their age I suppose, but not wanting to anger my mother, I would usually phrase it as can’t rather than wouldn’t, although I’m sure I was really saying the same thing. “Finish your turnips if you want dessert,” for example, when, of course, ‘Do it or else,’ was the silent signal from her eyes. There was seldom an argument when I saw her face I remember; I mean, of course I could eat them if I really wanted to: that was obvious. It was a free will thing; I was too young to know about the argument of free will versus determinism; that came later.

I suspect it was my father that introduced me to the difference between ‘giving up’ on something, and realizing that maybe I could do it, and made an attempt if I really desired whatever it was. There was a difference between making excuses to avoid something, and exercising my will: proving to myself that I might be able to do it if I tried. There was nothing written in the stars about having to lose a race, when if I tried a little harder, I just might win. Or get a scholarship, or become a Philosopher… or a Doctor. And, of course, even if I didn’t always succeed, at least I hadn’t ‘given up’.

The thing I remember him telling me again and again if I seemed to want to quit something I found hard, although important to me, was “It’s not the size of the dog in the fight, it’s the size of the fight in the dog”. I don’t imagine he really cared if his advice was original, and neither did I… It was a guiding principle for me: it was who my father was…

Okay, how about the old argument between free will and determinism? Is there a new winner, or am I simply going to further obfuscate things so that you no longer believe what you thought you’d already decided? The illusion of choice is murkier than common sense would have it; the game of choice is, at the very least, rigged: there are more players than appear in the program notes. The way Jawaharlal Nehru, the first Prime Minister of India is reputed to have put it seems particularly apt: ‘Life is like a game of cards. The hand you are dealt is determinism; the way you play is free will.‘ The attribution is perhaps more legend than prescient, but it reflects an honest attempt to deal with the controversy…

Do you really believe that you chose the tee shirt with the naughty message printed on its chest because you liked it, or merely to prove membership in the group for whom you hoped to wear it? Was it a statement for you, or for them? I mean, there are innumerable complex interactions with influences that necessarily shape any narrative about personal choice.

Could it be that what we do emerges from our biological state at any given moment, and that state itself is the product of how our body and brain grew, including genetic influences, life experience, and the environment at the time? The surroundings matter because our brains are plastic and our thoughts may change in response to them. Still, that doesn’t mean that outcomes are fixed no matter what we do or think… Things reorganize.

And anyway, how would we ever know? Maybe there is some reason the brain needs to think it is in control. Maybe that is what Agency is all about: if some action emanates from me, then the flaw can perhaps be overcome by me using that same agency and working harder on the problem.

But suppose that even then I don’t succeed? Is that an indication that I’ve not tried hard enough? If I continue to drink too much, or can’t seem to stop using drugs, is that necessarily a personal failure? A moral deficiency?

And what rehabilitative efforts should be chosen if the fault lies solely with my self-selected poor choices? There are studies that suggest that interventions are more effective when they take into account the conditions, past and present, that may have led to my behaviour and not simply blaming and punishing me for my current actions. If it were simply that I didn’t have enough self-control then surely the answer would not to be to lecture me on my failures and expect me to change. Indeed, there’s apparently ample evidence that behaviour changes, not because the recalcitrant individual suddenly wants to change, but because a changed environment makes other choices easier. So does that suggest Free will, or Determinism…?

Unfortunately, conceding anything to Determinism leaves open the argument that if nothing is anyone’s fault then they could not have chosen otherwise. And if nothing is my fault, then why should I even try? Fatalism wins…

But that’s a rather narrow interpretation: we may in some sense be restricted but that is not the same as being powerless[i]: our future is not inevitable. We still have agency; exercising agency doesn’t require us to be free agents: ‘our biological systems are plastic; when inputs change, behaviour can change. Evidence-based interventions work precisely because behaviour is responsive to conditions. For example, children raised in disadvantaged environments show better developmental, educational and later-life outcomes when early caregiving and learning conditions improve. The constraints remain, but the probabilities change… Letting go of free will doesn’t mean abandoning responsibility… Instead of asking who deserves the blame, the questions become What produced this outcome? and What would make a different outcome more likely next time?’

I mean, in the end, does it really matter if there is Free Will, or something baked into my recipe? It’s the size of the fight in the dog, after all…

[i] https://psyche.co/ideas/why-you-should-try-living-without-free-will-for-two-weeks

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