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Health & Fitness

Rationalizing Rationalization

We all do it, and you're probably doing it right now if you disagree.

Rationalization has been defined as “an unconscious defense mechanism by which attitudes, motives and behaviors which would otherwise be considered irrational or unacceptable are justified or made consciously tolerable by plausible means.”

About once a year in my day job as a radiologist (this blogging gig not paying as well as Cristel promised – please share and comment to show her my worth), I will interpret an imaging test – most commonly a mammogram – that reveals a golf ball (or larger) sized cancer that the patient claims to have just noticed a couple of days earlier. I used to think that these people were lying, but I’m now convinced that they’re simply rationalizing. I suspect that they unconsciously downplay the significance of the mass (eg, “It’s probably nothing”, “Maybe it will go away on its own”, “I’m too busy to get this looked into right now”). But – sadly – this kind of denial is quite powerful, and harmful.

We physicians are far from immune to doing our own rationalizing. No doctor likes to make mistakes, and we all (at least those of us without an underlying personality disorder) feel horrible when they inevitably occur. But, as humans, we’re never going to be perfect (and the physician who tells you that he/she has never made an error is a liar – find another doc if yours has ever uttered something similar). It’s interesting how doctors react when confronted with their own missteps. Some humbly admit them and try to learn from the experience (I wish this were 100% the case with me). But even the best intentioned among us will offer up rationalizations. “It was really busy that day.” “The patient was quite elderly and sick, so no real harm occurred.” Are these physicians – myself unfortunately sometimes included – bad and/or dangerous? I don’t think so. I just think it can be easier to deal with the occasional unavoidable medical error if it can somehow – correctly or not – be attributed to external forces or otherwise minimized in significance.

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But rationalization can also be used to justify actions that are by any objective measurement “bad”. Thieves and bullies come to mind in particular. A poor person may rationalize stealing from someone with greater wealth because those more affluent can afford being robbed. But it’s still theft and still a crime. Likewise, bullies – while their behavior is 100% despicable – are often very troubled individuals. Bullying others makes them feel better about themselves, and that may be how they rationalize their actions.

The fact is that everyone rationalizes, and none of us could probably get out of bed every morning if we didn’t. I’m reminded of a scene from the movie “The Big Chill”. Jeff Goldblum’s Michael says to Tom Berenger’s Sam, “I don't know anyone who could get through the day without two or three juicy rationalizations. They're more important than sex.” To which Sam replies, “Ah, come on. Nothing's more important than sex.” But Michael gets in the final word, “Oh yeah? Ever gone a week without a rationalization?”

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