Hiding in Plain Sight: Essays by Joon Yun, MD

Hiding In Plain Sight is a collection of essays that I have written on investing, healthcare, and life.

A Little Experiment

For the sake of experiment, read the next sentence once, while counting the number of “f”s that you see.

“Five-winged flies are the result of years of scientific study combined with the experience of many years.”

Most likely, you counted an “f” in each of the more vibrant words of the sentence: “five,” “flies” and “scientific.” Most people only see these three “f”s, when in fact there are six. The other “f”s are hidden in the unassuming preposition “of”. Your mind probably skipped over each “of” because it processed these words without absorbing the raw information of the letters that composed them.

This isn’t the first time your mind has excluded information right in front of you (or included or distorted information that wasn’t there). For example, you’ve probably read your own emails without seeing the spelling errors because your mind filled in the words is expected to see. Or perhaps you’ve conversed with someone and answered a different question than the one the person asked. Exclusion, inclusion, and distortion are the basis for many of the daily illusions that fill our lives, whether these illusions are visual, auditory or emotional.

Most of the time, we live on autopilot, even when we face a complex social situation. For example, research by Robert Abelson and Ellen Langer in the 1970s found that people usually follow mental “scripts” and are mindless much of the time in their social interactions. Instead of responding to what you are saying, most people respond to what they assume you are going to say. Surprisingly, we respond less to the specific words, images, and sounds we receive than to our mental images of what those stimuli should be.

Students learning about vision have been traditionally taught that as light moves through the lens of the eye, the light is bent and transposed onto the retina, which converts the light into electrical energy. The electrical energy is then ‘developed’ in the occipital lobe and other regions of the brain, transforming into the image that we “see.” The conventional model of sight suggests that there is direct, one to one correspondence between the objects in the world and the image of them in our brains. However, recent research has revealed that around eighty to ninety percent of what we “see” actually comes from what we already have stored in our cortex; under twenty percent of visual perception stems from the sensory data provided by our retinas. (Gregory, 1998).

Most adults have heard the adage “you never get a second chance to make a first impression.” We dress up for job interviews, first dates, business meetings and cocktail parties, vaguely aware that strangers will draw various conclusions about us based solely on their first interaction with us. Research shows mixed results about the veracity of the saying. While an explicit first impression can be changed upon the reveal that it is false, implicit impressions are less flexible. (Wyer, 2010). It seems that upon our first encounter with a new person, our brain doesn’t have a warehouse of images of that person to draw upon, so we take a closer look and absorb the details of that person. During subsequent encounters, we will most likely fall back on the first image rather than expend energy on re-seeing the person. In the past, our ability to rely so heavily on our mental image of the person was a useful skill and an adaptation that increased our efficiency. However, in today’s world, our heavy reliance on what we remember rather than what we are actually experiencing may be a maladaptation.

Perhaps you’ve tried to draw a tree and found to your dismay that your drawing looks nothing like the tree in front of you. Most of us carry around a predictive hypothesis of what the tree (and other external objects) should look like. (Gregory, 1998). People are so dependent upon their own mental image or description of a tree that they never really see what the oak, elm, birch, or sycamore in front of them looks like. They miss the fantastic tracery of its bark and the silhouette of its leaves against the sky in favor of a nonspecific, pre-fabricated image of a tree inside their mind’s eye. Most of the world then exists as a phantom in the brain, a pale shadow of itself, rather than as a living, changing, swirling body-slam of sensations.

Expectations Sculpt Perception

The phenomenon of phantom limbs offers a striking example of one way in which our body clings to first or early impressions. A phantom limb is a vivid sensation that an amputated or missing limb is still attached to the body. Neuroscientist V. S. Ramachandran realized that phantom limb sensations might be due to sensory reorganization in the brain. Ramachandran hypothesized that if someone were to lose his right hand in an accident, he might then have the feelings of a phantom limb because the input that normally would go from his hand to the left somatosensory cortex would be stopped and the areas in the somatosensory cortex that were near to the ones of the hand (the arm and face) would remap the cortical region that no longer received signals.

In an experiment, Ramachandran asked volunteers who had phantom pain in an amputated arm to put their remaining arm through a hole in the side of a box with a mirror inside. When looking through the top of the box, the volunteer would see both their arm and its mirror image, offering them the illusion of two arms. The volunteer would move both their intact arm and their phantom arm (in their mind) and then have the sense that he had two arms again. Despite the volunteer’s knowledge that the sensation was an illusion, the mirror box offered immediate relief. People formerly unable to unclench their phantom fist felt their hand open. After daily use of the mirror box over weeks, people had the sensation that their phantom limbs were shrinking back into their stumps; in some cases, the phantom limb vanished. It seems that when the brain receives new visual signals from the mirror box that intimate motion in the absent arm, the brain is forced to assimilate totally new information into its sensory map of what’s happening. The pain vanishes.

Scientists are not the only ones to recognize that our minds, at least in part, shape our reality. Back in the 1700s, the Romantic poets believed that the imaginative work of our minds played a role in creating our perception of truth and reality. In “Composed a Few Miles Above Tintern Abbey, on Revisiting the Banks of the Wye During a Tour,” William Wordsworth poeticized this concept:

“and of all that we behold
From this green earth; of all the mighty world
Of eye, and ear,—both what they half create,
And what perceive”

The human condition requires that we use our minds to shape what we see and hear. However, we didn’t always harbor such strong expectations about the things we should see. As children, we were driven by our desires and needs to see, touch, taste, feel and hear the world around us. Consequently, we lived in a constant state of wonder. Everything was new.

Children’s minds are poised to learn about the world as it exists, rather than the world as they expect it to be. A child’s brain possesses twice as many neural circuits as an adult’s brain. (Wesson, 2009). Spend a day walking with a child and you’ll find that they will show you many of the things you can no longer see. Not only do children “see” more accurately than adults much of the time, they also soak up new languages and new skills rapidly. If a child does not hear human language by the age of nine or ten, she will face an uphill battle learning to speak any language later in life. Visual stimulation early in life, too, is essential to a child’s ability to process visual data.

Like other sentient beings, children begin to lose their flexibility for learning wholly new languages and skills in puberty, around the age of 12, as they acquire hormones such as testosterone and estrogen. When adolescence hits, the phonetic sensitivity of children declines and it becomes difficult to learn a new language. It becomes difficult to learn the guitar. It becomes difficult to learn a new sport. Even if an adult does learn a new language after this age, true mastery is rare. Often those that have acquired a language after this age, but speak with an accent, believe they’re speaking perfectly because they can’t truly hear themselves. We have a tough time hearing others, much less ourselves.

Although adults can build upon the languages and abilities they have already acquired, they have great difficulty absorbing a whole new skill. Even if you only learn one instrument when you are young, your brain is primed to pick up another instrument and build upon its musical abilities if you try to pick up another instrument when you’re older. However, if you learn to play your first instrument as an adult, a completely different area of your brain is activated then the one that would have been activated if you had learned an instrument as a child. The same principle applies to languages. Although you have to learn the basics of reading when you are young, you can add vocabulary the rest of your life. Perhaps children should learn a smattering of many different languages when they are young so that later on they can build on that foundation, mastering any one of those languages rather than just choosing one or two.

Where might you look to determine the reason for the dramatic changes in our ability to learn from childhood to adulthood? You would probably examine what makes children and adults physically different and suspect that sex hormones like testosterone and estrogen play a role in mental development. In fact, testosterone does seem to make a difference. When asked to think of the most masculine young men you know, you may picture ‘dumb jocks.’ Conversely, when conjuring an image of the least masculine young men, you may think of artists or philosophers.

It turns out that testosterone does impact mental flexibility and learning. While young male zebra finches easily acquire new songs, this flexibility diminishes with the increase in exogenous testosterone that accompanies maturity. The loss of song plasticity correlates with a higher testicular mass. In one study, adult zebra finch males were administered either testosterone or flutamide (a testosterone receptor blocker) and the changes to their songs were tracked. Males implanted with testosterone changed their songs less than did those males that received flutamide implants. It may be inferred that the high testosterone concentrations associated with sexual maturity and song crystallization in zebra finches reduce the potential for learning new songs in adults. (Williams et al., 2002).

The link between an increase in the sex hormones that signals maturity and a loss of flexible learning is sharpened by the fact that human boys and girls with precocious puberty have exhibited developmental difficulties with learning languages. Furthermore, as children mature, the development of those intellectual abilities based upon reason, logic, and abstraction (fluid intelligence) slows down, even as the human ability to increase those skills learned through education and experience continues to grow. In other words, children start to build upon what they have already learned and it becomes increasingly challenging to acquire new abilities.

Our genes dictate that by the time we are 12-16, we graze less on raw sensation and begin to act upon the world with the skills we have acquired. After all, until about 2000 years ago, we could only expect to live until the age of 20. Around 1796, we expected to live until about age 24. We spent our first twelve years investigating the world and developing our perceptions about it, and then the next ten years acting upon those perceptions. It was an adaptive strategy at the time because we had a much shorter period of time in which to accomplish any given task and couldn’t afford to live in a constant state of intense wonder, taking things a sensation at a time. Also, the adaptive strategy of spending our first-decade acquiring knowledge
and our second decade acting upon the world armed with that knowledge permits us to be born into any culture in the world and survive. As the Yale social psychologist, John Bargh mentions, “We’re totally transportable which means we’re totally open to being adapted to wherever we land no matter the people, the norms, the language or culture. We just absorb it.”

Many parents notice that upon entry into adolescence, their once curious child thinks he or she knows it all. From an evolutionary perspective, an adolescent’s attitude makes sense. He or she has spent ten years accumulating knowledge and is physically ready to start executing in the world. Unfortunately, even the transient feeling of power engendered by adolescence can dramatically change the way an adolescent responds to information. Psychologists find that increased authority makes the powerful person less sympathetic to the concerns and emotions of others. Several studies have found that people in positions of authority are more likely to rely on stereotypes and generalizations in their interactions with other people. When listening to an argument, most people in authority look at whether the argument confirms what they already believe, ignoring those facts that disprove their position. In other words, power can reduce our ability to learn.

Just centuries ago, our environment was simpler and more static, so it made sense to develop shortcuts with which to behave automatically, rather than pay attention and act mindfully. However, in light of our increased lifespan and the rapid-fire changes of the modern world, does this strategy of perception make sense today?

In our eagerness to fill in the blanks and move more quickly through the world, our cognitive structures grow increasingly unwilling to accommodate new experiences. We estrange ourselves from our senses and become strangers to the external world. “The lover of nature is he whose inward and outward senses are still truly adjusted to each other; who has retained the spirit of infancy even into the era of manhood,” wrote transcendentalist Ralph Waldo Emerson. After childhood, most of us rely on our expectations, rather than pay attention. We rely on the interplay of our senses, rather than the full power of each of our senses. For example, we are likely to judge that an object has more green in it because it was presented in the form of a clover, whereas we see it as browner if it is presented in the shape of a donkey. (Barodisky 1999).

In a classic example of tricks that demonstrate the inattention of the human mind, psychologists Daniel J. Simons and Christopher F. Chabris asked spectators to count the number of times a team of three basketball players passed a ball to each other while ignoring the passes made by three other players. Half of the spectators were concentrating so hard on the task of counting that they failed to notice a man in a gorilla suit enter and beat his chest — even when they were staring straight at him.

Our vision renders us blind.

What was a remarkable adaptation to a more static environment centuries ago has become hazardous in today’s information traffic jam? Take the car accident of fifteen-year-old Christopher Hill in Oklahoma in 2009. Hill, an otherwise exemplary driver, was driving his car and making a cell phone call at the same time. Distracted, he ran a red light. His car struck another vehicle at forty-five miles per hour, killing its driver. Afterward, he stated that he had never seen the color of the light. Drivers typically overestimate their ability to multi-task, engaging in behaviors they might not think are dangerous, like texting and driving at the same time. Dr. Donald A. Redelmeier, a physician-researcher, and Robert Tibshirani, a statistician at Stanford University, found that talking on a cellphone while driving is as dangerous as driving drunk. Tibshirani said the paper they published on this finding “is likely to dwarf all of my other work in statistics, in terms of its direct impact on public health.” In line with Redelmeier and Tibshirani’s thesis, in a virtual driving simulation, a participant making a phone call missed the fact of a body lying on the side of the road. She soon crashed while texting. Because the driver’s attention was focused on a telephone call, she was distracted from an object that would ordinarily grab her attention due to its novelty.

We also give more attention to the novelty of curves than to the predictability of straight lines. Our eyes usually sample our environment through a vision system known as the saccadic system. Saccades are very rapid movements of the eye, the head or another body part. In the instance of eye saccades, the movement of the eye permits small parts of a scene to be sensed with greater resolution, which allows the resources of the body to be used more efficiently. Anything out of the ordinary or unexpected draws our attention, at which point the saccadic system is interrupted and we focus intently on the questionable image. When we are satisfied with our understanding of the scene, our saccadic scanning resumes. From a Darwinian perspective, this strategy was very useful: we could spot the movements of a predator out of the corner of our eye and then focus intently on that spot until the danger had passed.

Curved movements short-circuit the saccadic system. Indeed, the pickpocket Apollo Robbins noted that he could only steal the wallet of a man who knew he was going to have his pocket picked when he moved his free hand in an arc instead of a straight line. (Martinez-Conde and Macknick, 2008). The arc momentarily distracted the victim, allowing Robbins to use his other hand to pick the pocket.

When the mark focuses on the curve of Robbins’ hand, the mark’s mind is distracted away from the site of the pickpocketing by the additional attention required to process the curve; if the pickpocket moves his hand in a straight line, the eye is able to accurately predict the end-point and revert to scanning the environment. Alternatively, scientists posit that curved motions may just be perceptually more salient than linear ones and attract stronger attention. (Martinez-Conde and Macknick, 2008). Under either of these explanatory hypotheses, it is the mark’s inability to truly attend to the environment that renders him vulnerable to the trick, just as it is often a driver’s failure to attend to his environment that causes a crash.

Magic tricks also provide lessons on the human mind and attention. Neuroscientists have conducted experiments with “the vanishing ball illusion.” This trick begins with a magician tossing a ball a few times and easily catching it. On the final toss, the magician only pretends to throw the ball, continuing to follow the imagined trajectory of the ball. However, he has palmed the ball. Nonetheless, most observers perceive that the ball has ascended and vanished into thin air. Scientists determined that the magician’s head and eye movements redirected the spectators’ attention to the predicted position of the ball. (Kuhn and Tatler, 2005).

A year later, scientists discovered that the spectators’ gaze did not point to where they said that the ball vanished. (Kuhn and Land, 2006). The finding suggested the illusion did not trick the brain. Rather, the magician’s head and eye movements were critical to the illusion, because they redirected the observer’s focus, not their gaze, to the predicted position of the ball. The neurons that responded to the implied motion of the ball suggested by the magician’s head and eye movements are found in the same visual areas of the brain as neurons that are sensitive to real motion. Implied and real motion activated similar neural circuits. An observer perceives that the moving object is further along its path than its actual final position. Perhaps, rather than looking at the real destination of the ball, our brain takes a shortcut and extrapolates the likely outcome based on the motion that went before, rather than by looking at the ball itself. (Kuhn and Land, 2006).

Reversing Perceptual Blindness

The French philosopher Henri Bergson wrote, “The eye sees only what the mind is prepared to comprehend.” As adults, once we recognize that we have become blind, can we choose to start seeing again? One way to start seeing what we’ve missed is to reframe the world by taking the familiar out of context. For example, when we draw a tree, we might look at it upside down between our legs. The tree appears to be new, and so we can see it as it is (and therefore, draw it more accurately). When doctors look at chest x-ray after chest x-ray, they may become so inured to looking past the fact of the bones of the heart and lungs, that they miss a rib fracture. In order to ‘see’ the fracture, the doctor might need to turn the chest x-ray sideways, inhibiting the learned preconception, in favor of the details that can only be noticed when the image is “new.”

Another way to reframe the world is to change yourself. Even as simple an act as getting a haircut can alter how others see you or how you see yourself, causing a chain reaction of alterations in how you and the world interact. Daily engagements with pranks, art, humor, and design can also revitalize or change your perspective because they move you away from conventional thinking and toward the edges and margins of thought and experience where we encounter the unexpected.

You can also counteract the mind’s tendency to take shortcuts by practicing improvisation. Although we usually interact with others in a narrow model of behavior or “scripts” as studied by Langer and Abelson, practicing improvisation puts us in fast-paced, unexpected circumstances that require us to respond to other people outside of the scripts in which we usually operate. Because what’s being said in improv is unfamiliar, we pay more attention and respond to the other person’s actual body language and what they are really saying, instead of anticipating their speech and responding to what we think they’ve said.

Or you can dramatically change your environment and shock your body and mind out of complacency. You can go to Burning Man, go snorkeling, or vacation in a foreign country. While new neurons are not created in the brain — an adult has roughly 100 billion of them- intense new experiences allow new connections to be formed and strengthened between neurons. The more the new experience diverges from your everyday experience, the more your brain will be challenged and exercised into a state similar to that of being a child and the rawer sensory information you can take in. On a practical level, when you return to your usual routine, the different perspective you bring back with you allows you to take in more and see what you were unable to see before. So, for example, when you first snorkel or scuba dive, you may be fascinated and awestruck by the beauty and glory beneath the surface of the sea. After a while, you’ll adapt to what you’ve seen. When you return to land, the world seems strange and unfamiliar. Going further, most people who are used to snorkeling or diving during the daytime will still be astonished by the undersea world at night, when their sense of sound is heightened and they tend to find that the ocean seems much louder than it did by sunlight. Suppress or silence one sense and another grows louder to compensate.

Increasing our sensitivity is the form of change in the world that is most easily leveraged and yet it is often the last solution we consider when faced with any one of the wide arrays of social problems. As our world rapidly morphs into a global village, we must solve problems that are worsened by ideological conflict — war, poverty, disease, child soldiers. Are the problems themselves hard, or have we become insensate? Rather than tackle these problems on a case-by-case basis, it might make more sense to demand and create a solution for our lost flexibility of perception. Our failure to see that we need to shift our focus from narrow solutions to expanded perception is itself an example of the phenomenon of hiding in plain sight.

The positive effects of remaining attentive to our environment are not limited to our visual sense alone, but apply to what we hear, taste, touch, and feel. We can only avoid the tricks, phantoms, and illusions — those things that exist only in our mind and not in the real world — by developing strategies to increase our mindfulness in every sense.

DOI: 10.3907/HPS10J1

Originally published in The Journal of the Palo Alto Institute on September 1, 2010.