First, Do No Harm

As a psychology professor I teach students who plan to be practitioners of social science. They have been moved with compassion by the problems so many people face, such as being in a painful marriage or having a child with developmental challenges. With good intentions, psychology majors long to alleviate the suffering that people experience.

One of my primary goals as a teacher is to help students understand that good intentions and common sense are not enough to help people. Indeed, common sense and good intentions can be harmful. My favorite example is an intervention program that was developed by researchers at the University of Oregon.

These researchers developed an intervention program to prevent delinquency in low-income boys who had risk factors for future delinquency. The program included several components to help the boys, including after-school tutoring and summer camps to keep the boys out of trouble when not in school. It is easy to imagine the thankful young adults graduating from the program, pleased that others took an interest in them and helped them grow into responsible adults.

Unlike many developers of intervention programs, the Oregon researchers conducted a systematic study of the program to examine its effectiveness. Some of the boys who were at risk for delinquency in the initial pool of boys were randomly assigned to receive the intervention; others were randomly assigned to get no special assistance. It turned out that the boys in the intervention program were more likely to engage in delinquent behavior than the boys who got no "help." The intervention program caused delinquency!

Without scientifically examining the effects of the intervention, well-meaning people would have harmed children and their communities.

It is not just social-science interventions than can give the appearance of helping when they are in fact harmful. In the 1950s, arterial ligation was a commonly used surgical procedure for the treatment of chest pain that was the result of the heart not getting enough oxygen. The success rate of the surgery was impressive; 76 percent of patients improved after the surgery. When put to the test, however, arterial ligation was found to be harmful.

Researchers at the University of Kansas gave some patients with chest pain the standard arterial ligation procedure. Other patients received a placebo surgery—incisions were made, but the actual procedure was not done. The success rate for the placebo surgery was 100 percent!

Thus, a commonly used surgical procedure with many pleased customers was in fact harmful. Arterial ligation put people at risk for all of the possible complications from surgery, and it was less successful than a placebo. Without scientific examination, we cannot know if our treatments, be they psychological or medical, are helpful or harmful.

We are now approaching the high point of wedding season. It is well known that half of all new marriages will end in divorce and that some couples who stay together will not be happy. Bookstores abound with books by well-meaning, sometimes credentialed people who promise to help couples have successful marriages. Those of us who want to improve marriage need to ask whether there is good data showing that these programs work. A marriage improvement program can be worse than unhelpful; it could make many couples’ problems worse, even if many people say it was helpful to them personally. Most of the self-help marriage books that are available promote approaches that have not been rigorously tested. Some of these books may have a bibliography showing that the authors have read scientific papers, but the authors have not scientifically tested their approach in the real world.

One of the commonsense but untested approaches is to teach people common stereotypes of males and females. The idea is that men and women are radically different and that if we only understand one another marriages will work. There are logical reasons to expect this approach to fail a scientific test. First, not all people fit the stereotypes. Thus the explanations for how to understand one’s spouse would be incorrect. Second, even for people who fit the stereotypes, a generic understanding of the opposite sex is not enough for a successful marriage. People need skills for a successful marriage.

The number one predictor of marital success is how conflict is handled. Poorly handled conflict is not only damaging, it poisons friendship. Happily, there are skills-based programs that have significant scientific support. These programs teach couples how to handle conflict, as well as how to build friendship.

The great thing about skills-based approaches to improving marriage is that they teach couples skills that promote marital satisfaction without regard to whether people fit stereotypes. Furthermore many of these programs have been scientifically demonstrated to make couples happier and less likely to divorce. Those of us who want to help couples must first do no harm.

Good social science allows us to not only to avoid doing harm, but to teach skills shown to improve lives.
