Somewhere in my house is a book by Umberto Eco in which he compares Sherlock Holmes, Poe's detective C. Auguste Dupin and the American philosopher and Logician Charles Sanders Pierce. I don't know where it is but I've been looking for it, so I could say something about in connection with the TV show House M.D.
Anyway, we will get to Pierce regardless.
The first thing to note is that House M.D. is fiction and is not even the fiction produced by one singular writer. There is a substantial difference between it and reality. Not being a doctor and not a hospital worker or that familiar with medical science, I really can't say how great a difference there is between it and reality but I assume the difference is substantial. It is not, though, science fiction except in an argumentative sense. It is presented as the events in our world in a hospital caused by real diseases. However, we would be mad to draw any lessons about health care or treating disease from watching House M.D.
But I'm in interested in reasoning and I'm interest in fiction and I'm interested in fictional reasoning. House M.D. isn't a particularly intellectually challenging show but like a lot of detective fiction and like the subgenre of forensic science detective shows that were popular around the same time as House M.D. it is a show that is intended to communicate cleverness. The issue of the week is primarily solved by cleverness rather than compassion, bravery, intuition (OK sometimes), superpowers, combat or physical strength. Cleverness requires reason and so we are shown reasoning.
What kind of reasoning do we see?
Induction: which I'll broadly characterise as reasoning for many example to a more general conclusion. We don't see this very often because of the nature of the problems that the show focuses on. It is implied obviously in the medical knowledge of the doctors and the association of induction with science more generally. Of course, real science is more complex than just inductive reasoning gone wild and the long history of the philosophy of science points to induction just being one part of a more complex process. However, if we broadly include the use of statistical inference to investigate medical phenomenon than we do see it tangentially in the show.
Interestingly, when the concept of large scale medical trials is associated with a character in the show, the character is an antagonist to Doctor House. In season 1, the billionaire who becomes the Chair of the Board of the hospital aims to use the hospital as a base for clinical trials on cancer treatments. In season 2, House seeks petty revenge on another doctor who ratted him out in college but who is now claiming to have discovered a treatment for migraines. House isn't fighting these people because they are interested in clinical trials but the opposition fits thematically. House is never trying to go from the particular to the general but rather, as diagnostician, he is trying to go from the general to the particular.
Deduction: which I'll broadly classify as following formal rules about truth statements to arrive a conclusion. We see a lot more of this, in particular, in the "differential diagnosis" scenes we see a lot of semi-formal syllogism-like reasoning. They aren't really like this:
- All patients with symptom X have condition Y.
- The patient has symptom X.
- ∴ the patient has condition Y.
Even in the world of fiction, medicine isn't that easy. However, we do often see claims more like this:
- All patients with condition Y have symptom X.
- The patient dose not have symptom X.
- ∴ the patient does not have condition Y.
Notably, this isn't conclusive because, again, reality isn't that simple and neither is drama. During the story we may discover why the patient is an exception or that they really did have symptom X but it was masked by something or the test failed or the MRI didn't spot it because of reasons and so on.
There is more complex if...then... style reasoning when it comes to treatment, as various methods are used to both treat and diagnose. Again, I'm not saying this actually reflects how medicine really works but it feels more realistic.
Falsification: categorical conclusions can be refuted with a counter example. Going back to the migraine episode, House attempts to show that the anti-migraine drug doesn't work by inducing a migraine using nitroglycerine first in a comatose patient and then himself and using the supposed cure. As both he and the coma patient do still get migraines, he has demonstrated that the cure doesn't work. Except, of course, he hasn't if you think about it. The rival he attempts to discredit does end up being discredited but it is implied this is due to flaws in the maths of his study.
More generally, House and his team do often attempt to establish a tentative hypothesis and then seek to see if they can disprove it. This often works and sometimes they do this just to rule out a hypothesis they don't think is very plausible but which might otherwise get in the way.
Abductive reasoning: This is why I wanted to find that book. Holmes often uses abductive reasoning. So does Eco's Holmes like character William of Baskerville in The Name of the Rose. You can think of it as being like inductive reasoning but also as the opposite of it. A detective and a diagnostician can draw on a wide range of facts about the world but they need to reason that down to a particular conclusion rather than a generalisation. Who killed Professor Plum in the drawing room? Why does this patient have a rash?
The common example is to go from the when it rains the grass gets wet, to the grass is wet and so it probably has rained. What are likely, probable causes/explanations that cover all the data we have? Again, in the differential diagnosis scenes the team offer multiple explanations. They eliminate some but they never actually arrive at a definitive conclusion. Partly that's because of drama but also because they are whittling down an unfeasibly large space of all possible causes, to a much smaller space of likely causes. Those scenes end with them all heading off to try tests, scans and treatments to narrow the search down.
As I said at the start: this is fiction and the show can't be taken as an actual view of reality. However, as a kind of simulation of how people think and investigate, it is interesting. I think it has an edge over the CSI-style shows of the era of TV (or maybe that was a few years earlier) where the leaps of reasoning where bigger and often fueled by impossible technology.
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