April 24, 2022
Jennifer Kilkus Ph.D., ABPP
“Why did I get cancer?” Those who have been diagnosed with cancer often wrestle with this painful question. While we know that there are some health behaviors that are associated with an increased likelihood of a cancer diagnosis (smoking, heavy alcohol use), there are many people facing a cancer diagnosis where there is no definitive “reason.” For those that have no obvious connected health behavior or family history that explains the “why,” it can be a challenge to make sense of their diagnosis. In the attempt to process and interpret the many pieces of information we navigate each day, our brains often rely on heuristics—a mental shortcut that allows us to make judgments quickly and efficiently. Heuristics are often activated in situations that are complex, unfamiliar, and emotionally charged1. The efficiency provided by heuristics unfortunately comes with some downsides. While heuristics can be helpful, they can also lead to cognitive bias. Cognitive biases are errors in our thinking that lead us to draw inaccurate conclusions about the world around us. This biased way of thinking leads us to process information in a way that fits the way we already view the world. This increases the likelihood that we'll make judgments about situations that ignore key pieces of information that allow us to come to more logical conclusions. One of the most common types of cognitive biases that I hear in cancer care is the “just world” bias. First identified by Melvin Lerner in the 1960s2, this cognitive bias is based on the assumption that the world is a just place and that people get what they deserve. “Individuals have a need to believe that they live in a world where people generally get what they deserve. The belief that the world is just enables the individual to confront his physical and social environment as though they were stable and orderly. Without such a belief it would be difficult for the individual to commit himself to the pursuit of long range goals or even to the socially regulated behaviour of day-to-day life. Since the belief that the world is just serves such an important adaptive function for the individual, people are very reluctant to give up this belief, and they can be greatly troubled if they encounter evidence that suggests that the world is not really just or orderly after all.3” This way of thinking helps us make sense of some of the most challenging questions we encounter in our world. Why are some people abused, while others are not? Why do some people experience poverty, while others do not? The “just world” fallacy provides us a way to make sense of these situations in the absence of a definitive explanation for why they occur. However, this is a simplistic and inaccurate way of understanding situations that ultimately results in blaming others for their circumstances, even in the absence of evidence to support this conclusion. article continues after advertisement With cancer, the "just world" fallacy often translates to the belief that “I must have done something to cause my cancer.” This may be a belief that those coping with cancer hold themselves, or they may hear it from others, even when it’s not said quite so explicitly. For example, I have heard from many of the people I work with that one of the first things they hear from others about their diagnosis is an attempt to understand the “why.” “Well, are you a smoker?”; “What kind of diet do you eat?” This, not so subtly, implies that there must be something that the individual could have done to prevent their cancer. In a just world, after all, “everything happens for a reason” and “you reap what you sow.” It is a way of organizing scary and out-of-control situations so that they feel more predictable. “If I only [don’t drink, don’t smoke, eat well, stay out of trouble], then this won’t happen to me.” The reality is that cancer doesn’t discriminate. Cancer doesn’t care if you are a good person or a bad person, rich or poor, devoutly religious or not. While we do know that there are some factors that we can control to reduce our risk of cancer, there are other factors outside of our control, such as genetic and environmental contributors, that also influence cancer risk. Although this may be frightening to consider, it is ultimately a more accurate, balanced, and compassionate understanding of cancer than the “just world” fallacy. How do we avoid the “just world” fallacy? Here are a few suggestions to start recognizing and changing this common cognitive bias.