Posted in Psychology & Medicine

## Tit For Tat

In human society, there are many ways for a person to interact with others when in a group setting. Some may choose to be selfish and only be out for their best interests, while others may choose altruism and cooperate with each other. The mathematical model that tries to predict human behaviour and outcome in these settings is the Prisoner’s Dilemma – the core of game theory. Tit for tat is one strategy that can be employed in such a setting.

The basis of tit for tat is equivalent exchange. A tit for tat player always chooses to cooperate unless provoked. As seen in the Prisoner’s Dilemma, if both players cooperate, both benefit (let us say 3 points each); if one player defects, that person gains more than from cooperation (5 points) while the tit for tat player gains 0 points.
If a tit for tat player is provoked, that player will retaliate. However, the player is also quick to forgive. Ergo, if the other player chose to cooperate, the tit for tat player (following the principle of equivalent exchange), will also cooperate. If the other player defected, the tit for tat player loses the first round and then chooses to defect from then on.
Note that tit for tat strategy only works when there is more than one game so that the player has a chance to retaliate.

Let us use an example to illustrate why tit for tat strategy works. In this scenario, two tit for tat players and two defectors all play six games each, using the above point system (if both defect, they each receive 1 point). The results are as follows:
• Tit for tat vs defector: Tit for tat loses first round, both defect for next 5 rounds (5 vs 10)
• Tit for tat vs tit for tat: Both cooperate on every round (18 vs 18)
• Defector vs defector: Both defect on every round (6 vs 6)

When the points are added up, a tit for tat player gains 28 points (5 + 5 + 18) while a defector only gains 26 points (6 + 10 + 10). This is a surprising turn of events, as the defectors never lost a round and tit for tat players never “won” a round. This goes to show how cooperation leads to better long-term results while selfishness prevails.

There are shortcomings of this strategy. If there is a failure in communication and one tit for tat player mistakes the other’s actions as an “attack”, they will retaliate. The other player then retaliates to this and a vicious cycle is formed. This is the basis of many conflicts ranging from schoolyard fights to wars (although interestingly, tit for tat strategy is also found during wars in the form of “live and let live”). One way to prevent this is tit for tat with forgiveness, where one player randomly cooperates to try break the cycle (a defector would respond negatively while a tit for tat player will accept the cooperation), or the tit for two tats, where the tit for tat player waits a turn before retaliating, giving the opponent a chance to “make up for their mistake”.

Computer simulations have all proven that tit for tat strategy (especially the other two types mentioned just before) are extremely effective in games. In fact, it is considered one of the most optimal strategies in overcoming the Prisoner’s Dilemma.

In human societies, there is usually a mix of “nice people” and “selfish people”. By cooperating and trusting each other, we can produce a much greater gain over time compared to being selfish. And since society still unfortunately has “defectors”, you can retaliate to those who refuse to cooperate by defecting on them also. Ergo, a good approach to life is to initially reach out your hand to whoever you meet and treat them from there on according to how they respond. If they take your hand and want to cooperate, treat them with altruism and help them out. If they swat your hand away and try to use you for their selfish gain, it is fine to shun them and not help them out.

Through cooperation, understanding and connection, we can build a far more productive and efficient society, just like the ants.

Posted in Psychology & Medicine

## Bystander Effect

March 13, 1964 – Queens, New York. A young woman called Kitty Genovese was running from a man chasing her across the parking lot. She screamed for help as she ran from the attacker but not a single person came to her rescue. The attacker stabbed her repeatedly but the police were never alerted to the incident. The astonishing fact is that not only was there someone watching the whole attack – completely able to call the police or intervene – but there were no less than 38 bystanders.

This case sparked a question in social psychology: what prevented those 38 people from stopping a murder happening in front of them? Was it fear of attracting the assaulter’s attention? The bystanders were all watching from their apartment and calling the police would have been simple and discreet, so this was not the reason. Psychologists designed an experiment to study the natural human response as a bystander in an emergency situation.

The experiment was simple: have participants fill a survey in a room and have the helper leave the room. The helper would then stage a collapse with a yell. The participants’ response would then be observed (particularly their response time).
What they found was fascinating. When only one person was in the room, it was very likely he or she would check to see what happened. But with a group (even three would suffice), the response time would dramatically increase, if they responded at all. Simply put: the more bystanders there are, the less likely someone will step in to do something.

The reason is actually simpler than people think. It is not that people are naturally evil and wish to see others suffer; the bystander effect is a consequence of the basic human psyche.
Firstly, people constantly observe others’ responses in a social situation. This creates a paradox where everyone assumes that since no one is doing anything, they themselves do not act either.
Secondly, there is a shared sense of delusion where people think “others will do it”. This is known as “responsibility splitting” and explains why more people lead to less response.
These two factors combined with cognitive dissonance reduce the guilt and burden of the bystander as they consider it alright to not respond as long as no one else does (or if they do, good for them).

Unfortunately, this effect is so powerful that they occur in about 70% of assault cases and also other emergencies such as a person collapsing from a heart attack (i.e. no one rushes to perform CPR). The same effect is seen in cases of suicides (where the person publicly announces their intentions with no one responding) and classrooms (when the teacher asks the class a question).

This is why one of the greatest tips for emergency response is to pick a single person out and instruct them to do something. For example, “You there, in the red jacket, call the ambulance” is much more effective than “Somebody do something”.

Posted in Psychology & Medicine

## I…

It is human nature to want to know more about another person. However, ironically most people know less about themselves than they know others. The following is a simple psychological test that tells you about your true self.

Complete as many sentences as freely as you can, writing down whatever comes to your head. You have 5 minutes: (e.g. I am a male, I attend university)

1. I _____________________
2. I _____________________
3. I _____________________
4. I _____________________
5. I _____________________
6. I _____________________
7. I _____________________
8. I _____________________
9. I _____________________
10. I _____________________
11. I _____________________
12. I _____________________
13. I _____________________
14. I _____________________
15. I _____________________
16. I _____________________
17. I _____________________
18. I _____________________
19. I _____________________
20. I _____________________

This test is very useful as it is simple yet accurately portrays the subconscious mind and inner self. It is especially used in adult psychiatry consultations as answers become more subjective and creative as the subject’s age increases.
According to a study, from about number 10 the answers show the person’s wants and potential, and from 15 onwards subconscious desires and concerns. Ergo, answers become more accurate in their depiction of the true self as you fill in the lines.

The responses are sorted into six main categories:

1. Social status (I am an employee of…)
2. Faith (I am sure that justice will always win in the end)
3. Desire (I want to be rich)
4. Likes (I like watermelons)
5. Judgement (I am stubborn)
6. Blank (nothing written)

Interestingly, nothing shows more than you expect. For example, those who do not finish all twenty lines tend to be authoritative. This is because they show a tendency of seeing the world as black or white, or good or evil and cannot stand fuzzy, “grey” statements. Therefore, their view of their self tend to be simplistic, making their answers less detailed.

Now, let us explore the world of the inner self and the subconscious mind. For a more objective analysis of yourself, ask someone else to scrutinise your answers.

Posted in Psychology & Medicine

## CPR

CPR stands for cardiopulmonary resuscitation – or in plain English, artificially (and partially) restoring the function of the heart and lungs of an unconscious, pulseless person. As blood flow (perfusion) is critical in the survival of major organs such as the brain, this procedure can save lives by prolonging a victim’s life until the paramedics arrive to provide professional medical care.

When the heart stops beating, or becomes inefficient due to erratic beating, blood flow stops. In the case of the brain, this means that the cells will start dying after 4~5 minutes if perfusion is not restored. CPR can restore about 30% of perfusion, delaying the onset of brain death.

This may be critical when someone suffers a heart attack (myocardial infarction) and paramedics will not arrive for over 10 minutes. Ergo, this is one of the most important emergency skills one should know to help people in need as soon as possible.

There are different guidelines for CPR in many countries, but here is a standard procedure guideline (NZ).
It is summarised into the acronym: DR’S ABCD (doctor’s ABCD), and is a flowchart that goes from one step to the next (detailed explanation after summary).

1. Danger: check that area is safe and risk-free
2. Response: check for patient response by shouting, shaking, pain
3. Send for help: pick one person to call emergency services
4. Airway: check airway, remove obstruction, tilt head back and lift chin
5. Breathing: check for breathing, go to CPR if no breathing
6. Circulation: check for pulse if breathing, if no pulse, start CPR (30 chest compressions : 2 breaths)

The first rule of first aid is that you must not put yourself in danger. For example, if the patient is on the road, pull them to a safe area to minimise the risk to your own health.

Then, check for a response. The easiest way is to call loudly to them such as “Can you hear me”, and inflicting pain (such as rapping on their chest or shaking their shoulders) and see if they become conscious.

If they remain unconscious, immediately designate a person around you by pointing to them (otherwise they will be less likely to be responsible) to call the emergency service (111, 911, 119 etc.), alerting them the location and state of the patient.

This is the point when clinical skills come in.

Airway: An unconscious person may have their airway obstructed by vomit or their own tongue (which falls back by gravity into the throat). You must secure the airway by scooping out any material, and clearing the tongue out of the way. This is done by tilting the head back far (as if they are looking up), then using one hand to pull their chin out. This opens the airway up so that mouth-to-mouth becomes effective.

Breathing: Put one ear right next to the person’s nose and mouth and check for any breathing sounds or air flow. If they are breathing, check the pulse to see if they are pumping blood. If not, go straight to CPR.

Circulation: It is best to check the central pulses such as the carotid (side of neck, next to the Adam’s apple), brachial (squeeze inner side of biceps) or femoral pulses. The carotid is often the easiest as most people know how to take it. If you feel a pulse, put the patient in recovery position as they are just unconscious, breathing and has blood flowing. If not, proceed to CPR (as you do with when the patient is not breathing).

CPR is composed of two actions: chest compressions and mouth-to-mouth breathing. The former is the strong compression of the chest wall to squeeze blood in and out of the heart; the latter is breathing air into the patient’s lungs and letting exhalation come out naturally.

Chest compressions are often misrepresented in medical dramas, and is extremely important that you do it correctly. First find where the sternum is (centre of ribcage, between the nipples) and place the heel of your left palm on it, then spread your fingers out. Put your right hand over your left and close your fingers around it for a good grip. If the patient is lying flat on the ground (with head tilted back), kneel beside them and stoop over their chest with straight, locked arms (bent arms exert much less pressure).

You are now ready to begin chest compressions. Press down hard, until the chest wall is compressed to about 1/3~½ depth (the chest wall is a springy structure, and do not worry about broken ribs, as being alive is more important for the person), then ease pressure to let it bounce back up. Ideally the time pushing and the time letting it bounce back should be the same, giving a good rhythm. Repeat this 30 times at the beat of 100/min, or in easier terms: to the beats of the Bee Gee’s song Stayin’ Alive (scientifically proven).

After 30 compressions, tilt the patient’s head back, lift their chin up, and lock your mouth over their mouth and nose to make an airtight seal. It is crucial that you use a face shield to prevent the spread of disease. Be aware that breaths are less important than the compressions, so if you do not have a face shield, let someone else do the breathing and focus on chest compressions. Pinch the nose closed to ensure air does not escape.
Forcefully breathe into them and look for the chest rising. Let go of the nose and pull away so that they can breathe out. Repeat once, then return to chest compressions.

After 2 minutes of CPR (30 compressions : 2 breaths, repeat 4 times), change places with another person capable of CPR, as otherwise you will tire out and become inefficient.

Defibrillation is only possible if you are near an AED (automated external defibrillator). Nowadays, AEDs are designed to be completely user-friendly so simply follow the instructions on the machine.

It is important to note that not all abnormal heart rhythms are “shockable” (see Flatline). Follow the AED’s instruction, as it will state whether shock is advised or not. Make sure that CPR is still happening continuously.

Repeat until help arrives.

As a final note, remember that the patient is dead whether you do CPR or not, so there is nothing to lose. Believe it or not, this will be of incredible help in calming your mind when struck with such an emergency. Even with CPR, there is a maximum 30% chance the patient will survive, 10% if it occurs outside the hospital. But if you do nothing, their survival chance will be 0%, so put all your energy into resuscitating them, and you may just save a life.