The Frontal Cortex

Hanukkah and Colonoscopies

Tonight is the first night of Hanukkah, which is, as Adam Sandler has correctly noted, a rather unsatisfying holiday. It’s typically sold to impressionable Jewish kids as being better than Christmas, since there are eight days of presents, and not just one climactic morning. But as one soon discovers, those eight days are a bit deceiving. The way Hanukkah typically works – at least in my family – is that all the good presents arrive on the first night (the new bike, the big Lego set, etc.) followed by seven days of diminishing returns. In my childhood, the last night of Hanukkah was usually reserved for mechanical pencils and other “gifts” that were actually school supplies.

I know what you’re thinking: what an ungrateful brat! Besides, isn’t a new mechanical pencil better than nothing? If humans were rational creatures, the answer would be yes. Alas, Hanukkah doesn’t take place in an economics textbook, and that mechanical pencil actually devalues the shiny bike of seven days earlier. This is known as the peak-end rule, and it has important implications for the distribution of gifts over Hanukkah.

Let me explain. In the mid-1990′s, the psychologists Donald Redelmeier and Daniel Kahneman came up with a brilliant research project. They studied two groups of patients undergoing colonscopies. One group received a standard colonoscopy. The second group received the same treatment, except that at the very end of the procedure the doctors let the instrument sit in place for a few extra minutes. (This is relatively painless, at least when compared to the probing that comes before.)

Which group experienced less pain? At first glance, the answer seems obvious: the first group should report less overall pain, since their procedure was a few minutes shorter. But this isn’t what happened. The second group experienced significantly less discomfort. Of course, this is a completely counterintuitive reaction, since it implies that the way to make a medical procedure less painful is to make it last longer. According to Kahneman, the only trick is to make the additional minutes represent a relative decrease in the intensity of pain. When doctors listened to Kahneman’s advice, patients were more likely to return for a follow-up colonoscopy.

How did the psychologists explain this counter-intuitive result? According to Kahneman, people judge their sensory experience relative to a reference point, which in this case was the painful sensation of a camera probing their intestine. As a result, when the probe stopped moving, what the subjects perceived was a relative decrease in pain, which felt nice. The happy ending made up for the overall increase in painful moments. (This is known as the peak-end rule.) As Kahneman observes, “A general property of perceptual systems is that they are designed to enhance the accessibility of changes and differences. All perception is reference-dependent.”

The lesson is clear: if you want to improve Hanukkah, simply improve the final night, and save some big gift for that last lighting of the menorah. The happy ending will conveniently erase all those memories of mechanical pencils.

Comments

  1. #1 Kamel
    December 22, 2008

    My mother recently asked me if there was any sort of small, stocking stuffer type gift I wanted in particular. I told her coffee… and mechnical pencil.

    They aren’t so bad.

  2. #2 chezjake
    December 22, 2008

    And I’d always thought that colonoscopies were “peek end” procedures.

  3. #3 gingerly
    December 22, 2008

    That was a wonderfully unlikely post. I had to laugh, and it’s even sensible.

  4. #4 Jay S.
    December 22, 2008

    I say take it one step further. Take all the gift cards you will inevitably get during Hanukkah, go buy your things, wrap them up and open them on Christmas morning.

    Just the notion of a fat man in a red suit squeezing down your chimney to bequeath you with gifts brings a certain Savoir Faire to even the most minimal of gifts like mechanical pencils.

  5. #5 Rachael
    December 22, 2008

    Let me say that even as a 12 year old, I could entertain myself for hours with nothing more than an officemax catalog…office supplies rule…

    I’ve always been bothered by the idea of Hanukkah being a “Jewish Christmas”. I was denied Christmas my whole childhood – as if it did me any good other than feeling left out and sad. I was so jealous of all of the “normal” kids with their bright lights, tree and tasty things to eat. So now? I’m still Jewish and I still celebrate Hanukkah, I still plan to raise my children Jewish, and I also celebrate Christmas. To all those parents out there: spread the joy, and focus on the more meaningful occasions of Yom Kippur and Passover. Teach your family and neighbors that even though we all believe different things, we can share in a happy time of the year together.

    Regarding the colonoscopy… is it the relative decrease in pain, or is it the timing of that decrease (ie, the last memory of the experience is less painful)?

  6. #6 jb
    December 22, 2008

    One of my favorite versions of reality is that passed on by Rachel Naomi Remen,M.D., cancer therapist and collector of patients’ stories. This is from a collection called “My Grandfather’s Blessings”:
    “According to the Kabbalah, at some point in the beginning of things, the Holy was broken into countless sparks which were scattered throughout the universe. There is a godspark in everyone and everything, a sort of diaspora of goodness. God’s immanent presence among us is encountered daily in the most simple, humble, and ordinary ways. The Kabbalah teaches that the Holy may speak to you from its many hidden places at any time. The world may whisper in your ear, or the spark of God in you may whisper in your heart. My grandfather taught me how to listen.
    “One is encouraged to acknowledge such unexpected meetings with the Holy by saying a blessing. There are many
    hundreds of such blessings, each one attesting to a moment of awakening in which one remembers the holy nature of the world. In such moments heaven and earth meet and greet and recognize each other…..
    “Blessings come in forms as simple as the greeting commonly used in India. On meeting a total stranger, one bows and says ‘ NAMASTE: I see the divine spark within you’.”
    So Namaste to Jonah and family and readers at the dark time of year whatever we individually celebrate!

  7. #7 MM
    December 22, 2008

    I think that it makes sense that the first colonoscopy group reported experiencing more pain than the second. Let’s say that first group’s total exam time was 10 minutes, 5 of which were very painful (due to the probing part of the exam). That means that these patients experienced severe pain during half of their exam. Second group’s exam lasted longer (let’s say 15 minutes). They also experienced 5 minutes of intense pain caused by probing. However, because their exam was longer the very painful part of the exam accounts for 1/3 of the total exam time. So it follows that second group’s exam was less painful.

    And personally, I don’t think that the excitement of getting a new bike (or whatever it is that one might desire to get) on the last day of Hanukkha would be any different from getting it on the first day of Hanukkha. Your total loot at the end of the holiday would still be the same.

  8. #8 temp
    December 23, 2008

    Those of us in nursing all know that colonoscopies belong
    to a group of procedures known as “peek in” procedures,
    so it is hardly surprising that one’s memory should be determined
    by the “peak end” experience of this procedure.

  9. #9 Chris
    December 23, 2008

    I wonder why would anyone choose to give the best presents on the first night. It seems completely intuitive to me that you should start slow, build up progressively and end with a big finish.

    And now that I wrote this, I realize it looks like I’m writing about something completely different.

  10. #10 ethel
    December 23, 2008

    I had meds during my colonoscopy and am happy to say I remember none of it. Somebody has been going to the wrong doctors.

  11. #11 Curious
    December 23, 2008

    This is not news – there’s the old joke “it feels so good now that you’ve stopped beating me.”

    And I’m with Ethel: if a colonoscopy is painful, change doctors!

    So what all this means is, get all the Jews on earth to change their gift giving behavior, right?

    Let me know how that goes, will you?

  12. #12 Shmuel
    December 24, 2008

    There is actually Talmud on this. See Hillel vs. Shammai:

    “Hillel and Shammai saw the lighting of Chanukah candles as representing how we feel about the holiday of Chanukah. Both agreed that we should experience increased excitement as Chanukah goes on. However Shammai said that in reality, most people do not feel increased excitement as Chanukah goes on. A person’s excitement diminishes as he becomes accustomed to something. Chanukah is no different; a person’s excitement diminishes each day as he gets more and more used to it. Therefore, Shammai said that our lighting candles should reflect the reality of how we feel and so we should light eight candles on the first day of Chanukah (when our excitement is at its peak) and then gradually decrease the number to reflect our diminishing excitement. On the other hand Hillel said that we should light candles according to how we are SUPPOSED to feel. Given that our excitement is supposed to increase as Chanukah goes on, we should start out lighting one candle and then increase the number until we get to eight the peak of our excitement.”

    http://www.morim.org/contents.aspx?id=2002

  13. #13 Judy Weismonger
    December 24, 2008

    In this nearing birthday of the imaginary jesus, the Christians need to show us their love.

    My Christmas Letter of Good Cheer to Christians:

    Long before you silly, confused, lying, obfuscating, faking frauds created your NEW religion 2000 years ago (by voting jesus in as a god in 325 AD by the Nicene Council)—Winter Solstice was celebrated for at least 5000 to 8000 years before you upstarts stole the celebration, up to and including appointing the birth of jesus as the same day as Winter Solstice, Dec 25th (which conveniently was also the birthday appointed to two other gods, Apollo and Mithra).

    So…when we say…Happy Winter Solstice…the traditions and acknowledgment of when the life-giving SUN is farthest from the earth and thus begins the realignment of the earth and the Sun back to being closer to us…so plants can live, we can grow food and eat, the earth warms up, water flows, and Spring is on the way…sustaining life on this planet, it is really significant. Your religion has completely ignored life on this planet which is very important. Winter Solstice means something real.

    Your dream world and delusional religion, cannot plant crops, sustain life, or even acknowledge the importance of the SUN….since you are all life-haters…and are in reality suicidal self-hating creatures, who worship a neo-god who also committed suicide….

    It is not Merry Whatever as one of you sarcastic xians said, chagrined at Xmas no longer being as important or “real” as it once was considered to be. Dec 25th is again being acknowledged as one of the most important days of the year known for at least 5 millenium. But, no never mind…the suffering of your imaginary jesus and gawd have to be more important than all other religions or CELEBRATIONS OF LIFE…

    Instead of celebrating life, you xians worship death and just can’t wait to join this multiple-god trio including a “ghost”….in eternity…doing who knows what…how boring. OK then, I say…do it….Make the 25th of December the day that you join jesus….in heaven, or where ever your delusional and insane brain takes you. Since you are saved…then joining jesus in heaven…will be just a mere step into the harmonious, ever boring after world of your brainless religious invention.

    In fact…use the 25th of December…to have cruci-fiction parties….get those crosses out, nail each other to the cross….SUFFER just like jesus did….my oh my what a role model you have chosen to worship i.e. some nearly naked, bloody, beaten up dead guy in a diaper hanging on a stick who intentionally committed suicide by cop (Roman Soldier)…

    PS: I would never, ever ask or approve of anyone “dying for me,” or “committing suicide” for any reason so I can go to some imaginary, unknown place in the sky…and I find an entire religion based on this “belief” out right insane. The backwards of mental hospitals are full of people like you…who have done various and hideous things to themselves and others in the name of god and jesus….including drowning all of their children in a bath tub because god told them to (Andrea Yates).

    If you do a Google search, or go to YouTube.com….you can take lessons on how to drive nails into your palms and feet just like some nut case Filipinos do every year. They almost got it right…problem is they don’t hang on the stick long enough to end up like jesus…they just do it for only a short time, long enough to get enough attention from the crowds to satisfy their sick egoes.

    Oh yeah, even you dumb xians don’t even get cruci-fiction right…in real cruci-fictions by the Romans, nails were driven through the wrists….not the hands, because the many, small bones in the hand can separate by supporting the weight of the body, causing the crucified to fall off the cross and just hang upside down by their feet and flop around like a gaffed fish….so do it right…drive those Christian Nails right through the wrists…and hang there…and see if god saves you. And the more you suffer, you will know that this is what jesus wants you to do…so do it. Show us your love, show us how much you are suffering for us. Jesus is going to be so proud.

    In the 21st Century….christianity is right up there with other bizarre practices, such as female genital mutilation, piercing nipples, lips, eye brows, noses, tongues, and other parts of the genitalia, or tatooing “Mother” across one’s back…and other defacements of the human body. And, such practices are all supremely painful…making the sufferer “feel” as if they are doing something really unique, worthwhile, and wonderful…so join them, start nailing each other to the cross every year. Get on with your orgy of suffering “for us,” and…do it right, after all jesus did it, so, why you too?

    Just how much you xians hate yourselves and are willing to suffer because of self-hate, including hate for all of human life (the sin of carnality) depends on how hypocritical the xian is in reality. Real xians can’t wait to die. You xians state frequently, that you are “born sinners”…you are born evil, you are not even worthy of kissing the hem of jesus “dress,”

    And,…the rest of you fake your self hate, when in reality, you are full of narcisscistic, hysterical, egotistic need to dominate others, and psychologically use blackmail, extortion and threats, including instilling guilt and shame to manipulate other unsophisticated, and vulnerable human beings. Therefore, to better “sell” xianity like used car salesmen,using the most base emotions and manipulations, you xians need to crucify yourselves as a witness to your “faith” and an example of how much “christian love” means.

    In reality, whereby you xians then want the rest of us to worship your suffering….its all about YOU…and getting attention. Afterall, the word “christian” means little christ…so be a little christ and crucify yourselves just like jesus did. Show us by example….what we should do, show us your love.

    Xianity is all about insecurity, fear, lack of self esteem or a sense of worth of your own life and the life of others…Your religion is an example of the LUDDITE fear of progress, and the need to self destruct into annialistic mindlessness of which you just think you are going to enjoy—Forever.

    Freud and other philosophers of psychology have noted there are two main drives in human beings…the drive to Live, and the drive to Die….The Christian Religion has taken the drive to DIE and encased it in an art form and an orgy of self hate, and the worship of suicide and self mutilation….well OK then…stop whining around telling everyone we should be just like you…show us by example, what you really worship and believe.

    Every one of you xians…should re-enact the cruci-fiction on yourselves….show us how much you love and emulate jesus…jesus is afterall, the example you follow, so do it…crucify yourselves.

    I can’t wait…be sure to get someone to take pictures or a video and put it on YouTube.com…don’t let the Filipinos be better xians then you.

    Judy Weismonger–Atheist Activist Against Religious Insanity

  14. #14 Gargravarr
    December 25, 2008

    Dear me, Ms. Weismonger, how bitter you sound. IMHO, that was entirely out of place here. I have a number of very dear friends of various religions, including atheism. You seem to have none at all. I feel sorry for you.

  15. #15 CanadianChick
    December 25, 2008

    I find the different perspectives on Hanukkah interesting.

    A dear friend says that to him, the quintessential moment of Hanukkah is the moment just after the 8th candle is lit.

    We created a video of just that moment, posted it on YouTube, and he put that in a comment.

    The only other comment we’ve received on the video page is someone who feels the opposite – that the 8th night is sad, because it’s a reminder of all the fun that is over…

    Oh, and Judy – bite me.

  16. #16 Nerissa Belcher
    December 26, 2008

    Can the peak-end rule could be used to good effect for other things? For example, suppose someone were to diet all day but then end their day with a nice chunk of chocolate. Would dieting become easier? Or suppose a student were to study all evening but then finish up by reading a fun novel? Would the extended study sessions become more comfortable?

  17. #17 jb
    December 28, 2008

    Most readers who celebrate Hanukkah are givers as well as receivers and the Talmud addresses this as well. Again, according to RNR, in the Mishna Torah, Maimonides, the great doctor rabbi, describes the eight levels of “charity” or giving to others. At the time, Rachel was 5 years old so her grandfather, an Orthodox rabbi, would simplify these teachings to their most basic wisdom.
    He said that at the most basic level of giving to others, “a man begrudgingly buys a coat for a shivering man, gives it to him in the presence of thers, and waits to be thanked”. At the seventh level there are fewer conditions,… “and finally at the first and purest level of giving to others, a man openheartedly gives his own coat away without knowing who will receive it, and he who receives it does not know who has given it to him. Then giving becomes a natural expression of the goodness in us, and we give as naturally as flowers breathe out their perfume.”
    I was reminded of this teaching and the joy that giving can bring while visiting an aging relative this past week. In the few days I was with her, I dashed around refilling meds, buying and wrapping Christmas gifts for her and her friends, addressing and sending cards, and finally on the last morning, doing something for some of the people who help her at her assisted living home. There was not time to play secret Santa and assess everyone’s preferences nor could I spend a lot, so everyone got a gift card from Honey Dew donuts, a business favored by one of the caregivers.
    When I spoke to my aunt on Christmas night she was delighted not by the gifts she’d received but by the many thanks she’d gotten from the gift card receivers. These were not the purest transactions perhaps but ones that gladdened my aunt’s heart and unexpectedly, mine.
    PS Thank you Jonah and commenters for your ‘gifts’ over the past year.

  18. #18 techne
    December 29, 2008

    The best presents on the first night? Who does this? What were your parents thinking? I’m glad my mom had more sense. The first night would have one good, but not best, present. The boring stuff would come in the middle, and the best present_s_ on the last night.

    A more important factor in us not thinking that Hanukkah sucked was that we had no Christian friends to compare ourselves to–we went to a Jewish school and everyone was in the same boat. Name That CogSci Principle! I got more Hanukkah identity confusion from a book intended to reassure me about the holiday, “There’s no such thing as a Hanukkah bush, Sandy Goldstein.” Until then I didn’t really know that I was “supposed” to want a christmas tree.

    The talmudic discussion is fascinating, and news to me. Hanukkah art always shows a full hanukkiah, so the satisfaction of the last night was finally getting to that. I’d save the blue or white candles out of the cheapo-candle box for the last night so I didn’t have weirdo mismatched green and purple ones. Not much I know, but hey. Hanukkah isn’t much.

  19. #19 Chadrock
    January 4, 2009

    To Judy: You have some incorrect science in your post. The earth is actually about 4 billion miles CLOSER during the winter solstace than the summer solstace. The seasons are due to the ANGLE of the sun’s rays, not the distance from the sun.

    Sincerely,
    Chadrock, a “happy” athiest

  20. #20 alexa harrington
    January 5, 2009

    First of all, the title of this post is still making me laugh, so good work there. And, secondly, I’m Jewish(ish) by marriage–my husband is an authentic Jew through his mother and we are raising our kids Jewish, but we also do the Christmas thing (for the tree/lights/presents) and Easter (for the jellybeans) because that’s what I grew up with. All of which means our kids get 9 days of gifts.

    It’s really hard to compete with the wonderfulness of Christmas Morning, so we mostly don’t try to convince our kids that Hanukkah kicks Christmas’ butt. But, in order to protect the specialness of Hanukkah and to deter our offspring from writing the Jewish tradition off outright, we are sure to point out how fun the candle-lighting is (what’s not fun about fire?) and we start with the smaller gifts and work up to the largest gift on the 8th night.

    I know, we’re holiday geniuses. Except that we’re not, because our kids (who are 7 and 3 and should still be suckers and fall for our lines) give us that look that kids give when they think their parents are dumb whenever we try to get them all hyped up about Hanukkah. Does it count that we try?

  21. #21 okey oyna
    March 4, 2009

    thanks you

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