When Belief Gets in the Way

I have written a couple of articles recently about the difference between perception and reality, and how it affects the way we use data. Relying on our perceptions rather than the reality of our data can cause major issues. I would encourage you to read those articles if you haven't already. But, of course, this issue is wider than how we handle data.

The phrase “perception is reality” gets repeated a lot. Too much. Usually without much thought. It’s a phrase that rears its head in boardrooms, clinics, management workshops, marketing decks and performance reviews. The idea is that how something appears, how it’s understood or misunderstood, can shape what people do. And yes, of course perception influences decisions. There is no way we can argue about that. But that’s not the same as it being true.

You see, when perception starts to replace reality, decisions go off course. People get misdiagnosed. The wrong person gets promoted. Entire systems are moulded around something that only looked true from a distance. And by the time anyone realises that the reality is different, the damage is already done.

when perception starts to replace reality, decisions go off course. People get misdiagnosed. The wrong person gets promoted. Entire systems are moulded around something that only looked true from a distance. And by the time anyone realises that the reality is different, the damage is already done.

You may think that I am being critical of others for this mindset, but I have to admit that I have acted this way myself. If we’re honest we all have. From a personal standpoint, I used to believe that Myalgic Encephalomyelitis (ME), now more commonly referred to as Chronic Fatigue Syndrome (CFS), wasn’t a real illness. Not really. I thought it was psychological, that people were just being lazy. Or maybe it was the effect of stress, anxiety, burnout. A mixture of mental health symptoms wrapped up in fatigue. I guess I agreed with a certain comedian when he joked about ME saying, “Saw someone collecting the other day for ME, not MS, not the crippling, wasting disease, oh no, ME. That’s the one where... 'I don't feel like going to work today'.”

Then I became really ill. I had no energy, I had body aches, I had severe chest pain and a number of other unexplained symptoms. I was shuttled between different doctors, specialists, hospital departments. All of them found nothing wrong. I collapsed at work and ended up in hospital. Again, the symptoms were there but they could find nothing physically wrong to explain what was happening. For me it was frightening. But then I was diagnosed with CFS in 2016. And the belief that this was a disease that was all in the mind crumbled. The symptoms I had weren’t vague, and they weren’t subtle. They were physical, unrelenting, and in no way imagined. It wasn’t depression. It wasn’t something I could think my way out of. It ultimately meant I had to step away from the senior job role I had held in the NHS for many years.

That shift in perspective, the personal experience, didn’t just change how I saw ME/CFS. It changed how I thought about belief itself; how easy it is to adopt a perception, to live completely inside it, and never think to challenge it until it hits home.

It changed how I thought about belief itself; how easy it is to adopt a perception, to live completely inside it, and never think to challenge it until it hits home.

Even now, in some countries, ME is still treated as a mental illness. People are misdiagnosed. Worse, some are forcibly sectioned. Taken from their homes, locked into psychiatric facilities, left without appropriate care. Families fight to get them out. Unfortunately, not everyone makes it.

There are documented cases of people with ME/CFS who have died; either because they were denied treatment or because they were given the wrong kind. Treatments meant to “manage anxiety” that instead triggered irreversible crashes. Feeding tubes delayed. Pain not believed. Patients treated as problems rather than people.

And the thing is, this didn’t happen because there wasn’t evidence. It happened because the perception form the medical profession, and the public, hadn’t caught up with the facts. Of course, since the Covid pandemic, many people have ended up with what is referred to as long covid. Something the medical profession are unable to deny. And not surprisingly this bears a striking resemblance to the symptoms of ME/CFS. Suddenly there is research being done to try to work out what is happening; something that was never done with ME/CFS.

You can see this same perception vs reality pattern with antibiotics. For years, antibiotics were seen as a cure-all. GPs handed them out for everything. Viral infections, sore throats, colds. All the things antibiotics do nothing for. But patients expected them, and doctors wanted to help, so the pills kept coming.

Now, antibiotic resistance is making some infections incredibly hard to treat. Entire classes of medication are losing their edge. And it wasn’t malice or ignorance that got us here; it was that same mix of outdated belief and wishful thinking. A story that felt true, until it very much wasn’t.

it wasn’t malice or ignorance that got us here; it was that same mix of outdated belief and wishful thinking. A story that felt true, until it very much wasn’t.

And this was mostly due to the placebo effect. People thinking they’re receiving effective treatment, and their body responds; even if it’s not. Belief triggers physical change. Which sounds helpful, and sometimes is. But it also muddies the water.

If enough people believe in something, it can start to look like it works. Even when it doesn’t. And that’s when perception starts pushing its way into decisions that ought to be based on something firmer, like evidence. If enough people believe something is true, they will act on that belief. Even if its false.

The thing is, that the more you rely on belief to justify your actions, the harder it becomes to tell what’s effective and what just feels effective.

the more you rely on belief to justify your actions, the harder it becomes to tell what’s effective and what just feels effective.

Of course, this isn’t just limited to healthcare. In business, the “perception is reality” mindset also runs deep. People build entire careers on managing how they’re seen, rather than what they do.

You’ve probably worked with someone who was better at self-promotion than delivery. They turn up and talk a good game in meetings, they say the right things on LinkedIn, and they always seem to be in the right room when credit’s being handed out. They’re the ones who get promoted. They’re the ones who are held up as examples.

Meanwhile, the person who quietly fixes things, who keeps systems running, supports the team, gets results but doesn’t advertise them, often gets overlooked. Sometimes even let go. Not because they’re less capable. Just less visible. The perception is that they are not as “good” as others, that they are not of the same calibre.

Unfortunately, confidence usually gets mistaken for competence. This is nothing new. A manager who controls rather than leads, who takes credit for others’ work, who dominates meetings, stifles discussion, and makes people anxious, can still rise if they know how to portray their behaviour in a positive light.

If they frame it as “disruption” or “bold leadership”, people nod along. Especially those above them who aren’t watching that closely. And the damage this causes is usually picked up by the team.

If they frame it as “disruption” or “bold leadership”, people nod along. Especially those above them who aren’t watching that closely. And the damage this causes is usually picked up by the team.

But those teams don’t always have a voice. Not one that gets heard, anyway.

And then there’s measurement. The KPIs and dashboards and reporting tools that are supposed to offer us clarity. But what they usually do is reinforce the illusion, backing up our perceptions. We measure the things that other people perceive as being important, rather than what really is.

So someone hits a sales target by offering steep discounts that destroy profit margins. But the KPI around the target has been met. Another person cuts costs by employing junior staff and giving them work that should be given to senior staff. It all looks good on paper until the cracks start showing. The junior staff get burned out, they don’t have the necessary skills or experience and the wrong decisions are made. Even then, it can be months before anyone links those cracks back to the people who caused them, by which time they have often moved on.

After writing about this idea in previous weeks, I’ve seen a couple of people echo the same mantra: “perception is reality”. People in leadership roles. People with decision-making power. People who have a large following and should know better. It’s hard not to be demotivated when I see it. Because I know where that thinking leads.

It leads to patients being locked up because they “don’t look sick”. To brilliant staff being passed over for the louder voice. To systems that protect reputation while letting reality rot underneath.

We don’t fix this by swinging to the other extreme and pretending perception doesn’t matter. Of course it does. But it’s not a substitute for truth. And it’s definitely not harmless.

We don’t fix this by swinging to the other extreme and pretending perception doesn’t matter. Of course it does. But it’s not a substitute for truth. And it’s definitely not harmless.

I mentioned the joke about ME/CFS and how a lot of sufferers felt like it reinforced harmful stereotypes about the illness. The perception rather than the reality. To his credit the comedian in question has now adjusted his routine to clarify that ME is a real, physiological condition, stating that he used to think it was psychosomatic but now understands it is not. But there has been no public apology and unfortunately, for many of his fans, the damage from “perception” has already been done.

The real question is whether we’re willing to let our assumptions, our perceived reality, be challenged. Whether we can sit with the discomfort of discovering we were wrong about something. And whether we can admit it to others.

I had to. With ME/CFS, I had no choice.

It changed everything. Not only did it majorly impact on my career, it affected how I see others. How I listen to people. How I try to spot the difference between perceived performance and the substance underneath.

And once you start noticing the gap between what looks true and what actually is, between perception and reality, you see it everywhere.

And in our current environment that’s no bad thing.