What would you do if you were in your favorite shopping mall and the escalator was not working? Would you consider it an act of sabotage and demand an investigation? Most people would just walk up the frozen staircase and not give it a second thought. You don’t have to take my word for it. Just go out in the wild, find a frozen escalator and see what happens. The escalator in the mall I go to is usually not working. There is no outrage or complaints to the manager. People just walk up and down it using the stair function. That is what most people know about escalators from personal experience. This post will examine how you could think about that problem. But first – a few facts about escalators.
There are about 35,000 escalators in the US. Escalator
density varies widely from state-to-state from much higher number in large
metropolitan areas to only 2 escalators in the state of Wyoming. Performance metrics are available for systems
where they are used extensively like transit systems. Systems are rated on
availability and how long they operate before failing. The engineering metric is Mean Time Before
Failure (MTBF). An example from one
metro transit system of 588 escalators measured availability at about 92% and
MTBF of 153 hours (6.4 days). The average time to repair those escalators was
14 hours. Of all the maintenance work
done only 32% was scheduled. The
remainder was due to service calls, safety repairs, and customer
incidents. Interestingly service calls
included escalators that turned off unexpectedly. All this data indicates that
escalators are high maintenance devices compared with other commonly used
devices like your automobile.
There are an estimated 10,000-17,000 escalator related injures
per year. 75% of those injuries are from
falls and slips (1). Risk factors
include advanced age and alcohol use. Many of those injuries are severe enough
to require admission to a trauma center and in rare cases can result in death.
If you encounter a frozen escalator or one working
erratically you could tell yourself: “Well I know from my personal experience
that escalators will not be working from time to time. This is a little
annoying but I can walk up the escalator or find an elevator like everyone
else. I assume the next time I am here it will be repaired.” If you know more about escalators you might
think: “I know escalators have a high failure rate and about one in ten may not
be available on any given day – this is to be expected. I will just work around it” After all the escalator was put there for the
convenience of customers and the public.
These lines of thought are the collective reality that we
experience. In considering a probability model of thought our collective
experience creates a high probability that when we encounter a broken
escalator, we will consider it a routine occurrence and quickly move to a work
around. A thought experiment illustrates
this fact. If I poll 100 people on how
they handle a broken escalator – most of them will give the expected
responses. The outliers may be people
who know about escalator maintenance or how these situations need to be
handled.
But there are outliers.
Outliers could have phobias about escalators. Escalators have well known safety hazards of falling
and slipping. They have an awkward motion for many people and a person with
vertigo or other balance problems may find it difficult to use them. These people may have had a mishap on an
escalator and sustained an injury. There
is a term for escalator phobia that I will not use here because I don’t think
it adds much. People who are phobic of escalators may tend to avoid them. That is easier to do in shopping malls than
transit systems. Not having worked in
escalator dense areas I have never encountered a person with that phobia but
have seen many people with phobias about crossing bridges and railroad
tracks.
Are there other ways to think about a broken escalator than
just inconvenience. As I was writing this,
I thought of Jason Bourne one of my favorite fictional movie characters. In the famous escape from Waterloo Station
the scene begins and ends with escalators. Fortunately for Bourne they were working in
both cases. But if they were not working,
we can speculate he would probably be seeing the problem though his usual
combination of situational awareness that would include alternate routes and
what could be used to his strategic advantage.
The bottleneck created is an example of potential strategic use.
There are outliers beyond the outliers. Folks with unique interpretations of everyday
situations at a frequency of one person in a thousand to ten thousand. They may have never seen an escalator or how
it works. But if they were born and
raised in a modern society that is not very likely. One recent interpretation was that the
escalator was not working because it was sabotaged. Where does sabotage fit in to a probabilistic
model of everyday thought? Sabotage is
an unlikely explanation of everyday events.
People who I have professionally encountered over the years have told me
about how the electricity in their home, their health, their food, their pets,
their automobile, their work, their spouse, their legal status, and their
finances were sabotaged by several methods.
Some of the methods were incredible like beams from satellites or
delivery vans parked outside on the street using some kind of electronic device. Others seemed more possible like “they came
in the middle of the night and replaced my wife while we were sleeping. She looks sounds, and acts the same but I
know she is not real.”
Note the operative term they in the above scenarios. They are a possible or imagined enemy
causing the real or imagined problems. They can easily be a scapegoat. Rod Serling was an expert in looking at how
this dynamic plays out in society. Slightly
after the McCarthy era
– he wrote an episode of the Twilight Zone called The Monsters are Due on
Maple Street. The entire plot
focuses on what happens when there is a power outage on a residential street
and people start looking for a scapegoat.
The final narrative is a comment on human nature and how we can be
counted upon as a group to get the probabilities wrong.
What happens if the sabotage explanation persists and cannot
be explained by groupthink, spycraft or reality? Fixed false explanations and beliefs about
action or delusions come to the attention of psychiatrists as paranoia on an
individual level. There are various
disorders and those diagnoses depend on other features but one of the central
features is the delusion. There are also
many people living in the community who are hypervigilant and suspicious
without false beliefs who function normally.
Paranoia can be a personality feature or a delusion.
The ability to modify delusional beliefs by psychotherapy
has been suggested since 1952. Aaron
Beck – one of the founders of cognitive behavior therapy published a case
report (1) on the successful treatment of delusional thinking is a patient with
schizophrenia. Since then, techniques
have been discussed in many supportive psychotherapy texts (2-5). The common elements of psychotherapy
including the therapeutic relationship, therapeutic alliance, and specific
interventions necessary to discuss delusions are all covered in detail. A detailed phenomenological interview and
discussion are necessary focused on the onset of the thought. This is necessary to explore emotional
elements and how they potentially lead to a delusion. Anxiety is a common initial state with many
delusions being an explanation for the anxiety.
In the case of escalators – it is easy to imagine a person
anxious and rushing to an appointment or trying to complete their shopping and
they discover the escalator they use for that purpose is broken. They may express frustration: “Why today?”,
Why me?”, “Today of all days!”, etc. But
it is unlikely that they would think the escalator is sabotaged to prevent them
from completing their task. Having an established set of delusions prior to the
incident would increase the probability of thinking about sabotage.
If I was seeing a patient with escalator paranoia telling me
about how the escalators he was using were sabotaged – I would proceed with
preparation for the therapy with the basic steps outlined above. At some point we would need to discuss
alternate explanations for the escalator malfunction. That list may look like this and this list is
not exhaustive:
1: Need for service
or maintenance/mechanical failure
2: Power outage and
other random events
3: Imagined sabotage
by a real or imagined enemy
4: Control by a
government agency
5: A sign from a
deity – a curse or a message
6: Telekinesis – the
person observing the malfunction believes he is causing it telepathically.
That discussion would examine whatever theories a person has
with the goal of moving toward numbers 1 and 2 on the list. That conversation as psychotherapy may take
several months before there is any significant progress. It could involve
gathering much evidence for and against the hypotheses and beliefs. The contrast with politics and the Twilight
Zone episode is interesting because it potentially works in the opposite
direction. Direct evidence against the hypothesis is never considered since it
is based on a political theory of persecution.
The message is reinforced by loyal followers and affiliated media. These days that involves significant
amplification through social media. The press in general does a very poor job
of fact checking and refuting the process that Rod Serling correctly
characterized in 1960 (6). That group
dynamic is difficult to stop and we currently watching that unfold.
George Dawson, MD, DFAPA
References:
1: Schminke LH, Jeger
V, Evangelopoulos DS, Zimmerman H, Exadaktylos AK. Riding the Escalator: How
Dangerous is it Really? West J Emerg Med. 2013 Mar;14(2):141-5. doi:
10.5811/westjem.2012.12.13346. PMID: 23599850; PMCID: PMC3628462.
2: Beck AT.
Successful outpatient psychotherapy of a chronic schizophrenic with a delusion
based on borrowed guilt. Psychiatry. 1952 Aug;15(3):305-12. doi:
10.1080/00332747.1952.11022883. PMID: 12983446.
3: Perris C. Cognitive therapy with schizophrenic
patients. New York. The Guilford Press,
1989: 160-186.
4: Wright JH,
Turkington D, Kingdon DG, Basco MR.
Cognitive-behavioral therapy for severe mental illness – an illustrated
guide. Arlington, VA. American Psychiatric Publishing, Inc.,
2009: 99-123.
5: Garrett M. Psychotherapy for psychosis – integrating
cognitive behavioral and psychodynamic treatment. New York.
The Guilford Press, 2019: 194-197.
6: Novalis PN,
Rojcewicz SJ, Peele R. Clinical manual
of supportive psychotherapy. Washington,
DC. American Psychiatric Press, 1993: 138-146.
7: Serling R. The monsters are due on Maple Street. Twilight Zone. Season 1, Episode 22 originally aired on
March 4, 1960. YouTube clip.
Graphics Credit:
Sascha Kohlmann, CC BY-SA 3.0
<https://creativecommons.org/licenses/by-sa/3.0>, via Wikimedia Commons
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