This post will compare four concepts.
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The four mechanisms
Expand the table to get right into them.
| Parameter | Cognitive Dissonance | Semmelweis Reflex | Doublethink | Groupthink |
|---|---|---|---|---|
| Proponent(s) | Leon Festinger (1957) | Ignaz Semmelweis (mid-19th century) | George Orwell (1949) | Irving Janis (1972) |
| Focus | Internal conflict | Immediate rejection of proposals, ideas or new knowledge. | Internalised control and often maintained by external pressure. | Group conformity |
| Source of Tension | Conflicting ideas within an individual’s mind | Probably none unless the above return in which case cognitive dissonance may emerge. | Contradictory thoughts imposed from outside and often accepted. | Pressure to maintain group harmony |
| Level of Tension | High, consciously felt | None – as nothing to consider immediately after rejection. | Suppressed, may manifest indirectly | Varies – can be high for dissenters, low for those conforming |
| Risk or advantage to Individual | Potential for growth if dissonance is addressed constructively and not defensively – else risk worsens | Stagnation, missed opportunities | Loss of critical thinking, vulnerability to manipulation | Suppression of individuality, potential for harmful choices |
| Risk to Society | Can lead to individual irrational behaviour | Impedes progress, can harm others (e.g. ignoring medical advances) | Fuels authoritarianism, large-scale manipulation | Leads to flawed decision-making, erosion of ethics |
| Mitigation | Self-awareness, open-mindedness, seeking diverse perspectives | Critical evaluation of evidence, willingness to change course – if ideas return. | Resisting indoctrination, fostering independent thought | Encouraging dissent, establishing processes for questioning assumptions |
| Resolution | Changing beliefs/behaviour, finding new information/justifications to align with actions | Often requires a crisis or overwhelming evidence to break through resistance | Requires breaking free of external control which can be incredibly difficult | Challenging group norms, breaking cohesiveness, can involve confrontation, ostracism, or the group dissolving |
This is quite a long post. It is truly a collection of knowledge for future reference.
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Table of Contents
- The four mechanisms
- Cognitive Dissonance
- Semmelweis Reflex
- Doublethink
- Groupthink
- Core areas for psychiatry.
Cognitive Dissonance
Cognitive dissonance is an internal state of unease or tension that arises when a person holds two or more contradictory beliefs, ideas, or values. It can also occur when someone’s actions do not align with their beliefs. This psychological discomfort motivates the person to find ways to reduce the tension and restore a sense of inner consistency. It works simply like this: ‘You do not like what you have heard, experienced, or done. It deeply contradicts your core belief about X thing [ being a fair person, maintaining harmonious relationships, making sound judgments, etc.]. You are thrown into emotion. To ease this discomfort, you gather everything you can find to say you are right, ignoring the possibility of any validity to what was heard, said, or experienced by others.‘
“The mind is a master contortionist,” or so the old saying might go, if it was informed by social psychology. Cognitive dissonance, a cornerstone theory in understanding human behaviour, shows us how we twist our thoughts, justifications, and even memories to maintain a sense of inner consistency.
While the term “cognitive dissonance” and its formal theory are relatively recent, the underlying concept has roots in age-old philosophical debates about human rationality and our desire for inner consistency.
History
In the mid-20th century, social psychologist Leon Festinger spearheaded the groundbreaking research that put cognitive dissonance on the map. Here’s the core narrative:
- The Infamous “When Prophecy Fails” Study (1956): Festinger and his colleagues infiltrated a UFO cult convinced the world would end in a catastrophic flood. When the prophecy failed spectacularly, the researchers didn’t witness collapse, but an astonishing reinforcement of belief! This defied logic and intrigued Festinger deeply.
- Forced Compliance Experiment (1959): Another classic study by Festinger and Carlsmith paid participants either $1 or $20 to lie about a boring task being enjoyable. Those paid less experienced more dissonance; having little external reason to lie forced an internal shift, making them actually view the task more positively.
- A Formal Theory Emerges: These studies became the foundation for Festinger’s “A Theory of Cognitive Dissonance” (1957). He proposed that we all have an inherent drive to feel like our thoughts, feelings, and actions make sense. When they do not, we experience tension and are motivated to find ways to lessen it.
The story unfolds: in a quiet Midwestern town, whispers swirled around an enigmatic woman named Dorothy Martin, known to her close-knit group as Marian Keech. She wasn’t some fringe prophetess, but a woman dabbling in automatic writing, a trance-like state where her hand seemed to move on its own, scrawling out cryptic messages from entities called Guardians, extraterrestrials from a distant, superior world. This wasn’t her first rodeo – earlier connections to a UFO-fixated doctor had infused her belief system with cosmic concerns.
The stakes couldn’t be higher: these Guardians did not offer vague spiritual guidance, but stark warnings. A great flood, prophesied to engulf much of the earth on a chillingly precise date: December 21st. A small band of Seekers, convinced by Dorothy’s channelled messages, heeded the call – they left behind jobs, families, the very fabric of “normal” life in fervent preparation for the end and their promised rescue via flying saucer.
But within this circle of believers lurked outsiders, social psychologists with a daring plan. Festinger, Riecken, and Schachter risked their reputations and perhaps their sanity to infiltrate this group. They became actors on a stage of apocalyptic belief, mimicking strange pre-salvation rituals and feigning certainty to gain trust. Every day, the tension mounted; they knew what the Seekers did not – smaller, more immediate prophecies woven into the fabric of the group had already fizzled, quietly ignored in the face of the grand, looming deadline.
December 21st arrived, the flood a horrifyingly absent spectre. The clock ticked past the prophesied hour, stretching into a sleepless night filled with a quiet devastation that defied expectation. But as dawn broke, Dorothy did not crumble. A lifeline emerged – a new message from the Guardians: their unwavering faith had miraculously diverted disaster! This wasn’t a collapse of belief, but a desperate pirouette, a twisting of reality to ease the unbearable discord between their convictions and the stubbornly intact world.
Instead of retreating in shame, the now-energised Seekers burst out into the world. They desperately sought converts, not with quiet appeals, but with a zealous certainty born of desperation. Their goal was to grow their numbers, to find social proof to soothe their internal dissonance. The group fractured, splintering into factions clinging to adjusted, even wilder versions of the prophecy.
The Seekers might, at first glance, seem like a bizarre speck of history. But their story is a blueprint, echoing through cults, conspiracy theorists, and anyone clinging to a belief that all evidence contradicts. “When Prophecy Fails” is a chilling case study in how far the human mind will bend to protect itself, and the often-unexpected consequences of that psychological self-preservation.
Impact and Evolution:
Festinger’s work sparked a revolution in understanding human decision-making and behaviour. Cognitive dissonance wasn’t a one-size-fits-all explanation, however. Later researchers:
- Expanded the Scope: They explored dissonance in everything from political attitudes, to post-purchase regret, to how we justify our actions, even harmful ones.
- Critiques and Refinements: Some challenged the universality of the theory, proposing alternative explanations for the classic study results. This pushed further research and refinements of how dissonance works.
The Legacy:
Cognitive dissonance remains one of the most influential concepts in psychology. Even if the term is unfamiliar, its effects are seen everywhere: a smoker rationalising their habit, a politician refusing to change course despite new evidence, or someone feeling the need to hype up a mediocre purchase to themselves. Understanding dissonance helps us make sense of our own, and others’, sometimes bafflingly illogical choices.
But what does a doomsday cult from the 1950s have to do with the practice of psychiatry here and now?
The “When Prophecy Fails” study (explored later) was a dramatic example of how people grapple with uncomfortable inconsistencies in their beliefs. While the details of the case might seem far removed from a psychiatric setting, the underlying psychological mechanisms at play are universal. It is not infrequently the case that in psychiatry we see things that do not fit well into our educated frameworks. Cognitive dissonance may strike and lead us to erroneous analyses and wrong conclusions. In future posts, I’ll explore how to recognise cognitive dissonance in patients, in ourselves, and in the broader mental health landscape, and offer strategies informed by this theory to help promote positive change. For the while, let’s take a dive into the history of the concept.
Mindful of the core concept of CD, moral principles and a basic sense of fairness can be put at risk via the following mechanisms:
- Justification of behaviour: When individuals act in ways that conflict with their moral standards, they may seek to justify their actions to reduce dissonance. For instance, someone who values honesty but lies in a particular situation might justify the lie as a necessary act for a greater good.
- Changing moral beliefs: In some cases, to resolve dissonance, individuals might adjust their moral beliefs rather than their behaviours. For example, someone might start believing that certain deceptive practices are acceptable if they repeatedly find themselves lying to avoid conflict or harm.
- Selective information processing: People may also selectively seek out information that confirms their actions or beliefs and avoid information that increases dissonance. This can lead to biased information processing, where only supportive evidence is acknowledged.
Implications for Moral Integrity
The process of resolving cognitive dissonance can indeed weaken or shift one’s moral convictions, especially if it leads to justifying unethical actions or adapting moral beliefs to align with less ethical behaviours. This can have several implications:
- Erosion of moral standards: Over time, frequent and unresolved dissonance might lead to an erosion of strong moral standards, as individuals continuously adapt their beliefs to justify their actions.
- Rationalisation and ethical drift: Continuous justification of small unethical actions can lead to a phenomenon known as “ethical drift,” where individuals slowly but progressively engage in more unethical behaviours.
- Impact on personal and social identity: How individuals resolve cognitive dissonance can significantly affect their self-concept and relationships. Adapting moral standards to justify behaviours might alleviate dissonance but can also lead to internal conflicts and tension in personal and social relationships.
Constructive Approaches to Cognitive Dissonance
To maintain moral integrity while managing cognitive dissonance, individuals can:
- Reflect on discrepancies: Actively reflecting on discrepancies between actions and values can help identify areas for personal growth and ethical development.
- Seek constructive feedback: Engaging in open dialogues with others about one’s actions and beliefs can provide external perspectives that help address ethical blind spots.
- Commit to learning and growth: Viewing cognitive dissonance as an opportunity for learning rather than a threat to self-identity can facilitate more adaptive and ethical resolutions.
Understanding and navigating the mechanisms of cognitive dissonance is essential for maintaining moral integrity and aligning one’s actions with one’s ethical values. This ongoing process requires self-awareness, open-mindedness, and a commitment to personal and moral development.
In healthcare, resource shortages can range from insufficient staffing and inadequate medical supplies to limited availability of critical care beds or essential drugs. these constraints can lead to dilemmas such as:
- Prioritising care: Who receives treatment when resources are insufficient for all in need? Decisions about prioritising patients for care based on medical need, the likelihood of benefit, and other ethical criteria can be emotionally and morally taxing.
- Quality of care: Limited resources might compel healthcare providers to offer a lower standard of care than what is ideal or sometimes even considered adequate under normal circumstances.
- Turning a blind eye: Clinicians might face situations where they have to “normalise” the distress due to resource limitations, potentially leading to desensitisation to suffering. This can manifest as turning a blind eye to certain patient needs, not out of indifference but as a coping mechanism in an overwhelmed healthcare system.
Impact on Ethical Standards
These situations can erode ethical standards in several ways:
- Moral distress: This occurs when clinicians know the ethically appropriate action to take but are constrained from taking it by various factors, leading to distress and potential burnout.
- Ethical desensitisation: Prolonged exposure to ethically challenging situations without adequate resolution can lead to desensitisation, where clinicians may become more accepting of lower standards of care.
- Rationalisation: Clinicians might rationalise inadequate care as being “the best that can be done” under the circumstances, potentially leading to a shift in ethical standards over time.
Strategies to Uphold Ethics in Resource-Limited Settings
To mitigate the erosion of ethical standards in medicine due to resource shortages, several strategies can be implemented:
- Ethical training and support: Regular training in medical ethics can prepare clinicians for the challenges they face, and support systems like ethics committees can provide guidance on difficult cases.
- Transparent and fair decision-making: Establishing clear guidelines for triage and resource allocation that are transparent and based on fair criteria can help ensure that decisions are ethically justified and consistent.
- Advocacy and system improvement: Clinicians can play a role in advocating for better resources and system improvements, both within their institutions and at a policy level, to address the root causes of resource shortages.
- Emotional and professional support: Providing mental health support and promoting a culture of care among healthcare professionals can help manage moral distress and prevent burnout.
Facing ethical challenges in resource-limited settings is a complex aspect of medical practice that requires a thoughtful, proactive approach to maintain high standards of care and ethical integrity. By addressing these challenges directly, healthcare systems can support their professionals in making difficult decisions that are both clinically sound and ethically justifiable.
- Awareness of dissonance: The first step is recognising that cognitive dissonance is a common experience for psychiatrists, who often face complex cases involving ethical dilemmas, conflicting duties, or challenging patient interactions. Acknowledging that dissonance exists can help professionals address it more constructively.
- Understanding ethical impact: Cognitive dissonance can lead to ethical erosion if not properly managed. For instance, rationalising decisions that compromise patient care or ethical standards because of systemic pressures (like resource limitations) can lower the quality of care and ethical practice over time.
- Preventive education: Regular training and discussions about medical ethics can prepare psychiatrists to handle situations that might generate cognitive dissonance. This includes exploring scenarios where ethical and clinical responsibilities might conflict and discussing appropriate responses.
- Promoting ethical decision-making: Creating an environment that encourages open dialogue about ethical dilemmas can help psychiatrists explore different perspectives and reduce the likelihood of making decisions in isolation. Ethical consultation and peer supervision can provide crucial support.
- Addressing systemic issues: Many ethical challenges that cause cognitive dissonance arise from systemic issues, such as resource constraints or policy limitations. Addressing these at an institutional or systemic level can reduce the frequency and impact of dissonance-triggering situations.
- Supporting mental health of clinicians: Recognising the psychological impact of ethical dilemmas and cognitive dissonance on psychiatrists themselves is crucial. Providing mental health support and resources for coping with job-related stress can help maintain ethical standards and professional care.
Application in Clinical Practice
In practice, these lessons translate into several key strategies:
- Regular reflective practice: Encouraging psychiatrists to engage in reflective practice, where they regularly examine their decisions and the ethical dimensions of their work. This can help identify when they are experiencing dissonance and why.
- Enhanced communication training: Since much of the dissonance can arise from patient interactions, training in communication, especially in handling difficult conversations or delivering bad news, can mitigate dissonance.
- Ethical decision-making frameworks: Implementing structured ethical decision-making frameworks within psychiatric practices can guide clinicians through the process of making tough decisions, ensuring that all relevant factors are considered.
- Leadership and policy advocacy: Psychiatrists, particularly those in leadership positions, can advocate for policies that address common sources of cognitive dissonance, such as inadequate access to necessary services or support for patients, thereby improving the ethical climate.
In sum, the lessons from cognitive dissonance in psychiatry underscore the need for awareness, preparedness, systemic support, and ongoing education to manage ethical challenges effectively. By adopting these lessons, psychiatric professionals can maintain a high standard of ethical practice even in the face of complex, distressing situations.
Semmelweis Reflex
Definition: The Semmelweis reflex is a metaphor for the reflex-like tendency to reject new evidence or new knowledge because it contradicts established norms, beliefs, or paradigms.
Experiences: Probably an easy way to conceptualise the reflex is to consider how people may react to certain foods. Some people like to try unusual foods. So, for example, some will have tried frogs’ legs, crocodile, ostrich, opossum, horse meat or locusts. It is not unusual to for some to react with twisted faces and respond, “Stop! Stop! I don’t want to vomit – I can’t think about it!” The point is there was a reflex rejection to the mere idea of eating something quite unusual. Chicken or beef is fine for some. If you’ve been grown up as a Muslim, then pork is automatically rejected. If one has grown up a vegetarian, then the thought of eating meat will be automatically ‘no go’ for contemplation.
Examples in medical history
Handwashing and disease prevention: Ignaz Semmelweis, in the mid-19th century, observed that handwashing dramatically reduced rates of puerperal fever (childbed fever) among maternity patients. His findings were rejected by many physicians at the time, leading to unnecessary deaths. It wasn’t until after Semmelweis’s death that the importance of hand hygiene was truly embraced, paving the way for modern infection control practices.
Ulcers and bacteria: The notion that bacteria (H. pylori) could cause peptic ulcers was initially met with extreme scepticism. The prevailing belief centred on stress and excess stomach acid as the root cause. Drs Barry Marshall and Robin Warren faced immense resistance and even self-experimentation before their discovery in the 1980s was widely accepted, revolutionising ulcer treatment. H. Pylori: Short for Helicobacter pylori, this is a type of bacteria that thrives in the harsh acidic environment of the stomach. It can infect the lining of the stomach and duodenum (the first part of the small intestine). The Ulcer Link: Initially dismissed, it is now accepted that H. Pylori infection is a major cause of peptic ulcers, open sores in the stomach or duodenal lining. Left untreated, it can lead to bleeding, severe pain, and other complications. The Antibiotic Revolution: The discovery that ulcers were frequently driven by bacterial infection changed everything. Standard ulcer treatment now involves a combination of Antibiotics: Usually two different antibiotics to destroy H. Pylori. Common choices include amoxicillin, clarithromycin, metronidazole, and others.
Cholesterol and heart disease: In the early 20th century, researcher Ancel Keys proposed a link between dietary cholesterol, saturated fat, and heart disease risk. This was met with fierce opposition from both within the medical community and the food industry. It took decades of research and public health campaigns before the importance of managing cholesterol for heart health became widely recognised. The issue was not simply about dietary cholesterol. However, the importance of cholesterol and saturated fat were overlooked.
Prions and infectious disease: Stanley Prusiner’s work in the 1980s proposed the existence of prions, infectious proteins that defied the conventional understanding of viruses and bacteria. He faced skepticism and even hostility due to the radical nature of his theory. Eventually, his discovery of prions revolutionised our understanding of diseases like Creutzfeldt-Jakob disease (“mad cow disease”) and other neurodegenerative conditions.
The Semmelweis phenomenon, a case of tragically delayed scientific progress, holds crucial lessons for the field of psychiatry:
- The danger of intellectual arrogance: Semmelweis’s colleagues dismissed his findings out of hand, clinging to their established beliefs. Psychiatry, while rooted in science, must avoid the trap of assuming it has all the answers. Openness to emerging research paradigms, even if they challenge conventional wisdom, is crucial.
- Evidence-based decision making: The Semmelweis reflex protects the way things have been done rather than prioritising what actually works. Psychiatry must champion evidence-based practice, where the best available data from clinical research, therapist experience, and patient values guides treatment choices, not just tradition.
- Combatting stigma through humility: Public perceptions of mental illness are often lagging and full of misconceptions. Assuming an authoritative stance, instead of acknowledging complexities and uncertainties, can fuel stigma like the doctors who refused to even consider handwashing as significant.
- Fostering a culture of inquiry: Semmelweis’s ideas were rejected in an atmosphere where questioning authority was discouraged. Psychiatry needs to cultivate spaces where respectful challenges, discussion of alternative approaches, and self-evaluation are welcomed, not stifled.
- Tackling systemic blind spots: Similar to how focusing solely on individual doctors’ hygiene missed the bigger picture, psychiatry must look beyond individual patient factors. Advocacy for addressing social determinants of mental health and biases within treatment systems is essential to making real, lasting progress.
- The patient as ally: Just as patients ultimately suffered due to the Semmelweis reflex, rigid thinking in psychiatry harms those it seeks to help. Collaborating with patients as experts in their own lived experiences, and respecting diverse paths to recovery, should be paramount in creating truly patient-centred care.
Practical applications:
- Continued education: Psychiatrists need ongoing, critical engagement with new developments in neuroscience, psychotherapy research, and social psychiatry.
- Multi-disciplinary collaboration: Partnering with fields like sociology, public health, and even the arts can challenge blind spots and offer fresh perspectives on mental health.
- Peer review & open dialogue: Institutions should support open, constructive discussions on diagnoses, treatment guidelines, and ethical dilemmas within the field.
The Semmelweis reflex is a cautionary tale. Let’s honor it by ensuring psychiatry remains a field committed to openness, scientific rigor, and continuous progress for the well-being of those it serves.
Doublethink
“1984” by George Orwell is a dystopian novel set in the superstate of Oceania, where society is under the omnipresent surveillance of Big Brother and the Party. The protagonist, Winston Smith, works at the Ministry of Truth, where his job is to alter historical records to fit the Party’s propaganda. The novel explores themes of totalitarianism, surveillance, the manipulation of truth, and the erosion of individual freedom. Orwell’s depiction of a society under constant surveillance and the manipulation of reality to control the population is a grim warning against the abuse of power. In Orwell’s original concept doublethink is where two diametrically opposed ideas or beliefs exist comfortably for the most part, in the minds of individuals or groups.
Bypassing Cognitive Dissonance: Naturally, our brains strive for consistency in our beliefs and understanding of the world. When we’re faced with contradictory information, this triggers cognitive dissonance, which is an uncomfortable state. Doublethink offers a way to avoid this discomfort.
Maintaining the Illusion: Rather than engage critically with the contradiction, doublethink allows individuals or groups to compartmentalise the opposing beliefs. It creates a sort of mental gymnastics where the contradiction isn’t truly resolved, but simply ignored when it is inconvenient.
Social Conditioning: We’re all susceptible to social pressures to conform. Doublethink thrives within societies or groups that demand unquestioning loyalty to a particular ideology or set of beliefs.
Emotional Manipulation: Fear, a sense of belonging, and the need to feel morally superior can all be exploited to make individuals more likely to accept doublethink.
Gradual Erosion: Doublethink rarely happens overnight. It is often a slow process where small compromises in logic are made, eventually leading to the acceptance of deeply contradictory ideas.
Examples
Propaganda in Totalitarian Regimes:
- Nazi Germany: The Nazi regime glorified the concept of an Aryan master race while simultaneously dehumanising and exterminating millions based on their ethnicity, religion, or disabilities.
- Stalinist Soviet Union: The state promoted the ideal of a worker’s paradise while ruthlessly suppressing dissent, creating a vast network of gulags (forced labor camps), and purging those deemed “enemies of the state.”
Slavery and Freedom: In societies that practiced slavery, the contradiction was stark. Slaveholders often justified their actions with claims of racial superiority or paternalistic benevolence while denying the fundamental humanity and right to freedom of those enslaved. This dissonance allowed them to uphold the notion of their own righteousness while committing profound injustices.
Justifying War:
- “War is Peace”: This is a central tenet of the totalitarian society in George Orwell’s novel “1984”, and it sadly reflects historical realities. Nations often engage in aggressive warfare while framing it as self-defence or an act to establish lasting peace and order.
- Demonising the Enemy: Dehumanising an enemy through propaganda makes it easier to justify acts of violence against them, creating the illusion of moral superiority.
- Censorship and Intellectual Freedom: Throughout history, regimes seeking to control thought have censored books, art, and dissenting voices. Often, this suppression is done under the banner of protecting morality, national security, or preserving social order while simultaneously violating individual freedoms.
Relating “1984” to the experiences of doctors in the UK over the last 15 years involves considering the intersection of surveillance, autonomy, and the manipulation of information within the healthcare sector. One potential parallel is the increased digitisation and monitoring within the NHS, aimed at improving efficiency and patient care but also raising concerns about privacy, data security, and the autonomy of healthcare professionals. The implementation of electronic health records and performance metrics can be seen as a form of surveillance, intended to improve practices but also potentially limiting professional discretion and autonomy.
Furthermore, the concept of “doublethink” from “1984,” where contradictory beliefs exist simultaneously, might resonate with the ethical dilemmas faced by doctors navigating the pressures of healthcare provision, bureaucratic demands, and the need to maintain patient care standards. The balance between clinical autonomy and adherence to guidelines and targets set by healthcare authorities could reflect Orwell’s themes of truth manipulation and the suppression of individual thought.
In sum, while the NHS and the healthcare system in the UK are far from the totalitarian regime of “1984,” the novel’s themes of surveillance, control, and the manipulation of truth offer a lens through which to examine the challenges and pressures faced by doctors in an increasingly monitored and regulated healthcare environment. These reflections encourage a broader dialogue on how best to balance the benefits of technological and administrative oversight with the preservation of professional autonomy and ethical integrity within the medical field.
Groupthink
Definition and origin:
Groupthink is a psychological phenomenon that occurs within a group of people when the desire for harmony or conformity in the group results in an irrational or dysfunctional decision-making outcome. Group members try to minimise conflict and reach a consensus decision without critical evaluation of alternative viewpoints by actively suppressing dissenting viewpoints, and isolating themselves from outside influences.
Coined by: The term “groupthink” was coined by social psychologist Irving Janis in 1972. He published his initial findings in the influential book “Victims of Groupthink,” which analysed US foreign policy disasters such as the Bay of Pigs Invasion and the Pearl Harbor attack.
Evolution in history:
- Early studies and conceptualisation (1970s):
- Irving Janis introduced and described the concept of groupthink, using historical political failures to underline how cohesive groups make faulty decisions.
- Expansion and criticism (1980s–1990s):
- Researchers expanded the scope of groupthink to include various types of organisations and scenarios, from military decisions to corporate failures.
- Critics argued that Janis’s model was too simplistic and deterministic. Some suggested that group cohesion alone was not a sufficient condition to produce groupthink.
- Refinement and integration (2000s–present):
- Further research has attempted to refine the theory, linking it with other psychological theories and models, like cognitive dissonance and confirmation bias.
- Empirical studies have provided a more nuanced understanding of the conditions under which groupthink can occur, emphasising factors such as group isolation, directive leadership, and lack of norms requiring methodological procedures.
- Modern applications and relevance:
- In the digital age, discussions about groupthink have expanded to include social media dynamics, where rapid consensus can be formed in echo chambers isolated from dissenting opinions.
- Groupthink remains a significant concept in understanding decision-making in political, corporate, and other types of governance and organisational studies.
Groupthink has consistently been revisited in academic and applied settings to understand and prevent the pitfalls of collective decision-making that ignores individual dissent or critical thinking.
Pitfalls of groupthink in the practice of medicine:
- Reduced innovation and critical thinking:
- Medical teams may default to established protocols and past experiences rather than exploring new methods or innovative treatments. This can limit the potential for discovering more effective or efficient solutions to health care challenges.
- Inadequate risk assessment:
- In a groupthink scenario, the team may not fully evaluate the risks associated with a particular treatment or intervention, as dissenting opinions that might highlight potential risks or drawbacks are discouraged or overlooked.
- Diagnostic overshadowing:
- Groupthink can lead to diagnostic overshadowing where common or more obvious diagnoses are over-emphasised, and less apparent but possible conditions are ignored. This can result in misdiagnosis or delayed diagnosis, especially in complex cases where symptoms overlap multiple potential conditions.
- Resistance to external advice:
- Medical teams affected by groupthink may resist consulting with specialists outside of their immediate circle, potentially leading to poorer patient outcomes. This isolation can prevent the integration of more effective treatment plans developed through interdisciplinary collaboration.
- Pressure to conform:
- Junior doctors or less experienced medical staff might feel pressured to agree with senior staff without sufficient discussion. This can suppress new ideas or important feedback that could challenge the efficacy or safety of medical decisions.
- Compromised patient care:
- The ultimate consequence of groupthink in medicine is compromised patient care. Decisions made without full consideration of all factors and options may not serve the best interests of the patient, potentially leading to adverse outcomes.
- Legal and ethical implications:
- Medical decisions influenced by groupthink that result in patient harm can lead to legal and ethical consequences for healthcare providers. These could involve malpractice claims, professional disciplinary actions, and a loss of public trust in the affected healthcare institutions or personnel.
Core areas for psychiatry.
Patient beliefs and behaviours: Patients often hold complex and sometimes contradictory beliefs about their mental health conditions, treatment options, and potential outcomes. Cognitive dissonance can explain why a patient might resist an effective treatment due to conflicting information or anxieties, hindering their recovery path.
Clinician decision-making: Psychiatrists, despite their extensive training, are not immune to cognitive dissonance, Semmelweis, doublethink or groupthink. They must continually evaluate their decisions and diagnoses, recognising that biases and investment in a particular treatment plan could hinder a patient’s progress when adjustments are needed.
Challenging stigma: Public perception of mental illness is still heavily coloured by stigma and misunderstanding. Addressing these deeply held social beliefs requires strategies that acknowledge dissonance. Trying to force change with pure logic fails because logic often isn’t the driving force behind biased or discriminatory attitudes.
Understanding resistance to change: Within the field of psychiatry itself, there can be resistance to new research findings, diagnostic shifts, and innovative treatment approaches. Cognitive dissonance helps explain why seemingly logical advancements can still be met with barriers, highlighting the need for open dialogue and continued self-evaluation within the profession.
