Decisions and Influences

I read a homework assignment that my daughter had in English/Critical Thinking and the first thing that came to mind was how this can apply to ITP and treatment decisions. It's a long read, but it can make you think. The main thing that comes to my mind is how we, as individuals, tend to go with mainstream thinking or past accepted theories instead of being open to new possibilities. Any thoughts?


That social influences shape every person's practices, judgments and beliefs is a truism to which anyone will readily assent. A child masters his "native" dialect down to the finest nuances; a member of a tribe of cannibals accepts cannibalism as altogether fitting and proper. All the social sciences take their departure from the observation of the profound effects that groups exert on their members. For psychologists, group pressure upon the minds of individuals raises a host of questions they would like to investigate in detail.

How, and to what extent, do social sources constrain people's opinions and attitudes? This question is especially pertinent in our day. The same epoch that has witnessed the unprecedented technical extension of communication has also brought into existence the deliberate manipulation of opinion and the "engineering of consent." There are many good reasons why, as citizens and as scientists, we should be concerned with studying the ways in which human beings form their opinions and the role that social conditions play.

Studies of these questions began with the interest in hypnosis aroused by the French physician Jean Martin Charcot (a teacher of Sigmund Freud) toward the end of the 19th century. Charcot believed that only hysterical patients could be fully hypnotized, but this view was soon challenged by two other physicians, Hyppolyte Bernheim and A. A. Liebault, who demonstrated that they could put most people under the hypnotic spell. Bernheim proposed that hypnosis was but an extreme form of normal psychological process which became known as "suggestibility." It was shown that monotonous reiteration of instructions could induce in normal persons in the waking state involuntary bodily changes such as swaying or rigidity of the arms, and sensations such warmth and odor.

It was not long before social thinkers seized upon these discoveries as a basis for explaining numerous social phenomena, from the spread of opinion to the formation of crowds and the following of leaders. The sociologist Gabriel Tarde summed it all up in the aphorism "Social man is a somnambulist."

When the new discipline of social psychology was born at the beginning of this century, its first experiments were essentially adaptations of the suggestion demonstration. The technique generally followed a simple plan. The subjects, usually college students, were asked to give their opinions or preferences concerning various matters; some time later they were again asked to state their choices, but now they were also informed of the opinions held by authorities or large groups of their peers on the same matters. (Often the alleged consensus was fictitious.) Most of these studies had substantially the same result: confronted with opinions contrary to their own, many subjects apparently shifted their judgments in the direction of the views of the majorities or the experts. The late psychologist Edward L. Thorndike reported that he had succeeded in modifying the esthetic preferences of adults by this procedure. Other psychologists reported that people's evaluations of the merit of a literary passage could be raised or lowered by ascribing the passage to different authors. Apparently the sheer weight of numbers or authority sufficed to change opinions, even when no arguments for the opinions themselves were provided.

Now the very ease of success in these experiments arouses suspicion. Did the subjects actually change their opinions, or were the experimental victories scored only on paper? On grounds of common sense, one must question whether opinions are generally as watery as these studies indicate. There is some reason to wonder whether it was not the investigators who, in their enthusiasm for a theory, were suggestible, and whether the ostensibly gullible subjects were not providing answers which they thought good subjects were expected to give.

The investigations were guided by certain underlying assumptions, which today are common currency and account for much that is thought and said about the operations of propaganda and public opinion. The assumptions are that people submit uncritically and painlessly to external manipulation by suggestion or prestige, and that any given idea or value can be "sold" or "unsold" without reference to its merits. We should be skeptical, however, of the supposition that the power of social pressure necessarily implies uncritical submission to it: independence and the capacity to rise above group passion are also open to human beings. Further, one may question on psychological grounds whether it is possible as a rule to change a person's judgment of a situation or an object without first changing his knowledge or assumptions about it.

In what follows I shall describe some experiments in an investigation of the effects of group pressure which was carried out recently with the help of a number of my associates. The tests not only demonstrate the operations of group pressure upon individuals but also illustrate a new kind of attack on the problem and some of the more subtle questions that it raises.

A group of seven to nine young men, all college students, are assembled in a classroom for a "psychological experiment" in visual judgment. The experimenter informs them that they will be comparing the lengths of lines. He shows two large white cards. On one is a single vertical black line - the standard whose length is to be matched. On the other card are three vertical lines of various lengths. The subjects are to choose the one that is of the same length as the line on the other card. One of the three actually is of the same length; the other two are substantially different, the difference ranging from three quarters of an inch to an inch and three quarters.


Subjects were shown two cards. One bore a standard line. The other bore three lines, one of which was the same length as the standard. The subjects were asked to choose this line.


The experiment opens uneventfully. The subjects announce their answers in the order in which they have been seated in the room, and on the first round every person chooses the same matching line.

Then a second set of cards is exposed; again the group is unanimous. The members appear ready to endure politely another boring experiment. On the third trial there is an unexpected disturbance. One person near the end of the group disagrees with all the others in his selection of the matching line. He looks surprised, indeed incredulous, about the disagreement. On the following trial he disagrees again, while the others remain unanimous in their choice. The dissenter becomes more and more worried and hesitant as the disagreement continues in succeeding trials; he may pause before announcing his answer and speak in a low voice, or he may smile in an embarrassed way.

What the dissenter does not know is that all the other members of the group were instructed by the experimenter beforehand to give incorrect answers in unanimity at certain points. The single individual who is not a party to this pre-arrangement is the focal subject of our experiment. He is placed in a position in which, while he is actually giving the correct answers, he finds himself unexpectedly in a minority of one, opposed by a unanimous and arbitrary majority with respect to a clear and simple fact. Upon him we have brought to bear two opposed forces: the evidence of his senses and the unanimous opinion of a group of his peers. Also, he must declare his judgments in public, before a majority which has also stated its position publicly.

The instructed majority occasionally reports correctly in order to reduce the possibility that the naive subject will suspect collusion against him. (In only a few cases did the subject actually show suspicion; when this happened, the experiment was stopped and the results were not counted.) There are 18 trials in each series, and on 12 of these the majority responds erroneously.

How do people respond to group pressure in this situation? I shall report first the statistical results of a series in which a total of 123 subjects from three institutions of higher learning (not including my own, Swarthmore College) were placed in the minority situation described above.

Two alternatives were open to the subject: he could act independently, repudiating the majority, or he could go along with the majority, repudiating the evidence of his senses. Of the 123 put to the test, a considerable percentage yielded to the majority. Whereas in ordinary circumstances individuals matching the lines will make mistakes less than 1 per cent of the time, under group pressure the minority subjects swung to acceptance of the misleading majority's wrong judgments in 36.8 per cent of the selections.

Of course individuals differed in response. At one extreme, about one quarter of the subjects were completely independent and never agreed with the erroneous judgments of the majority. At the other extreme, some individuals went with the majority nearly all the time. The performances of individuals in this experiment tend to be highly consistent. Those who strike out on the path of independence do not, as a rule, succumb to the majority even over an extended series of trials, while those who choose the path of compliance are unable to free themselves as the ordeal is prolonged.

The reasons for the startling individual differences have not yet been investigated in detail. At this point we can only report some tentative generalizations from talks with the subjects, each of whom was interviewed at the end of the experiment. Among the independent individuals were many who held fast because of staunch confidence in their own judgment. The most significant fact about them was not absence of responsiveness to the majority but a capacity to recover from doubt and to re-establish their equilibrium. Others who acted independently came to believe that the majority was correct in its answers, but they continued their dissent on the simple ground that it was their obligation to call the play as they saw it.

Among the extremely yielding persons we found a group who quickly reached the conclusion: "I am wrong, they are right." Others yielded in order "not to spoil your results." Many of the individuals who went along suspected that the majority were "sheep" following the first responder, or that the majority were victims of an optical illusion; nevertheless, these suspicions failed to free them at the moment of decision. More disquieting were the reactions of subjects who construed their difference from the majority as a sign of some general deficiency in themselves, which at all costs they must hide. On this basis they desperately tried to merge with the majority, not realizing the longer-range consequences to themselves. All the yielding subjects underestimated the frequency with which they conformed.

Which aspect of the influence of a majority is more important - the size of the majority or its unanimity? The experiment was modified to examine this question. In one series the size of the opposition was varied from one to 15 persons. The results showed a clear trend. When a subject was confronted with only a single individual who contradicted his answers, he was swayed little: he continued to answer independently and correctly in nearly all trials. When the opposition was increased to two, the pressure became substantial: minority subjects now accepted the wrong answer 13.6 per cent of the time. Under the pressure of a majority of three, the subjects' errors jumped to 31.8 per cent. But further increases in the size of the majority apparently did not increase the weight of the pressure substantially. Clearly the size of the opposition is important only up to a point.

Disturbance of the majority's unanimity had a striking effect. In this experiment the subject was given the support of a truthful partner - either another individual who did not know of the pre-arranged agreement among the rest of the group, or a person who was instructed to give correct answers throughout. The presence of a supporting partner depleted the majority of much of its power. Its pressure on the dissenting individual was reduced to one fourth: that is, subjects answered incorrectly only one fourth as often as under the pressure of a unanimous majority. The weakest persons did not yield as readily. Most interesting were the reactions to the partner. Generally the feeling toward him was one of warmth and closeness; he was credited with inspiring confidence. However, the subjects repudiated the suggestion that the partner decided them to be independent.

Was the partner's effect a consequence of his dissent, or was it related to his accuracy? We now introduced into the experimental group a person who was instructed to dissent from the majority but also to disagree with the subject. In some experiments the majority was always to choose the worst of the comparison lines and the instructed dissenter to pick the line that was closer to the length of the standard one; in others the majority was consistently intermediate and the dissenter most in error. In this manner we were able to study the relative influence of "compromising" and "extremist" dissenters.

Again the results are clear. When a moderate dissenter is present, the effect of the majority on the subject decreases by approximately one third, and extremes of yielding disappear. Moreover, most of the errors the subjects do make are moderate, rather than flagrant. In short, the dissenter largely controls the choice of errors. To this extent the subjects broke away from the majority even while bending to it.

On the other hand, when the dissenter always chose the line that was more flagrantly different from the standard, the results were of quite a different kind. The extremist dissenter produced a remarkable freeing of the subjects; their errors dropped to only 9 per cent. Furthermore, all the errors were of the moderate variety. We were able to conclude that dissent per se increased independence and moderated the errors that occurred, and that the direction of dissent exerted consistent effects.

In all the foregoing experiments each subject was observed only in a single setting. We now turned to studying the effects upon a given individual of a change in the situation to which he was exposed. The first experiment examined the consequences of losing or gaining a partner. The instructed partner began by answering correctly on the first six trials. With his support the subject usually resisted pressure from the majority: 18 of 27 subjects were completely independent. But after six trials the partner joined the majority. As soon as he did so, there was an abrupt rise in the subjects' errors. Their submission to the majority was just about as frequent as when the minority subject was opposed by a unanimous majority throughout.

It was surprising to find that the experience of having had a partner and of having braved the majority opposition with him had failed to strengthen the individuals' independence. Questioning at the conclusion of the experiment suggested that we had overlooked an important circumstance; namely, the strong specific effect of "desertion" by the partner to the other side. We therefore changed the conditions so that the partner would simply leave the group at the proper point. (To allay suspicion it was announced in advance that he had an appointment with the dean.) In this form of the experiment, the partner's effect outlasted his presence. The errors increased after his departure, but less markedly than after a partner switched to the majority.

In a variant of this procedure the trials began with the majority unanimously giving correct answers. Then they gradually broke away until on the sixth trial the naive subject was alone and the group unanimously against him. As long as the subject had anyone on his side, he was almost invariably independent, but as soon as he found himself alone, the tendency to conform to the majority rose abruptly.

As might be expected, an individual's resistance to group pressure in these experiments depends to a considerable degree on how wrong the majority is. We varied the discrepancy between the standard line and the other lines systematically, with the hope of reaching a point where the error of the majority would be so glaring that every subject would repudiate it and choose independently. In this we regretfully did not succeed. Even when the difference between the lines was seven inches, there were still some who yielded to the error of the majority.

The study provides clear answers to a few relatively simple questions, and it raises many others that await investigation. We would like to know the degree of consistency of persons in situations which differ in content and structure. If consistency of independence or conformity in behavior is shown to be a fact, how is it functionally related to qualities of character and personality? In what ways is independence related to sociological or cultural conditions? Are leaders more independent than other people, or are they adept at following their followers? These and many other questions may perhaps be answerable by investigations of the type described here.

Life in society requires consensus as an indispensable condition. But consensus, to be productive, requires that each individual contribute independently out of his experience and insight. When consensus comes under the dominance of conformity, the social process is polluted and the individual at the same time surrenders the powers on which his functioning as a feeling and thinking being depends. That we have found the tendency to conformity in our society so strong that reasonably intelligent and well-meaning young people are willing to call white black is a matter of concern. It raises questions about our ways of education and about the values that guide our conduct.

Yet anyone inclined to draw too pessimistic conclusions from this report would do well to remind himself that the capacities for independence are not to be underestimated. He may also draw some consolation from a further observation: those who participated in this challenging experiment agreed nearly without exception that independence was preferable to conformity.


www.panarchy.org/asch/social.pressure.1955.html

Other psychologists reported that people's evaluations of the merit of a literary passage could be raised or lowered by ascribing the passage to different authors. Apparently the sheer weight of numbers or authority sufficed to change opinions, even when no arguments for the opinions themselves were provided.

I think we often ascribe too much authority to people with "MD" after their name. When it comes to ITP, an average hematologist might see ten cases per year^* out of thousands of patients, and their field of expertise is too vast for anyone to keep abreast of all of the latest research in every aspect of their specialty. It really is possible for one layman armed with Google to know more than the average hematologist, yet it is sooooo scary to think of disagreeing with an MD.

Ellen had severe arthritis in her hips (because her hip dysplasia was not diagnosed until the age of 45... thank you, medical profession). She waited as long as she could, until her orthopedist one day said that it was time to have hip replacements. I asked the doctor if there was any technology on the horizon that we should be aware of. His answer was an unqualified "no". I spent hours on the internet doing my homework, and thanks to another website similar to this one, I learned of a far superior procedure being performed abroad that was not yet approved here, and we traveled out of state for Ellen to be part of a study and have her hips replaced with a device that gives her full range of motion and we hope will last a lifetime. The orthopedist (a) did not have the time and energy to keep up with the latest research and (b) his profession was slow to accept the new device because it was different from what they were used to.

On the other hand, the internet is full of self-designated experts on everything under the sun, and they make a killing off of people who buy into every fad that runs counter to general medical principles.

I often worry that when I share information I have learned, that I could be wrong, and someone could make a wrong decision from what I say. And what if we are all just stewing in one big cauldron of group-think? I don't think so... too many rebels and renegades here (present company included!) but still sometimes I worry about it.

^{*Note: There are roughly 3,000 hematologists in the US and roughly 100 cases per million per year X roughly 300 million = 30,000 cases per year, so 10 cases average per hematologist.}

Rob:

I think about that too...that we (I) might be stuck in a certain thought process. But there are many articles to back things up and as long as they are current and credible, it's the best we've got. There are many varying opinions here and I appreciate the members that speak their minds. I think that, for the most part, the disagreements here are handled well and give a well rounded version of the issues. Yes, some things do tend to lean to one side, but the good is usually presented with the bad.

Some thoughts here. First, the doctor/patient relationship involves several important asymmetries. The doctor should know more about a disease or disorder (ITP, for instance) than the patient does, though as Rob points out, this is not necessarily the case. Should a patient question or disagree, the patient runs the risk of being labeled "difficult" or "anxious," two entries on a medical chart that are better avoided.

Second, the risk of groupthink or other psychosocial pressures on individual's beliefs may be related to how readily the outcome of a decision can be measured. People with ITP have an easy way to measure outcomes: check platelet counts. If someone I know suggests beads and rattles to treat my low platelets, I can try this, and when I see no change in my platelet count, I can reject the idea. Even if my count does improve, I rely on people here on the PDSA to remind me that correlation is not causation.

Third, we all make decisions, including embracing beliefs, under uncertainty. What we gain from interacting with people here and keeping track of platelet counts and other relevant metrics is a reduction in uncertainty, which in turn I think helps reduce the risks of the issues Sandi's daughter outlines in her paper.

Final thought: I've seen lots of useful corrections and suggestions here, and not a whole lot of people getting stuck in one line of thinking or on one explanation. It's part of what I like about this group.

My daughter didn't write it....reading it was her assignment. Just wanted to make that clear.

Aoi:

Thanks for the feedback. It's important for me to know that you feel you are getting fair information from the group as a whole.

I am a huge skeptic, so if someone tells me that beads and rattles raised their counts, I am not going to believe it. I am always more inclined to believe in spontaneous remissions rather than some sort of lifestyle change. I have tried to have more of an open mind in the past few years though, so I do consider diet changes to be a possibility. But usually if there's no way to prove it, I consider it to be anecdotal. I don't know if that is a good thing or a bad thing.

I am a huge skeptic, so if someone tells me that beads and rattles raised their counts, I am not going to believe it. I am always more inclined to believe in spontaneous remissions rather than some sort of lifestyle change. I have tried to have more of an open mind in the past few years though, so I do consider diet changes to be a possibility. But usually if there's no way to prove it, I consider it to be anecdotal. I don't know if that is a good thing or a bad thing.

I think that's a very good thing. If something isn't testable and falsifiable, then it is not science and has no potential for becoming a standard therapy or treatment. It's possible I'm too rational, but years and years of math and science does seem to have had that effect.

Aoi wrote: Should a patient question or disagree, the patient runs the risk of being labeled "difficult" or "anxious," two entries on a medical chart that are better avoided.

When it comes to my life or the life of a family member I cannot be concerned about being labeled! My cat had a red dot on her chart indicating she might bite - my granddog has a red dot on her chart indicating she might bite - after the tongue lashing I gave my PCP in October 2013, right there in the office hall, before I fired him I probably have 2 or 3 red dots on my chart at the HMO.

Sandi wrote: Rob:

I think about that too...that we (I) might be stuck in a certain thought process. But there are many articles to back things up and as long as they are current and credible, it's the best we've got. There are many varying opinions here and I appreciate the members that speak their minds. I think that, for the most part, the disagreements here are handled well and give a well rounded version of the issues. Yes, some things do tend to lean to one side, but the good is usually presented with the bad.

I agree. A really good example was the recent debate between KO27 and tamar, and others, regarding the relative risks and merits of WinRho and Rituxan. A good debate sheds much light and little heat. All deserve to be commended.

It helps me to know that if I say something that is incorrect are expressed poorly, someone will, always kindly, set things straight.

Well we all now know that Melinda comes with a warning, so stay back and walk towards her slowly, no sudden movements!

Melinda, do you remember when we used to joke that we would bite a doctor if they didn't do what we wanted? It was quite a while ago.

Sandi I do but didn't remember until you said it - too funny!

Dang PCP messed with me and he got what was coming - but you do what you have to do and that I did We need to disagree, we need to stick up for ourselves and our loved ones if we feel we are not being treated properly - we should not care what a doctor or nurse or PA or anyone in the medical field thinks, we need to do what we feel is right!