‘Cognitive Dissonance’ Became a Milestone In 1950s Psychology By Cynthia Crossen Wall Street Journal December 4, 2006
As the title of this article suggests, it is an historical look at Leon Festinger’s development of the concept of cognitive dissonance. I’ve written about it today because (1) it’s interesting on its own merits and (2) it serves as a reminder that the phenomena underlying patient compliance are not unique to healthcare and that theoretical work in non-healthcare fields, including but not limited to cognitive dissonance, may be directly applicable to the problems of nonadherence to treatment.
This excerpt makes the same point:
Why, for example, do people who know cigarettes are bad for their health continue to smoke? This is classic cognitive dissonance: They know one thing and feel another. Mr. Festinger believed this incongruity is as uncomfortable to the human organism as hunger. One way or another, the anxiety must be assuaged. So the smoker builds a bridge — a rationalization — from feeling to fact: If he stopped smoking, he’d gain weight, which would also be unhealthy; some risks are worth taking to have a full life; the risks of smoking have been exaggerated. Indeed, in a 1954 survey asking people if they felt the link between lung cancer and cigarettes had been proven, 86% of heavy smokers thought it wasn’t proven, while only 55% of nonsmokers doubted the connection.
And, the examples are fascinating. For example,
But where Mr. Festinger found the richest raw material for his theory was in a cult that developed in Chicago in 1954. A woman Mr. Festinger called Marion Keech claimed she was receiving messages from another planet, Clarion. The messages predicted that on a given date, a cataclysmic flood would engulf most of the continent. Those who joined Mrs. Keech’s sect would be picked up by flying saucers and evacuated from the planet. … Before the dates of the expected flood, the cult was mostly averse to publicity and had no interest in attracting other believers. On the day before the flood, the group was told that at midnight a man would appear at Mrs. Keech’s house and take them to a flying saucer. But no knock came at her door, and the group struggled to find an explanation for why there would be no flying saucer or flood. At 4:45 a.m., the group said, a message arrived from God saying He had stayed the flood because of their strength. What interested Mr. Festinger was not so much this face-saving explanation as what the cult members did in the following weeks. Rather than shunning public attention as they had before, they began zealously proselytizing. “There were almost no lengths to which these people would not go now to get publicity and to attract potential believers,” Mr. Festinger wrote. “If more converts could be found, then the dissonance between their belief and the knowledge that the prediction hadn’t been correct could be reduced.”
Commentary
Among other insights it offers, cognitive dissonance goes a long way toward explaining why starkly presenting patients with facts, regardless of how valid the data and how elegant the research, is insufficient to improve compliance. In fact, as the example of the doomsday cult excerpted above points out, those individuals whose beliefs are proven inaccurate in the most definite and most public manner are most likely to react by intensifying their commitment to those erroneous beliefs. It further follows that perhaps aggressive, dramatically confrontational approaches to patient education are not only ineffective but counterproductive.
