TRANQUILLISER DISSONANCE
Colin Downes-Grainger
July 9, 2008
Cognitive Dissonance: Cognitive dissonance is the psychological phenomenon first identified by Dr Leon Festinger at Stanford University. It occurs when there is a discrepancy between what a person believes, knows and values, and facts that call these into question. The discrepancy causes psychological discomfort, and the mind adjusts to reduce the discrepancy. Dissonance leads to rationalizations of unethical conduct and the maintenance of illogical positions.
Why does anyone blindly refuse to accept what is undeniably true? Psychologists describe this behaviour as cognitive dissonance. If you believe yourself to be acting or have acted in a positive way in the public interest then whatever the evidence that your actions or beliefs are wrong, you will seek to ease the psychological tension by distorting or ignoring the facts so that they fit. This illustrates how it is not facts that determine actions, it is the theories we hold and rigidly maintain that determine actions. This is how individuals within the Department of Health or the UK drugs regulator the MHRA and prescribers of the drugs live with themselves. They have theories about the prescribed benzodiazepine scandal and they have successfully fitted the facts to suit those theories. They ignore those that obviously don't fit their model and reinterpret where necessary to produce psychological balance and comfort.
Cognitive dissonance explains a lot of things; it explains for instance why the Department of Health maintains today that people who go to their doctors, are prescribed tranquillisers as medicine and subsequently become addicted are drug misusers - exactly the same type of people who knowingly, and with probably more awareness, take them illegally for recreational purposes. It explains why prescribers are driven to minimise recognition of the side-effects of the drugs. It explains why they believe that they are routinely exploited by patients with drug seeking motives and that it is ethical to avoid thinking about the consequences for patients of decades of 'thoughtless prescribing' as Professor Heather Ashton describes it. It explains why they have now reached a position where they find no irony in an assertion that they are the one's trying to prevent addiction (with the unspoken message that they have always held this position).
Thousands of innocent UK citizens have suffered (and continue to suffer) because of the impact of prescribed benzodiazepine addiction. When the realities of benzodiazepines became clear, first to patients and much later to medicine and politicians it created a huge potential problem psychologically. Doctors, the MHRA and the Department of Health who had all believed themselves to be acting in the interests of patients could not reconcile the suffering they were being told about with their own self view and their own beliefs about their work. So they began to believe, indeed had to believe, that they had acted ethically and that somehow the patients themselves were to blame. Medicine it seems has always blamed the patient where possible, though this does not fit at all with Hippocrates beliefs in the purpose of medicine and the way treatments are administered. The revelations about benzodiazepines coming from independent researchers and from patients could destroy how the providers of medicine saw themselves and consequently the revelations had to be reinterpreted. The world of Medicine and health politics saw itself as pro-patient and a bringer of benefit and the discovery that this was very far from true for a great many patients did not resonate at all. It became essential that patients be seen as the cause of their own demise whatever the evidence to the contrary.
When groups of health providers congregate in committees, they come already convinced of their noble motives, and their own higher level of expertise, uncomfortable research results and the experiences of patients notwithstanding. They know they are right, certain they have acted ethically, promptly and in the only way possible. And if you deny the truth long enough to yourself, you can never admit you acted wrongly. Instead it seems entirely appropriate to dig deeper defensive positions and move those positions where necessary.
The Department of Health and its advisers, the regulatory bodies and frontline prescribers can never admit they have caused harm on a grand scale. Because they have twisted their understanding of the benzodiazepine scandal to make it acceptable and unavoidable, they can ignore evidence from Parliamentary committees, from those who were harmed or from open-minded research. They devolve responsibility to others - local health authorities who have little understanding and even less money, or to advisers whose whole careers have been built on a belief in drugs and the support of drug companies. The drug manufacturers always knew what they were doing, steeped as they are in the sociological teachings of Edward Bernays, the nephew of Sigmund Freud. Bernays understood group dynamics and the way people think and are motivated; his understandings underwrote modern marketing techniques. It is a pity that medicine providers do not want to understand them; it would protect the innocent and obviate the need for frequent psychological adjustment.
The benzodiazepine situation can only be solved in one way. Those without a self-motivated stake in maintaining a state of unchallengeable expertise and a sense of authoritative nobility need to examine the facts and make a judgement. Without such an examination, there is no such thing as natural justice in the UK or man made justice for that matter.
Colin Downes-Grainger
July 9, 2008
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