Sunday, 13 May 2007

The fundamental attribution error or why patients get blamed for their problems

One of the things I notice working in acute mental health services is the tendency some teams have for blaming patients for their problems. This usually takes three forms. Firstly patients are said to have a “personality disorder” – a bit like having blue eyes it can’t be changed. Secondly that their substance abuse stops them being treated and lastly that they don’t turn up to appointments. Therefore the patients are really to blame for not getting better. However this view of patients is based on a well recognised fallacy in reasoning called the fundamental attribution error. This is based on experimental studies that have repeatedly demonstrated that as humans we attribute much more weight to “personality” factors that to environmental factors in explaining people’s behaviour. In fact the main determinant of people’s behaviour seems to be external environmental factors rather than “personality”.

The classic experiment that demonstrated this was described in 1967 by Jones and Harris. Subjects listened to pro- and anti-Fidel Castro speeches (it just had to be the USA….). Subjects were asked to rate the pro-Castro attitudes of the speakers. When the subjects believed that the speakers freely chose the positions they took (for or against Castro), they naturally rated the people who spoke in favour of Castro as having a more positive attitude toward Castro. However when the subjects were told that the speaker's positions were determined by a coin toss, they still rated speakers who spoke in favour of Castro as having a more positive attitude towards Castro than those who spoke against him. The subjects were unable to see the speakers as mere debaters performing a task chosen for them by circumstance; they could not refrain from attributing some disposition of sincerity to the speakers.

A further demonstration of the impact of environment on people’s behaviour (as opposed to personality) is shown by Philip Zimbardo’s classic experiments in August 1971 looking at the behaviour of “normal college students” put in to the roles of guards and prisoners. Some guards turned into sadists, despite knowing that the “prisoners” had done nothing wrong and the experiment had to be stopped after six days. "Many of the normal, healthy mock prisoners suffered such intense emotional stress reactions that they had to be released in a matter of days; most of the other prisoners acted like zombies totally obeying the demeaning orders of the guards; the distress of the prisoners was caused by their sense of powerlessness induced by the guards who began acting in cruel, dehumanizing and even sadistic ways. The study was terminated prematurely because it was getting out of control in the extent of degrading actions being perpetrated by the guards against the prisoners - all of whom had been normal, healthy, ordinary young college students less than a week before." (Zimbardo has just written a book “The Lucifer Effect: Understanding how good people turn evil” which makes links between this phenomena and such abuses as the torture that occurred in Abu Ghraib).

So in clinical practice I've become wary of blaming the patient for their problems – their behaviour is far more likely to be due to their environment than their “personality”. But of course understanding their environment requires time and interest to enquire about. Something that may be lacking in acute clinical practice.


Jones, E. E. & Harris, V. A. (1967). The attribution of attitudes. Journal of Experimental Social Psychology 3, 1–24

Zimbardo P. The Lucifer Effect: Understanding how good people turn evil. Random House. 2007 ISBN-10: 1400064112


kj15 said...

This is very true, everybody makes this mistake. Until they are aware of this little problem. and thats all it is a minor problem. But my question is do you think it can become a major problem, vast populations of people being defined from others view point and then actually believing it. Such as when something is validated enough times it seems like the right thing?

JAKE said...

Recently we just had a debate in class on imperialism. We were separated into two groups at random. One side of the room had to form an argument for pro-imperialism, and the other side anti-imperialism. There were both on each side people who were against the side that they had to argue for. However, they managed to convince others anyway. If someone who had not known what was going on had stepped into the room, they wouldve just thought we were all on the sides that we respected and agreed with. But that's obviously not true. So that's where FAE comes into play. The person might be thinking "oh they're arguing for their strong beliefs" instead of knowing what was really going on, which was "oh, theyre doing a good job in defending something they dont really agree with."

Anonymous said...

A great blog! Wow. I think you've accurately portrayed 'a tip of the iceburg' problem in mental health. Sadly, as a consumer with many 'consumer' friends...yes yes yes, people are being blamed and stigmatised for their conditions.

Life trauma isn't being identified and considered as a causative factor in M illness.

It's worsened with 'Recovery Based Approaches' because the onus is now on consumers to 'recover' using CBT etc.

Choices aren't being offered abt how to "recover' and it's easy to get trapped with a diagnosis that doesn't fit, clinicians whose practices aren't following H &D or Mental H Commssion protocols.

pamphlets abound - I've read them all from the lobby of my community health team, taken them into appointments to ask 'why?' are they not doing this stuff? Answer, isn't resources, isn't time,etc it's just 'team practice'

H& D advocates I've worked with describe Mental Health Teams as using 'power over' people instead of sharing power. This traumatises the people using services.

MH is ripe for changes - moving away from MH teams pratice of having meetings, - then TELLIng people their diagnosis', how they must treat it and what meds to take.

- working alongside people, negotiating possible dignosis and possible treatments would revolutionise present care, and I'd certainly turn up for appointments.

It's a great challenge we face, overcomming MH 's persisitance in using incorrect practices. - I challenge mental health workers to start reading their own protocols and following them. We who must use the services are often desperate for the change to be made.

Anonymous said...

Just re read the original comment... after reflecting further on the behaviours of individuals in mental health teams.

Perhaps if we apply the findings of Philip Zimbardo's 1971 experiment to the culture of people working in Mental Health teams, it may explain their behaviour towards their clients?

If it took only six days to corrupt people into sadistic behaviour, imagine how years of working in system where people don't follow protocols and guidelines and carry out practices that harm people must impact on the mental health and the behaviour of each person working in these mental health teams?

No wonder consumers are getting harmed and no wonder many consumers are searching for ways to get appropriate treatment without being harmed by people in the 'system'