The Dangers of Groupthink

By William Morgan, DC

The term “group think” was coined by the psychologist Irving Janis in his 1972 work, Victims of Group think: A Psychological Study of Foreign- Policy Decisions and Fiascoes. Group think describes what happens when individual thought cedes to the will of group consciousness. This may sound like a cross between an Orwellian novel and a bad zombie movie, but its prevalence in the world is common, and the dangers of group think are all too real, especially when it comes to decision-making in health care. Group think suppresses dissenting views and can lead to an over simplified view of problems and solutions.

Symptoms of Groupthink
Dr. Janis presented eight symptoms of group think:

• Group attitude of invulnerability. The group feels that it is “bulletproof,” so it takes unnecessary risks and is overly confident.
• Group rationalism—discrediting evidence that is contrary to the group beliefs.
• Group peer pressure inhibits the will to dissent. Members of the group are browbeaten into conformity of thought.
• Group belief of moral superiority.
• Stereotyping of outsiders in negative terms—such as “Oh, he is just a dumb straight.” Or, “Those medi-practors are so insecure in their ability to adjust.”
• Group self-censorship. Peer pressure and stereotyping create a spirit of self-censorship. The team members censor their own words and thoughts.
• Group complacency is fed by the group’s culture of self censorship and peer pressure.
• The appearance of unanimous decisions. Since no one voices a dissenting opinion (because of peer pressure, self-censorship and stereotyping of dissenters), the group feels that it always has a unanimous consensus.

Several failures have resulted from group think: the Maginot Line, the Y2K millennium bug hoax, global warming (both sides of the argument) and the Challenger space shuttle disaster.

In health care, we see group think dangers when treatment risks are considered acceptable by certain specialty groups. Physicians in a group may discuss the nuances of a surgical procedure, but they do not question the need for surgery. Another medical specialty may dispense pain medication while rationalizing the risk-to-benefit ratio. Equally disconcerting are health care administrators and decision-makers who issue decrees for the rest of society while cloistered away in a boardroom far from the treatment room.

Protect Yourself
Of course, it would be hypocritical for us not to reflect on our own profession. Certainly, when chiropractors get together, we can be as guilty as anyone else when it comes to group think. How can we protect ourselves? Whenever we meet in groups, boards or committees, we need to identify the risk of group think and take active steps to prevent its insidiousness from creeping into our midst.

Group leaders should seek input from those with dissenting views.The organization should encourage open discussion and feedback. Having someone play devil’s advocate would also be a way to infuse open thought into our organization.Seeking input from outside the group provides a healthy look at outside opinions. For example, at the hospital, I frequently call upon other physicians for their opinions in complicated cases.Finally, group leaders should avoid stating their opinions so strongly that the entire organization is coerced into marching in lock step with them.

Though Dr. Janis coined “group think” in recent decades, the tendency has been recognized for centuries. Hans Christian Andersen illustrated it eloquently in his story “The Emperor’s New Clothes”, when a little boy broke the trance of national group think by blurting out that the emperor had no clothes. We need to echo the little boy’s sentiment in defending our profession from the ill effects of group think.