I missed writing something for 12th May, international ME awareness day this week but I read a lot of really good posts on people’s blogs that commemorate those lost and missing because of this disease.
I wondered what I wanted to write for ME Awareness Day. The thought: “write about what you know,” kept running around my mind.
So here’s my post.
Milgram experiment, PACE trial, the NHS and compliance and obedience in large organisations
Some time ago I wrote a post about the PACE trial and what it says about the NHS when people such as Tom Kindlon do the critical analysis better than they did.
There’s a bigger question though. That is why a group of people would comply with a treatment regimen that even their own patients report is a blunt, harmful instrument in the treatment of CFSME.
Is it because the NHS is paying their wages they go along with it or comply?
Is it because that’s all we’ve got…..?
It must be for some reason, because it’s bleedin’ obvious that the combination of GET and CBT in the NICE Guidelines for CFSME works for a few people sometimes but fails many, many, many more….
Well, Psychiatrists like Simon Wessely know of a very famous experiment carried out into human compliance and obedience.
It is known as The Milgram Experiment
Milgram was interested in World War 2 and specifically why it was that people complied with the torture and death of the Jews.
“Is it a human, hard wired biologically determined thing that people comply with authority, putting their own feelings to one side?” he asked himself.
He decided he’d set up an experiment to test his theory.
The experiment took place in a room divided down the middle with a screen.
In a nutshell he asked people to sit on either side of the screen. One would administer electric shocks to the person on the other side of the screen if they got the answer to a question wrong – torture in other words.
As time and the numbers of inaccurate questions increased, so did the voltage.
Except there was no voltage – it was all a sham. The people in the experiment administering the shocks didn’t know that though.
If they heard shouts and screams from the other side and asked the person in charge if they should carry on and were told they had to, they did.
The room was resounding with shouts and cries from the actors on the other side of the screen but no matter how bad it got, because the majority of experimenters were told to – they carried on increasing the voltage of shocks even into life threatening levels.
They didn’t know it was a false situation. They thought it was real.
The Milgram Experiment rocked the world
The experiment shocked those reading the results. It was repeated in many different ways over many different years until Psychologists threw down their hats and said:
“OK, we’ve got it, human beings are compliant to other human beings in authority. Tell them whose in charge and they’ll pretty much to any terrible thing when being obedient.”
The Milgram Experiment unlocked a particularly fascinating area of human psychology and social psychology.
Organisational psychology
Now that’s Social Psychology. Social psychology also informs Organisational Psychology – i.e. what people in organisations do, how they behave, how workplaces create positive or negative environments for performance, etc.
Organisational psychology is a big branch of psychology too.
NHS is a BIG organisation
The NHS is a HUGE organisation. It is VAST and built into it are tiers and a hierarchy, bosses and staff members, those in charge and those receiving ‘orders.’
This works in very unique and specific ways in clinical settings where people are qualified to carry out particular types of work and their chain-of-command states who is ultimately clinically responsible for those decisions too.
Outside of the NHS but informing it, are organisations like NICE, the Care Quality Commission and the Department Of Health.
There are also large research organisations and charities like Cancer Research UK , ME Association and ActionForME. They are not NHS organisations but they are informed by it and in the case of conducting research, may influence it.
Where does NHS research happen?
Well that’s a good question and very relevant to the PACE Trial. It seems the PACE trial was funded to the tune of 8 million by the government ( I think that means the NHS research budget.)
Part of that funding contract went to Queen Mary University Of London – it’s in the East End – to do the number crunching required to produce the results.
It was carried out at Kings College Hospital and Oxford University.
Blimey, that’s a lot of organisational power there in that paragraph. Stacks of public money, a major London hospital of world renown, two major Universities and the government too.
I’m quaking in my boots at the thought of standing up to that monolithic collection of organisations, aren’t you?
Milgram has a place in considering PACE
In thinking about why it is that the official, organisational narrative about the PACE trial from within the NHS and NHS partners is against criticism and pro support, I think you need to consider what Milgram’s experiment has taught us.
It has taught us that no matter what, if we are in a situation where power and influence is exerted upon us, the chances are we will comply with what we are told to do even if it leads to harm.
Clinicians shouldn’t comply
No, clinicians shouldn’t comply if it is going to cause harm.
However if those very same clinicians are brainwashed by a hugely influential piece of organisationally initiated and ratifed research – In Milgram’s experiment that would be the person in charge – into thinking that perceived harm – again that would be the shouts and screams- is infact result of maladaptive thinking in a patient, then there’s nothing stopping them, is there….
Copyright Lindy 2016.
Disabled In Tory Britain 
Hi Lindy 🙂
Wow. ‘Shocking’ that Milgram experiment. Doesn’t seem that they have learned though. I thought these days it was a big thing pushing patient involvement, and shared decision-making. Maybe it’s all PR and not very effective in practice.
I think the PACE trial was around £6m and funding came from… The Department of Work and Pensions! Which is surely fuel for another of your most excellent blogs.
Govt. and NHS do have a major problem and have done for years. What to do with the chronically ill whose numbers keep rising year on year?
In comes a couple of psychologist-types who claim to have the answer. To cut long story short – and during Labours term in office but continued throughout coalition and now Tory governments – is this ‘work is best’ ethos alongside cognitive-behavioural training i.e. ‘learning’ to live with your limitations but not be reliant on welfare.
Of course as the so-called austerity measures really bit, this whole ethos fit well with the government’s need to cut costs drastically to allegedly balance the books – something that despite its best endeavours and appaling behaviour towards the sick and disabled, even this Tory government has failed to do.
There are so many long-term diseases that has so far defied understanding and still await effective treatment let alone cure, and so many people affected by them or by a combination of long-term illness burdens, that the goverment had to try something it felt and presumably were quite desperate as the welfare and health bills climbed ever higher.
Then you get this report ‘work pays’ saying in essence that being in work is much better for your health and wellbeing that being outside of it, and coupled with these half-arsed and ill-thought-through attempts at ‘social re-conditioning’ which seem to me to be inherently part of CBT and even GET; successive governments felt perfectly able to turn welfare upside-down and inside-out.
We used to have the ‘big stick’ approach in this country, and today is not much better. Even being ill is no excuse to not working.
The report I mention is here. It’s been a while since I read it – but it also either mentions CBT or CBT was spawned in the years that followed its birth:
Click to access hwwb-is-work-good-for-you.pdf
N.B. Some of the details in my little tirade above might be inaccurrate but the general gist is certainly correct. It’s been a while since I wrote properly ont his subject.
All the best
Russ
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Looks like it cost around £5million for the PACE trial. Quick Google search (though you can of course look up the actual costs and who paid what), revealed a response from Tom Kindlon who mentions the cost and also that DWP and MRC I believe were co-funders:
http://www.bmj.com/content/350/bmj.h227/rr-10
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Very interesting post. There’s definitely something relevant in the obedience tendency in humans and the hierarchy of the NHS. Also the other institutions involved have a lot of clout. We’re chipping away at huge edifices with a pen knife. It must be very difficult for individual nurses or doctors to challenge this too.
The question is whether NHS staff would equate electric shock and Graded Exercise? I suspect that they think it is a useful strategy rather than punishment! My feeling is that NHS staff genuinely want us to be well and can’t cope with not really knowing how to go about this. When presented with a technique that can be done now and is almost free (no equipment or medication) it is reassuring to find something can be done. It is also a technique where the patient can be blamed for doing it wrong if they get worse, without challenging your beliefs in the therapy (much like faith healing).
If my memory reliable, the Department for Work and Pensions funded PACE, which is an odd state of affairs in itself and not how research funding usually works here. There would be a bias to find a cheap therapy that got people off benefits (all very good if it did help of course, we’d like to go back to work).
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Hi – thanks for reading all of the post and for writing your response. Also, very interesting.
I read your reply and it triggered a few other thoughts – so here goes…
I really do think that everyone who works in the NHS in clinical services has their heart in the right place. They are caring and compassionate and want the best for patients. In my entire time of working there, I never heard anything that made me question the values of the people I worked alongside.
One of the positives of this very large organisation is that it is focused on health care so it does very quickly expose lack of the ‘right qualities’ in a person and also rubs corners off any issues about compassion and care constantly.
However the NHS is a very large slow moving ship and trying to make any sort of change is incredibly difficult if you are a sole voice, as you say, or even if you are not a sole voice and you and your team see your treatment programme is potentially harmful.
And that’s the bit I really stick on though. You see you shouldn’t continue with a treatment programme if it is harming a patient. There’s clinical ethics, professional guidelines, all sorts of things to highlight that to a clinician. You just shouldn’t…..
So why on earth do they carry on doing it and why hasn’t one person working in the NHS CFSME teams blown the whistle on this treatment programme yet? The silence is deafening…..
I wondered if the Milgram Experiment was too extreme an example to equate with GET and CBT and the care we have in the NHS but considering that, I still stand by my assertion that it is exactly the same.
People have been routinely harmed by these treatments and there is a large-scale organisationally constructed cover up of that harm.
I also think it is played out in the way the PACE Trial criteria were altered half way through – who didn’t challenge that decision at the time??? Because they were being obedient, that’s why…
Patients get discharged if they don’t comply with NICE NHS treatment for CFSME or aren’t evaluated as well (I’ve written about that from a personal perspective in this blog previously) so it’s very easy to push away and deny the harm. It gets thrown away or ignored.
People are being harmed and harmed badly by the Psycho-social model. We know it happens, we talk about it, we raise it, we respond to surveys about it, we write blogs about it, we do what we can to say it over and over and over again, but the ‘person in charge’ in Milgram’s Experiment, has said that you have to carry on.
They say that the screams and shouts and cries have to be ignored by using a very clever piece of organisationally constructed psychology that says: “those signs of discomfort, harm or pain don’t denote real issues in or for the patient, they denote a psychological lack of compliance in the patient – carry on administering those shocks…”
In other words, resistance is futile……
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