Appendix 39f - Obedience

by Michael Greger, MD and United Progressive Alumni

[ Medical School Resources | Appendices | Discussion ]


The Third Wave: Nazism in High School.[435]

Cubberly High School, Palo Alto California:

The Third Wave started as a learning experience and ended five days later a nightmare. Ron Jones was teaching his high school history class about Nazi Germany when a student asked the inevitable questions. How could so many Germans claim they didn't know what was going on?.... Jones decided to involve the class directly in finding the answer.

He started the following Monday's class by introducing a key Nazi concept: discipline.... The students practiced until they could move in a few seconds from standing outside the classroom to sitting at attention. Jones wondered how far he could push unquestioning obedience. He introduced new rules, including one stating that students must stand beside their desks when asking or answering questions, and must always start by saying, 'Mr. Jones.'

When Jones entered the classroom Tuesday, everyone was sitting at attention. A few students were smiling, but most were staring rigidly ahead. He went to the blackboard and wrote in big letters: 'STRENGTH THROUGH DISCIPLINE,' and below it, 'STRENGTH THROUGH COMMUNITY.' Jones had the students chant the slogans over and over. Near the end of the class he created a salute for class members - the right hand raised to the shoulder, fingers curled. He called it the Third Wave salute....

Jones issued membership cards... and assigned three students to report any members not complying with class rules. The assignment proved unnecessary. On Wednesday alone, 20 students came to Jones with news of students not saluting, criticizing the experiment or being uncooperative in other ways.

Thursday morning Jones walked into his class, now grown to 80 students, and announced 'the real reason for the Third Wave': It wasn't a just a classroom experiment, but a nationwide program 'to find students willing to fight for political change.' Jones said that at noon the next day a presidential candidate would appear on national television and announce the Third Wave program. There would be a special rally in the high-school auditorium to watch the announcement....

By noon Friday the auditorium was crammed with more than 200 students. Jones closed the doors and posted guards to keep everyone else out. Just before noon, Jones walked to the front of the auditorium and asked the audience to 'demonstrate the extent of their training.' He saluted, and 200 arms rose in reply. He shouted, 'Strength Through Discipline' again and again, and each time the response got louder and louder.... Jones switched on a rear-screen projector.

A Nazi rally came on, followed by pictures of people being shoved into vans, of death camps, and of people pleading ignorance at the war crimes trials: 'I was only doing my job.'

Jones was later invited by the German government to Nuremberg to address rallies concerned about neofascism.[436] "This kind of experiment is taking place every day - although not so brilliantly," Jones said. "Textbooks are one-sided.... There is not much democracy in the classroom. The sandpapering of freedom goes on every day."[437]

About the whole Third Wave experiment, Jones admitted in an interview feelings of sickness and remorse. He proposes the question, "How far would you have gone?"[438] Stanley Milgram tried to answer that question.

The Set-Up

If person X tells person Y to hurt person Z, under what conditions will person Y obey and under what conditions will person Y refuse?[439] Those conditions were what Stanley Milgram set out to find in his pioneering study of destructive obedience.[440] His series of experiments have been held up as, "One of the finest carried out in this generation... surely among the most celebrated in the history of psychology." Another commentator, "After 30 years, it still remains the prime example of creative experimental realism used in the service of a question of deep social and moral significance."[441]

The experiment consisted of ordering a naive subject to administer increasingly more punishment to a victim in the context of a learning experiment. Subjects were paid $4.50 to come to a Yale laboratory for what they were told was a "study of memory and learning." At the appointed time, two subjects meet in the parking lot outside the lab. The experimenter ushers them in. One of the two subjects is a plant, though, a confederate of the experimenter and pretends to just be another guy off the street. A rigged "random" drawing places the accomplice as the victim who is taken to an adjacent room and strapped into an "electric chair" apparatus. To convince the naive subject that the electrical apparatus is genuine, he is given a sample 45 volt shock on a shock generator.

Quoting from the original study:

A pretext [was]... devised that would justify the administration of electric shock by the naive subject.... The subject is told to administer a shock to the learner each time he gives a wrong response [to a learning task]. Moreover - and this is the key command - the subject is instructed to move one level higher on the shock generator each time the learner flashes the wrong answer....

The [shock generator] instrument panel consists of 30 lever switches... [each] clearly labeled with a voltage designation that ranges from 15 to 450 volts.... In addition, the following verbal designations are clearly indicated for groups of four switches going from left to right: Slight Shock [including the sample 45-volt shock], Moderate Shock, Strong Shock, Very Strong Shock, Intense Shock, Extremely Intense Shock, Danger: Severe Shock. (Two switches after that designation [415V and 450V] are simply marked XXX).... Upon depressing a switch: a pilot light corresponding to each switch is illuminated in bright red; an electric buzzing is heard; an electric blue light, labeled 'voltage energizer,' flashes; the dial on the voltage meter swings to the right; various relay clicks are sounded.... No subject in the experiment suspected that the instrument was merely a simulated shock generator.

The experiment was set up so that if the subject reached the 300-volt shock level, the "learner" pounds on the wall of the room in which he is bound to the electric chair and then refuses to give any more answers. The experimenter at that point instructs the subject to treat the absence of the response as a wrong answer, and instructs the subject to continue to increase the shock level one step at a time each time the learner fails to respond correctly. The learner's pounding is repeated after the 315-volt shock is administered; afterwards he is not heard from again.

Shocked

Yale seniors, all psychology majors, were provided with a detailed description of the experimental situation and were asked to predict the outcome. All of the students predicted that only an insignificant minority would go to the end of the shock series. The estimates ranged from 0 to 3%; i.e., the most "pessimistic" member of the class predicted that of 100 persons, 3 would continue through the most potent shock available on the shock generator - 450 volts. The students' predictions averaged 1%.

The experts disagreed. Using their astute knowledge of human behavior, forty psychiatrists at a leading medical school given the same description of the experiment, predicted that only a little over one tenth of one percent of the subjects would administer the highest shock on the board. They predicted that by the twentieth shock level (300 volts; the victim refuses to answer) less than 4% of the subjects would still be obedient. They were wrong. 100 percent were.

Upon command of the experimenter, each of the forty subjects went beyond the expected breakoff point; no subject stopped prior to administering Shock Level 20. And how many went all the way? Was it one in a hundred as the students predicted? Was it one in a thousand like the psychiatrists predicted? No.

Sixty-five percent of a sample of average American adult men were willing to punish another person with increasingly higher voltages of electric shock all the way to the maximum (450 volts) when ordered by an experimenter who did not possess any coercive powers to enforce his demands.[442]

And Yet He Continued

The subjects were videotape recorded. They were observed sweating, trembling, stuttering, biting their lips, groaning, and digging their fingernails into their flesh. These were described as characteristic rather than exceptional responses to the experiment. "I observed a mature and initially poised businessman enter the laboratory smiling and confident," writes Milgram. "Within 20 minutes he was reduced to a twitching, stuttering wreck, who was readily approaching a point of nervous collapse... and yet he continued to respond to every word of the experimenter, and obeyed to the end."

Not Good Enough

What if the experiment was identical to the first except that voice protests were introduced? What would happen if at 75 volts the victim starts grunting and at 120 volts the victim starts shouting to the experimenter that the shocks are becoming painful. At 135, painful groans, and at 150 volts the victim cries out, "Experimenter, get me out of here! I won't be in this experiment any more! I refuse to go on!" Cries of this type are set to continue with general rising intensity so that by 180 volts the victim cries out "I can't stand the pain," and at 270 volts his response to the shock is, "definitely an agonized scream." After 315 volts the violently screaming victim provides no answers, just shrieking in agony whenever a shock is administered.

Even though the evidence of the learner's suffering was much more prolonged, pronounced and unambiguous, this voice-feedback condition yielded almost an identical rate of obedience (25/40 vs. 26/40). Milgram asks, "What is the limit of such obedience? At many points we attempted to establish the boundary. Cries from the victim were inserted; not good enough. The victim claimed heart trouble; subjects still shocked him on command."[443]

Obedience Unlimited

The next step was to make it so the subjects could see the victims as well as hear them. "Subjects frequently averted their eyes from the person they were shocking, often turning their heads in an awkward and conspicuous manner," Milgram writes. "We note, however, that although the subject refuses to look at the victim, he continues to administer shocks."[444]

The final effort to establish the limit was called the "touch-proximity condition." The victim was placed not only in the same room with the subject, but one and a half feet away from him. The new set-up was designed so that the victim received a shock only when his hand rested on a shockplate. So at the 150-volt level when the victim demands to be let free a second time, he also refuses to place his hand on the shock plate. The experimenter then orders the naive subject to physically force the victim's hand onto the plate.

The researchers describe the scene as "brutal and depressing." They describe the subjects', "hard, impassive face showing total indifference as he subdues the screaming learner and gives him shocks."[445] And still 30% of the subjects went all the way. Almost one in three.

After almost a thousand adults were individually studied, Milgram concluded, "Perhaps our culture does not provide adequate models for disobedience."[446] "Obedience becomes an unquestioned operative norm in countless institutions and settings, many of which are endowed with a very high cultural status - e.g., the military, medicine...."[447] Medicine.

Variations on the Theme

Others replicated the studies. Was it because of the prestige of Yale University, the trappings of a research laboratory? What if the same study was done in an office building, conducted in an unimpressive concocted corporate setting lacking any credentials? The level of obedience was not significantly lower than that obtained at Yale.[448] Should we be surprised at what laboratory technicians allow themselves to do to countless nonhuman animals in labs around the world?

What if it were religious authority rather than scientific authority? What if the experimenter, was introduced to the subjects (all of whom were Christians) as a minister at a local church? Again, no significant difference was found.[449]

Commentators have concluded:

The average man on the street can be persuaded with ease to impose a series of electrical shocks on an immobilized victim until he is unconscious or dead. The fact is that Milgram, without employing duress or force, could create a situation in which an average, normal, intelligent individual would of his own accord inflict pain and misery upon a fellow human being, and, with sweating brow and inward fear and trembling, continue to inflict dire harm upon an innocent person, and continue grimly to the very limits possible of this behavior under no compulsion but a structured social situation.[450]

There are those that look at these studies and tell themselves that they would never have obeyed. I was one of them, but I know better now. I promised myself I would never compromise my morality in medical school, that I would stand up, refuse. I broke that promise and many others. We need medstudent twelve step. My name is Michael and I have participated in the victimization of others.

Nursing school is a place where women learn to be girls - Nursing historian Dorothy Sheahan[451]

Obedience in the medical setting has been studied directly. Experimenters called hospital nurses on the phone. An unfamiliar voice calling itself Dr. Smith asks that a patient under the nurse's care receive an obviously excessive dose - on the bottle it says maximum daily dose 10 mg; the nurse is asked to give 20 - of a fictional drug covertly placed in the drug cabinet on the floor. The drug's concocted name "Astrotech" is obviously not on the stock list and is therefore unauthorized, not cleared for use. Just the fact that the medication order is given only over the phone violates hospital policy. How many of the nurses, despite all this, would go to give the drug?

The researchers explained the scenario to twelve nurses; ten said that if they were in the situation they would not have given the drug. They asked 21 nursing students; all 21 said they would have refused. When they actually did the experiment though, how many nurses had to be stopped at the door of the patient's room, dose in hand? Ninety-five percent - 21 out of 22 - obeyed. Only a single nurse dared to question authority. The others expressed to the caller essentially no resistance to the order and offered no delay after conclusion of the call.

From the discussion at the end of the study:

None of the investigators and but one of the highly experienced nurse consultants with whom the project had been discussed in advance predicted the outcome correctly.

It has been long recognized that when there is friction between doctors and nurses, it is the patients who chiefly suffer. However, the present study underscores the danger to patients... of the nurse-doctor relationship even when there is little or no friction....

There is considerable evidence that a considerable amount of self-deception goes on in the average staff nurse. This investigation tends to show that the view... that the nurse will habitually defend the well-being of her patients as she sees it and strive to maintain the standards of her profession... is an illusion, which... is widespread and enduring.[452]

"A cute, fluffy puppy..."

I cringed to hear that there was a paper entitled "Obedience to Authority with an Authentic Victim." What if the victim was actually given graded shocks? As described in their protocol, two researchers took, "A cute, fluffy puppy...."

Same as Milgram, but with a puppy and with real shocks. College students, 13 men and 13 women, were told to give the puppy 30 shocks. The shocks caused the puppy to run, howl, and yelp. The final level, researchers report, resulted in, "continuous barking and howling."

The conclusion? "Females were not expected to be more willing than males to shock a cute puppy." But they were; all 13 women went all the way, delivering 30 shocks each.[453]

Polite Distance

My favorite Milgram commentary was written by Dr. Philip Zimbardo, author of one of America's most popular collegiate psychology texts.

Obedience is not to be understood solely by reference to the individual's conforming deed; that is merely the end product of a long process of prior programming by which the rationality of power, dominance, and authority become impressed upon us....

The major lesson taught in school systems is the necessity to obey trivial, irrelevant rules and to observe protocol, while at all times respecting authority because it exists.... We must critically reexamine the ethics and tactics of our revered social institutions, which lay the foundation for our mindless obedience to rules, to expectations, and to people playing at being authorities....

The question to ask of Milgram's research is not why did the majority of normal, average subjects behave in evil (felonious) ways, but what did the disobeying minority do after they refused to continue to shock the poor soul, who was obviously in pain? Did they intervene, go to his aid, denounce the researcher, protest to higher authorities, etc.? No, even their disobedience was within the framework of 'acceptability'; they stayed in their seats, 'in their assigned place,' politely, psychologically demurred, and they waited to be dismissed by the authority. Using other measures of obedience in addition to 'going all the way' on the shock generator, obedience to authority in Milgram's research was total!.... It ought to give each of us pause as no other single bit of research has.[454]

 
 

[435] Horn, J. "The Third Wave: Nazism in High School."

[436] Jones, R. "Based on a True Story." Whole Earth Review 79(1993):70.

[437] Fraser, CG. "Television Week." New York Times 4 October 1981:2A-3.

[438] Ibid.

[439] Milgram, S. "Some Conditions of Obedience and Disobedience to Authority." International Journal of Psychiatry 6(1968):259-276.

[440] Milgram, S. "Behavioral Study of Obedience." Journal Abnormal Social Psychology 67(1963):371-378.

[441] Blass, T. "Understanding Behavior in the Milgram Obedience Experiment." Journal of Personal and Social Psychology 60(1991):398-413.

[442] Ibid.

[443] Milgram, S. "Some Conditions of Obedience and Disobedience to Authority." International Journal of Psychiatry 6(1968):259-276.

[444] Ibid.

[445] Blass, T. "Understanding Behavior in the Milgram Obedience Experiment." Journal of Personal and Social Psychology 60(1991):398-413.

[446] Milgram, S. "Some Conditions of Obedience and Disobedience to Authority." International Journal of Psychiatry 6(1968):259-276.

[447] Miller, Colins, BE and DE Brief. "Perspectives on Obedience to Authority." Journal of Social Issues 51(1995):1-19.

[448] Milgram, S. "Some Conditions of Obedience and Disobedience to Authority." International Journal of Psychiatry 6(1968):259-276.

[449] Blass, T. "Understanding Behavior in the Milgram Obedience Experiment." Journal of Personal and Social Psychology 60(1991):398-413.

[450] Patten, SC. "Milgram's Shocking Experiments." Philosophy 52(1977):425-439.

[451] Brown, P. Perspectives in Medical Sociology Prospect Heights: Waveland Press, 1996:477.

[452] Hofling, CK, et al. "An Experimental Study in Nurse-Physician Relationships." Journal of Nervous and Mental Disease 143(1966):171-180.

[453] Sheridan, CL and RG King. "Obedience to Authority with an Authentic Victim." Proceedings of the 80th Annual Convention of the American Psychological Association (1972):165-166.

[454] Zimbardo, PG. "On 'Obedience to Authority.'" American Psychologist 1974(July):566.

 
 
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