Professor Raj Persaud
Good evening and welcome to this Gresham lecture. I am the Gresham Visiting Professor for Public Understanding of Psychiatry. I work as a consultant psychiatrist, working in the NHS, on, oddly enough, a ward at the Bethlem Royal Hospital called Gresham One Ward, and maybe Thomas Gresham had something to do with the endowment of my ward. The Bethlem Royal Hospital, is interestingly enough Britain's second oldest public hospital, founded some 750 years ago, which, given it is a psychiatric hospital, gives you a clue that 750 years ago, life was still quite stressful in London!
I must be a very naïve psychiatrist, because when I picked the title of 'Dominance' for this talk, I thought it would be fairly obvious that I would be talking about some psychological issues around dominance, but I obviously have misunderstood the often rather peculiar mind of the average Londoner, because Gresham has been getting some very strange phone calls from people hoping to attend this lecture. I think one phone call was someone enquiring as to whether they should wear rubber or leather! So following phone calls like that, I was rather looking forward to seeing who might be here in the audience...!
So I will be talking about some psychological issues around dominance. Doctors and patients often have a relationship which revolves around dominance, often because of the informational asymmetry between doctors and patients, and I suppose the one situation where patients may feel most vulnerable in terms of dominance is when they are under a surgeon's knife - that is when you feel you are most vulnerable in terms of being under an anaesthetic.
Believe it or not, there are many thousands of cases, particularly reported in America, of people being under the general anaesthetic and the anaesthetist has not quite got it right and the person's awake under the surgeon's knife. They are not feeling anything and they are unable to move, but they are actually conscious. They may not be fully conscious, but they often overhear the conversation between the surgeons operating on them, which I am sure can be quite a frightening or disturbing experience. I have here the list of the top six worst things you do not want to hear the two surgeons say to each other as they are operating on you. I got this off the internet so it must be true! In at number six of the worst things you do not want to hear the surgeon say if you suddenly wake up under the anaesthetic is if one surgeon was to say to the other: 'Don't worry, I think it is sharp enough.' At number five, there is, 'Damn, there go the lights again'. At number four, 'Wait a minute, if this is his spleen, then what's that?!' Then at number three, 'Could you stop that thing from beating' It's throwing my concentration off!' And the second from last is: 'That's cool! Now, can you make his leg twitch?' And finally, the worst thing you do not want to hear either of your two surgeons who are operating on you say to each other is: 'What do you mean you want a divorce?!'
So, dominance is something that is quite important in medicine, and between doctors and patients, and I am going to do a little psychological test here by reading out some questions from a personality questionnaire. I want you to put your hand up if you agree with these questions, and we will talk a little bit about what the questionnaire is measuring in a moment. But don't worry, we are not going to record your answers, we are not going to label you, but I would be interested for you to think about what this questionnaire might be measuring.
The first question is this: 'our country desperately needs a strong leader who will do what has to be done to destroy the new modern ways and wickedness that are ruining us.' Who agrees with that statement?
No one here at Gresham agrees? Who disagrees with that statement? Quite a large number of you.
Question number two: 'the old fashioned ways and the old fashioned values still show us the best way to live.' Who agrees with that statement?
Okay, only two or three people agree the old fashioned ways are the best ways to live. Who disagrees with that statement? Okay, a sizeable minority.
'Our country will be destroyed some day if we do not smash the perversions eating away at our moral fibre and traditional beliefs.' Who agrees with that statement?
Two or three. Who disagrees? Okay - there is a pattern developing here: again, a significant minority disagrees.
'Religious laws about abortion, pornography and marriage must be strictly followed before it is too late and those who break them must be strongly punished.' Who agrees with that?
Okay, no one here agrees with that. Who disagrees with that? Okay - I think we are approaching over 50% there. Two more questions to go?
'It would be best for everyone if the proper authorities censored magazines so that people could not get their hands on trashy and disgusting material.' Who agrees with that statement?
No one agrees with that statement. Who disagrees? Okay, again a sizeable group.
Final question: 'the only way our country can get through the crisis ahead is to get back to our traditional values, put some tough leaders in power, and silence the troublemakers spreading bad ideas.' Who agrees with that statement?
Okay, a couple of people agree. Who disagrees? Okay, very interesting?
Now, that questionnaire measures something, and it measures it very reliably. It actually predicts something about the way you are going to vote, politically. Anyone have any thoughts? Anyone want to take a guess at what that questionnaire is measuring as an aspect of your personality?
'Do you like Fascists?'! 'Conformity'? Good thoughts, both of those! 'Authoritarianism'? I think there are some people here who have done a bit of reading in psychology already perhaps. Yes, this is from a very famous questionnaire which measures a thing called the authoritarian personality type.
What is very interesting is, right back at the end of the Second World War, there was a lot of interest in psychology asking the question. So psychologists were asking the question: 'why was it the Germans, who were widely regarded as a highly civilised, intelligent group of people, could commit what appeared to be such heinous crimes?'
One theory was that there was a thing called the authoritarian personality and that Germans were particularly prone to suffering from it. At the heart of the authoritarian personality is the notion of obedience to authority. So people who score high on this scale have a strong belief in authority figures, they worship authority figures, they have a strong belief in the idea that authority figures should be obeyed almost totally because authority figures will be our salvation. So again, at the heart of the authoritarian personality type is the notion of submission to authority, that we should be very obedient to authority figures. People who score high on the authoritarian personality scale not only submit themselves to authority figures above them, but also believe very strongly in obedience from people below them or around them to themselves. So, for example, people who score high on this scale would want their children to be very obedient towards them.
It came to me as I was preparing this lecture that one of the reasons why I think there is an increased interest in the authoritarian personality type is because there is a resurgence of interest in the notion of obedience. This idea came to me because I have been doing a lot of travelling on planes recently. The security situation at Heathrow Airport, which a lot of people complain about, is a bit of a nightmare - the long queues you have to endure, what you can take or not take onto aeroplanes. What is really fascinating is how obedient, generally speaking, the travelling public is towards all these incredibly complicated and rather difficult measures. So obedience and the requirement of obedience seems again to be a big issue in our society.
It is clear that for any society to work well, there has to be a certain level of obedience. You had to all obey, for example, the idea that the lecture was going to start at a certain time, and you also had to obey the laws and the rules that govern transportation to this event. But is it not possible that there can be too much obedience in a society and a certain amount of rebelliousness and non-conformity might be a desirable state of affairs? Given so many of you here in this Gresham audience were putting your hands up that you disagreed with these statements, it would appear that a lot of you are actually scoring very low on the authoritarian personality type and this would suggest that you are much more over on the left wing or liberal end of the political spectrum, because scoring high on that questionnaire predicts, very reliably, a tendency to vote for parties towards the right of politics.
People who score high on authoritarian personality type would find this idea that there could be too much obedience very odd. Of course a very famous set of experiments done by Stanley Milgram, an American psychologist, in the '60s, showed that ordinary members of the public could, with very simple instructions from a white-coated authority figure, be asked, and they obeyed, to deliver life-threatening, apparent electric shocks to an innocent person. Stanley Milgram's research paradigm was about the idea that, given the right circumstance, anyone could do something that might be regarded as unethical or dangerous, and that is a very different idea, which kind of superseded the authoritarian personality type. The authoritarian personality type was about the idea that it takes a certain kind of person to do very dangerous things and then say they did it because they were just following orders. Milgram's experiment came along and really turned that on its head and said that in fact we are all prone to perhaps being rather obedient, or too obedient, given a circumstance and given the figure who might require that of us.
There is a balance, clearly, and this is one of the things I want to discuss with you, as to what is the right level of obedience. That naturally leads on to another interesting question, which is our leadership. We may be willing to obey some leaders and not willing to obey other leaders. The notion of leadership is actually very important in our lives, and it is something that people tend to think should be reserved for the notion of who should run the country or who should run large corporations. In fact, and this is a point I am going to come back to, we are social creatures at a fundamental level. We interact with each other, we cooperate with each other, and what that requires is leadership. We encounter leadership at every moment in our lives. Someone led this organisation and organised these lectures, for example. It is our encounter with leadership that has a lot to do with our quality of life. Between two-thirds and three-quarters of employees when asked say the worst aspect of their job is dealing with their immediate boss, a clear sign of a problem with leadership that leads to a lot of distress, and we know that when we have bad leadership, catastrophe occurs.
Interestingly enough, later on this evening, there is a rather significant sporting event occurring, and whether the England football team wins or loses has obviously quite a lot to do with the quality of leadership it experiences. Most sports commentators say that, at an individual level, the individual English football players are really rather good but something odd seems to happen when they start playing together, and they never are as successful as they ought to be.
Intrinsic in the idea of leadership is the idea of the team that you are leading, and at the heart of great leadership is the ability to get a group of people to sacrifice their personal self-interest for the wellbeing of the group. What determines which teams are more successful than others is leadership that enables the team to do that. Of course, the key paradigmatic leader of the last hundred years or so was Churchill. He was quite clearly able to get the British to sacrifice their own personal individual self-interest to pull together as a team and therefore survive what was indeed perhaps 'our darkest hour'.
So leadership is very important on an everyday basis in our lives. Research into companies that are very successful find that the key difference between successful corporations and ones that are less successful is the quality of the leadership, and the quality of the leadership that runs our country has a fundamental impact on the quality of our lives. One of the things I am going to come back to a little bit later is what can we do to choose better leaders.
Let us go back to the authoritarian leader who demands a lot of obedience from us. There are some very interesting Freudian ideas about where the authoritarian personality type comes from. Freud himself had an idea, and it was about the idea that really it comes from childhood experience; that we are trying to replicate a childhood experience: as children we become aware of our helplessness and our vulnerability to danger, and therefore we give our allegiance to our parents and obey our parents, and the exchange that is going on there is we will worship, idealise and obey the authority figures that are parents and, in exchange, they will save us from annihilation. That is the fundamental transaction going on with the authoritarian personality type, and that is why the authoritarian personality type believes fundamentally in much more absolute obedience than the rest of us, because the transaction is about the idea we need a powerful leader, whom we must subjugate ourselves to, because if we do not have this powerful leader, we will be destroyed.
So it leads naturally to another very interesting idea: at the heart of all authoritarian leaders is paranoia - 'There's an enemy massing at the border and you must obey me and do the long airport queue thing, and if you do that, we will save you from the enemy.' So there is another very important point here: there has to be an enemy for the authoritarian personality type to rise to power and to obtain the obedience that they need. Sometimes the enemy may not be real. Maybe the authoritarian personality type creates fear within us to fear an enemy which may not in actual reality exist because the authoritarian personality type knows that if we fear an enemy, in order to save ourselves, we will give our blind obedience in exchange for survival. So that is at the heart of that kind of leadership.
What is the test of the success of that kind of leader? Well, that kind of leader who has this paranoid position, that they're going to save us, and they're going to save us in exchange for our obedience, from the enemy at the gate, the success to that leader is survival. We, as a society, we've survived, and the other key criteria is we dominate, we subjugate and we destroy our enemies.
So if that, for you, is success, then obviously you are going to find authoritarian leaders rather appealing, but let us take a step back and think about what other measures of success we may be interested in.
Let us take a step back and think about ourselves and something that we find very difficult because we've very aware of our individual experience, our individual take on the world. It is the notion that in fact we are fundamentally socially creatures. By that, I mean we are social creatures almost in the way that bees are social creatures. Zoologists tend to think that bees now should not be viewed as individual insects or animals, but actually it is the hive that is the living organism, because within the hive, different bees have different roles and they only survive as an organism when all the bees are working together and playing their different roles. Actually, we are a lot more like bees than we realise. A lot of people put our success over nature down to our intelligence. In fact it is not so much our intelligence; it's our ability to cooperate with each other, and as a result, through that cooperation, we work in a more superior way than other species. No other species, if you observe the way animals deal with each other, cooperate with each other in the way that we do.
This is captured by a famous psychoanalytical phrase by a famous British psychoanalyst called Winnicut, where he said - and it is a slightly puzzling statement at first - he said: 'There is no such thing as a baby.' What he meant by that is, if you are walking along a beach and you come across a baby, by definition, there's going to be someone else very nearby that explains why that baby is alive, because no baby can survive, because they're so dependent on adults, without an adult looking after it. So where you find a baby, you will basically find a mother or a father not so far away. There is no such thing as a baby because a baby cannot exist in isolation. You could actually torture that phrase a bit and say there is no such thing as a single human being, for exactly the same reason. We all depend on each other, and therefore if you find a human being, not far away there are going to be other human beings which explain the survival of that human being.
Let me ram home the point by going back thousands and thousands of years ago, back into evolutionary past. There was a time when each individual did everything. What I mean by that was that, thousands and thousands of years ago, or hundreds of thousands of years ago, you grew your own crops, you went out and you hunted for your own animals to eat, you built your own house, etc. Each individual did everything. In other words, there was no specialisation. But then, one day, someone had a surplus - they reaped their crop, and they had more food than they personally needed to eat. Now, with that surplus, they could give that surplus to someone else, and in exchange for the surplus, that person might build your house for you or sew your clothes for you, and eventually, you get the advent of specialisation. No individual does everything - we specialise. People specialise in doing certain things, and because they specialise and devote themselves to it, they can do that thing much better than any individual who is actually doing everything. As we go forward in human progress, we have more and more super-specialisation.
Two thousand years ago, at the time of Hippocrates, you had a doctor, and a doctor did everything to do with medicine. As the thousands of years have rolled by in advances of medicine, we have super-specialisation amongst doctors now. I am not just a psychiatrist - i.e. a mind doctor - I do not just specialise in that area, but I am a general adult psychiatrist. That means that theoretically the NHS says 'You shouldn't treat people under the age of 16 or over the age of 65.' Within my group, catchment area, there are people who specialise in addictions. There are people who specialise in first onset psychosis. So you see the advent of super-specialisation, and that is actually at the heart of our success as a species. If you have each individual super-specialising, then they can do that one thing much better than any one individual could do everything.
There is another really interesting thing that then happens if you have super-specialisation, which is this: basically, the thing that I can do really well is general adult psychiatry. I cannot wire a plug or fix my car very well. So what I now need to do is trade my services, so I do the general adult psychiatry things, and I get other people who super-specialise, like plumbers, electricians and builders to trade their services with me, and that is how we get on together.
Now we come to a really interesting idea, which is the notion of the trade. Trading is at the heart of our cooperation with each other. There comes a problem with the trade: I trade my services, I do the general adult psychiatry thing, and I get electrical services back from the electrician and plumbing services back from the plumber. At the heart of every trade that goes on between people is a central question, which is: 'did I get a good deal with the garage fixed my car?' In the money I handed over to them, were they conning me or actually was I getting good value? That is the central dilemma you now have at the heart of every trade. Notice that in a society where everyone does everything there is no need to trade with each other, so we do not have this problem of how fair the trade was.
Clearly, the more we specialise, the more there becomes informational asymmetry. When you come to see me for psychiatry services, you theoretically, as a consumer, do not know much about psychiatry, so you have to take it on trust when I prescribe a certain treatment. There is informational asymmetry, and therefore there is trust at the heart of most trades.
The problem is that often people get exploited, and often people get conned in the situation that we find ourselves in. A famous survey was carried out in Switzerland because there doctors are paid on a fee by service approach: so it is a purely private system, so you go to your doctor, he provides a service and you pay him. What they found is that in any kind of fee for service situation, doctors tend to over-prescribe treatments unnecessarily. They tend to order too many tests, because they are getting paid for that kind of activity. What they found was that, in Switzerland, doctors and the relatives of doctors have 25% fewer operations done on them, which suggests that if you have the information to know whether you really need the operation or not, you tend to have many fewer operations than people who do not know. Right there you see a problem which is happening, which is in this trading that we are always doing with each other, some people are losing out.
There is another group of goods which particularly are prone to this, which are called credence goods. These are goods whereby, even after you have purchased the good, you cannot know whether you got a good quality product or not. That may sound odd, but have you had this experience? You took your car in to be serviced and the mechanic said, 'Your brake pads need changing.' You never noticed anything wrong with your brakes, did you? You get your brake pads changed, you drive the car away but you don't notice any difference in performance of the car. This is a credence good. You have no idea about the quality of the product you supposedly bought. What you have to do is rely and trust in the person who told you that your brake pads needed changing. So trust is at the heart of any trading situation where you have this kind of specialisation.
Now what then seems to develop is people begin to be suspicious of trades, particularly trades which seem to be too good to be true. It is actually called the TGTBT Effect in psychology - Too Good To Be True. The fact that people think something can be too good to be true is a strong indicator of the fact we are all aware of the fact we are trading with each other and that there's the possibility we could be losing out.
There is a famous experiment done in psychology which illustrates the 'too good to be true effect'. What they did, the psychologists, was they set up a stall in a shopping mall and they said they were giving dollar bills away, so any passer-by could stop and the psychologist said, 'Here, you can have a dollar bill - no strings attached, we're not going to ask you for anything in return.' They were giving money away, literally. How many people stopped and took the free dollar bills? Only 10% of passers-by stopped and accepted the free money. The other 90% walked by. Why? Because they assumed it's too good to be true - there must be a string attached.
They repeated the experiment with $50 bills: $50 bills were freely available if you came up to the stall. Then 78% of the public walked by. So the number that stopped and picked up the bill went up a little bit, but what's going on here? What is going on here is that if we see a stall in a mall where people are offering free money, we assume it's too good to be true - it cannot be free money, there must be a string attached, we are not interested in the string attached so we walk by, and that is telling us something about our previous experiences. Our previous experience has been that something that appears to be free is not indeed free, and therefore that is telling us something about our concerns over the trading that we're constantly doing with each other.
You could be very paranoid about trades and, as a result, do not do too many trades, or only do trades when you can be absolutely confident that you're not being cheated. Clearly, the 90% of people walking by the $1 bill that was being freely handed out and the 80% that walked by - 78% that walked by the $50 bill that was being freely handed out are in a position, some psychologists would say there was quite a fair amount of paranoia. They assume there must be something else going on and that was why they were not accepting the free money.
The problem with not being paranoid enough and being too trusting of course is that you will lose out in that situation. So again, we come back to an interesting question of what is the correct balance - what is the correct balance in terms of trust? We are often think about the correct balance in trusting each other, but what about the correct balance in terms of trust that we might give our leaders? Because there is an important transaction that happens with our leaders, which is we give them our obedience and we trust them not to abuse our obedience. So we are giving them our obedience and we hope to get something back - we hope to get great leadership and we hope to get a society that is well run.
Let's go back to what I said about how we judge the success of the authoritarian leader. The authoritarian leader's position is that the enemies are massing at the border and what they offer you is survival and the subjugation and the elimination of your enemies. That is success by an authoritarian leader's standpoint.
If we take the view that actually the way that we as human beings have become successful is successfully trading with each other, super-specialising but trading with each other and working well as a team. Hopefully tonight we'll not see a team that has everyone as a striker, or everyone as a goalkeeper, but a team that understands the importance of each person playing a different role and working together. If a great leader helps us work together as a team, then what we need are leaders that help encourage the notion that we can trust each other - they help encourage a climate of trust, and they help encourage the notion of trading with each other.
Notice something that is really prevalent at the moment, and we enter some very controversial territory here, and why I think many of our leaders now are really quite far over on the authoritarian scale - what our leaders say is that we have enemies, and these enemies must be imprisoned or destroyed, and that is the only approach to having enemies. We don't have leaders that say actually, in the long run, eventually what we are going to have to do with these enemies is make friends with them, because that was what we had to do with the Germans and the Japanese. Fifty years ago, these people were our mortal enemies, but now, we trade with them - in fact, we trade rather a lot with them, and we've made them our friends. Ultimately, is not the long term best plan and strategy with enemies to turn them into friends, turn them into people that we can trade with, both in the social, psychological sense, and also in the business sense, rather than to see them permanently as enemies who must be subjugated or destroyed? We have to think about that question, about what our leaders are asking from us, and what our leaders' vision is in terms of human relationships.
So I did not want to talk for too long this evening, given that there is a pressing engagement for many of you later on, so I am going to think about closing there and taking some questions, but one final point I want to make: Thomas Gresham, 400 years or so ago, founded a series of free lectures, where there really are no strings attached. No one is going to ask anything of you this evening and no one has asked anything of anyone who has attended any of the Gresham lectures for the last 400 years. That is something really rather remarkable in today's day and age, and I am really pleased that all of you here this evening, when you encountered the free good that was being handed out, like the $1 bill or the $50 bill in the famous psychology experiment, you didn't just walk by. You stopped and you had a look, because you realise that actually it is not the case that always things are too good to be true!
©Professor Raj Persaud, Gresham College, 21 November 2007