The Prison Experiment and Abuses of Authority

September 8, 2015

Clinicians have some degree of power. We must curb abuse-whether under the guise of research, transference in psychotherapy, in prescribing medication, or when deciding on treatments.

PSYCHIATRIC VIEWS ON THE NEWS

The recently released film,The Stanford Prison Experiment, was 13 years in the making. I would recommend it as required viewing for all mental health caregivers-but with a warning from this MD. It may have adverse effects.

Personally, I felt more emotionally distraught after watching it than I had at any time during my career working in a medium security prison. At best, the movie triggered secondary trauma I experienced in my clinical work with inmates.

How could I be so affected? It’s just a movie, right? Yes, it is, and although fiction, it is based on real life, as the leader of the 1971 “experiment” at Stanford University, psychology professor Philip Zimbardo, has said in interviews (Dr Zimbardo was also a consultant for the film).

Dr Zimbardo and colleagues recruited, selected, and paid a group of male Stanford students to participate in a planned 14-day prison simulation. A toss of the coin determined whether each participant would be a guard or a prisoner. The objective was to find out whether an institution could temporarily shatter one’s identity and influence one’s personality and ability to adapt to prison life.

[[{"type":"media","view_mode":"media_crop","fid":"41128","attributes":{"alt":"Trauma","class":"media-image media-image-right","id":"media_crop_1176751194650","media_crop_h":"0","media_crop_image_style":"-1","media_crop_instance":"4292","media_crop_rotate":"0","media_crop_scale_h":"0","media_crop_scale_w":"0","media_crop_w":"0","media_crop_x":"0","media_crop_y":"0","style":"width: 193px; height: 128px; float: right;","title":"©ViewApart/Shutterstock","typeof":"foaf:Image"}}]]By the end of Day 1, it became apparent that the guards were breaking their own rules for physical restraint. Yet, the experiment (if it can be called that), was not stopped. The emotional and physical brutality escalated. Like The Lord of the Flies, some guards were more aggressive than others, and some prisoners more compliant.

The researchers claimed to be surprised by this phenomenon. However, they not only allowed it to continue, but they seem to have encouraged the guards. Later, they claimed that no one suffered long-term after-effects. I wonder about that.

Stanford and prison
You wouldn’t think Stanford University and prison would go together, would you? Stanford attracts intelligent and wealthy students, many of whom might be considered nerds. If any place could maintain the veneer of civilization under trying conditions, wouldn’t it be Stanford?

My son attended Stanford from 1996 to 2000. He and I attended a lecture given by Dr Zimbardo. I shuddered then, wondering how my son would have fared in such an experiment. (Fortunately, inspired by some of his history professors, he became a Rabbi, though not without experiencing some traumatic fraternity events.).

The experiment ended after 6 days, prodded by Dr Zimbardo’s colleague, girlfriend, and former student, who later became his wife. After viewing some of the action, she confronted Dr Zimbardo about potential harm to the students engaged in the experiment. Soon after that confrontation, Dr Zimbardo witnessed some of the guards demanding that inmates mimic a sexual assault upon one another. Dr Zimbardo then decided to stop the experiment early. Surely, Freud would not have been surprised at this eruption of what he felt were our essential drives, aggression and sex.

The year of the experiment, 1971, was the same year I completed medical school and took the Hippocratic Oath to “do no harm.” As it turns out, that is a nearly impossible oath to keep, but one to strive for.

The danger of situationism
Though not referred to in the Stanford Prison movie, it seems to be a variation of Stanley Milgram’s experiment a decade earlier. In a mock experiment testing for memory, Milgram indicated that to one degree or another, most people would obey authority figures to give what was assumed to be escalating electric shocks to subjects.1

In 2007, ABC TV collaborated with psychologist Jerry Berger to try to replicate Milgram’s experiment for an episode of Primetime titled “Basic Instincts: The Science of Evil.” The results were similar, as they seem to be in many real life situations. Although this kind of experiment would never be approved in an academic institution today, it appears that the results would still hold.

The TV show was geared to the Abu Ghraib military torture in our “War on Terror.” Or take the citizens, both male and female, who supported Nazi Germany-or who now support ISIS. Take police brutality. Or fraternity hazing and sexual assault. It should come as no surprise that the day after I saw the movie, the front page story in the August 19th New York Times was “Prison Guard ‘Beat Up Squad’ Blamed in New York Inmate’s Death.”

To a lesser extent, the movie may also remind you of abuses of power in any institution. In corporations. In sports. In religious institutions. In families. And, in medical schools, where we train our future physicians.

Although medical schools have been trying to address behavior that may be construed as abusive on the part of some physicians, a recent exception was reported in the August 21st New York Times article “Doctors Behaving Badly.” This article summarizes a controversial piece in the Annals of Internal Medicine, in which 2 male physicians displayed inappropriate sexual comments while 2 female patients were anesthetized. In such situations, power is potentially complete over an unconscious patient, although others in the room have the opportunity to respond. In both cases, medical students were observers and reportedly deeply disturbed, but said nothing for fear of confronting their supervisors.

This kind of influence is known as situationism. It posits that people’s behavior is strongly influenced by what is happening around them.

Ethical questions
The movie left me with many moral and ethical questions. Why did the University not better monitor the experiment? Should Dr Zimbardo have received a reprimand, probation, or even dismissal? Regardless, he went on to devote much of his academic career to warn of the dangers of power, especially in his book The Lucifer Effect?2

I guess I should still ask myself the same ethical questions. I led an academic mental health managed care system for many years. One former APA President called me “evil.” I thought I was learning and sharing the benefits and risks of managed care.3 In other words, for both Dr Zimbardo and me, did the ends-knowledge-justify the means?

Who might have the courage to stop such experiments or wrongdoing in real life? In Dr Zimbardo’s case, those with whom he was emotionally close apparently had reservations and expressed them. In my managed care situation, I decided to end our contracts when I figured that there was not enough funding to provide competent care any longer.

Recommendations
Mental health providers have some degree of power. We must curb abuse-whether under the guise of research, transference in psychotherapy, in prescribing medication, or when deciding to hospitalize patients against their will.

After my work in prison, I thought that any would-be mental health caregiver should spend some time in prison. Seeing this movie is the next best-or worst-thing. You might want to supplement that viewing with an earlier documentary, Quiet Rage: The Stanford Experiment.

If you watch the film, discuss it with someone afterward, as I did with my colleague and friend, Randall Levin, MD (Our wives did not want to see it).

Although the movie covers one experiment, we all must confront our own Stanford prison experiments of one kind or another. I assume that we all hope to test out well when we are in authority.

References:

1. Milgram S. Obedience to Authority: An Experimental View. New York: Harper Collins; 1974.
2. Zimbardo P. The Lucifer Effect: Understanding How Good People Turn Evil. New York: Random House; 2007.
3. Moffic HS. The Ethical Way: Challenges and Solutions for Managed Behavioral Healthcare. San Francisco: Jossey-Bass; 1997.