October 12th, 2020

I have long thought about the world of manipulating one's thoughts to maintain a wrong belief because it aligns with what the thinker wants or needs. In the field of medicine, I am constantly amazed at the entrenched beliefs of my colleagues when they are faced with solid evidence that the belief that is held tight is likely untrue. This brings me to the theory of Cognitive Dissonance as written by Leon Festinger in 1957:

1) the existence of dissonance, being psychologically uncomfortable, will motivate the person to try to reduce the dissonance and achieve consonance 2) When dissonance is present, in addition to trying to reduce it, the person will actively avoid situations and information that would increase the dissonance. What Dr. Festinger was looking at was the reality that I am seeing play out in medicine.

I had a recent experience with an expert at a prominent university regarding eczema, food reactions and allergic risk over time. We politely disagreed about the antecedent triggers of a large subset of the eczema patients, milk protein intolerance, and the eventual outcome that occurs following avoidance and reintroduction over time. While the story is less important than the reality that the old entrenched belief that he held so tight was not playing out in hundreds of sequential patients in our office, left him dissonant to any explanation to the why. The discussion was, exactly that, a discussion of what we are seeing in real time versus some published literature from years gone by. I raise this point not as a proof of our correctness, but as an example of cognitive dissonance and medicine. The subsequent choices made because of dissonance can and do have negative impacts on patients.

When I was a junior partner here at Salisbury Pediatrics, I routinely told sad and distraught mothers that their colicky infant had a gut brain connection problem, the prevailing theory at the time. Fast forward a few years and we realized that these children were really suffering from cow milk protein intolerance. I lament the many mothers that received my poor knowledge in those early years and the ones that will in the future for other reasons. However, I was taught early on in my training by great physicians to hold tight to your truths until someone proves them wrong and then switch over night. Medicine and life in general are on a learning curve and that is a constant. Teachers blessed us students with the tools to avoid cognitive dissonance by accepting change, understanding that mistakes will happen and that we are always learning and growing.

After finishing another phenomenal Peter Attia Podcast, #130, where Dr. Carol Tavris and Elliot Aronson discuss the further evolution of Festinger's work and modern analysis of it, I thought that I would discuss one of their examples to highlight this theory as I believe that it is critical to your child's growth and evolution. They use a poignant example of the 1989 Central Park NYC jogger case where teenage youths were wrongly convicted and served time in jail for a decade before the true perpetrator of the case, who was in jail in 2001, confessed and was a DNA match. The prosecuting attorney, Mrs. Fairstein, refused to vacate the convictions despite the overwhelming evidence against the original decision. This is a most egregious example of Cognitive Dissonance. Mrs. Fairstein was so steadfast in her misguided belief that her original case was solid that she refused to see the most blatant refuting evidence. To admit that she was wrong would have been too painful as these boys languished in jail for years based on her decisions. Thus, she became cognitively dissonant. This is a classic psychological safety mechanism. We don't want this to be the future of us or our children. Accepting responsibility, course correcting, living for the now, not repeating the same errors and so on are critical to sanity and growth.

This is exactly the point from which we must teach our children to hold truths tightly until evidence to the contrary proves the other and better theory, proof or reality. When we have humility as parents, we tell our children and loved ones that we are making the best decision from a position of authority based on today's data but we reserve the right to change based on better data. This is exactly how we want our children to view the world in the future. If we always held to old truths, we would have no new theories, no advancement and no growth,

Dr. M

Festinger The Theory of Cognitive Dissonance