Health Psychology : a Textbook

COGNITIVE DISSONANCE THEORY

Totman (1976, 1987) placed his cognitive dissonance theory of placebos in the following

context: ‘Why did faith healing last for such a long time?’ and ‘Why are many of the

homeopathic medicines, which have no medically active content, still used?’ He argued

that faith healing has lasted and homeopathic medicines are still used because they

work. In answer to his question why this might be, Totman suggested that the one factor

that all of these medically inert treatments have in common, is that they required an

investment by the individual in terms of money, dedication, pain, time or inconvenience.

He argued that if medically inactive drugs were freely available they would not be

effective and that if an individual lived around the corner to Lourdes then a trip to

Lourdes would have no effect on their health status.

The effect of investment

Totman suggested that this investment results in the individual having to go through two

processes: (1) the individual needs to justify their behaviour; and (2) the individual needs

to see themselves as rational and in control. If these two factors are in line with each

other (e.g. ‘I spent money on a treatment and it worked’), then the individual experiences

low dissonance. If, however, there is a conflict between these two factors (e.g. ‘I spent

money on a treatment and I do not feel any better’), the individual experiences a state of

high dissonance. Totman argued that high justification (it worked) results in low guilt

and low dissonance (e.g. ‘I can justify my behaviour, I am rational and in control’).

However, low justification (e.g. ‘it didn’t work’) results in high guilt and high dissonance

(e.g. I cannot justify my behaviour, I am not rational or in control). How does this relate

to placebo effects and changes in symptoms?

Justification and changes in symptoms

If an individual travels far and pays a lot of money to see a faith healer then they need

to justify this behaviour. Also they need to see themselves as being rational and in

control. If they have put a lot of investment into seeing a faith healer and the faith healer

has no effect on their health status, then they will not be able to see themselves as being

rational and in control, and will therefore be in a state of high dissonance. The best way

to resolve this dissonance according to Totman is for there to be an outcome that enables

the individual to be able to justify their behaviour and to see themselves as rational and

in control. In terms of the faith healer, the best outcome would be an improvement in

health status. This would enable the individual to justify their behaviour and to enable

them to maintain a sense of self as one who is rational and sensible. Totman argued

that when in a state of high dissonance, unconscious regulating mechanisms are

activated, which may cause physical changes that improve the health of the individual,

which enables the individual to justify their behaviour, and this resolves the dissonance.

Totman therefore suggested that for a placebo effect to occur, the individual does not

require an expectation that they will get better, but a need to find justification for their

PLACEBOS AND THE INTERRELATIONSHIP BETWEEN BELIEFS, BEHAVIOUR AND HEALTH 319