Attitude change in the psychiatric patient: a test of balance theory
Havelock, Ronald Geoffrey
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Two attitude dimensions which become highly relevant for the person who is admitted to the psychiatric ward of a hospital are acceptance of mental illness and acceptance of mental patients. It is assumed that under the impact of hospitalization acceptance of both mental illness and mental patients and rejection of both mental illness and mental patients tend to become consonant attitude combinations, and it is also assumed that rejection of mental patients and acceptance of mental illness becomes a dissonant attitude combination. Three hypotheses were derived from balance theory and subjected to test. They were first, that people realign attitudes to reduce dissonance, second that people realign attitudes to increase consonance, and third, that people maintain consonant attitude combinations more frequently than dissonant combinations. These hypotheses were tested in the following manner. Ninety-four new admissions to the open psychiatric ward of the Boston Veterans Administration Hospital were administered a questionnaire and interview at time of admission and again after a significant period of hospitalization (approximately ninety days). The questionnaire contained sixteen items measuring acceptance-rejection of mental patients, divided into four subsets each sampling from somewhat different response modes (statement agreement, statement disagreement, adjective ratings, and sentence completion). On the basis of "social distance" score summed across all sixteen items, subjects were divided into accept, neutral, and reject groups of equal frequency. The interview inquired into the patient's perception, belief, and interpretations concerning symptoms, probable cause, and preferred treatment of his own illness. Verbatim interview responses were rated for expression of acceptance and rejection of a psychiatric viewpoint. On the basis of summed ratings, subjects were divided into three groups of equal frequency representing acceptance, neutrality, and rejection at the dimension of mental illness. On the basis of the groupings on the dimension of mental patient and mental illness, subjects were assigned to nine attitude combinations representing varying degrees of consonance, dissonance, and non-consonance. Initial attitude combinations were treated as the independent variable and changes from one combination to another were treated as the dependent variable. Results: There was no special tendency for subjects with dissonant attitude combinations to shift away fran dissonance either in the direction of consonance or merely to non-dissonance. The first hypothesis was thus not confirmed. However, there did appear to be a significant tendency for subjects to shift from non-consonant to consonant attitude combinations, confirming the second hypothesis. Finally, there was no significant indication of greater stability in initially consonant attitude combinations than in non-consonant combinations. The third hypothesis, like the first, was therefore not confirmed. Theoretical Implications: There appears to be some utility in subdividing the omnibus balance hypothesis into three sub-hypotheses: namely, dissonance reduction, consonance increment, and consonance maintenance. Practical Implications: Social integration and acceptance of other mental patients may be a necessary precursor of acceptance of a psychological orientation toward illness in one's self. If psychological insight is the goal, a patient may be more receptive after he has come to perceive mental patients as potential friends and companions and people who are not too much different from himself. If social integration is the principal goal, however, there is no guarantee that acceptance of mental illness in the self will induce greater acceptance of other mental patients. Balance theory, per se, does not appear to be an effective predictor of attitude change in this setting, and it is premature to suggest direct application of the theory to ward management problems. Nevertheless, theoretical analyses are useful in clarifying and sharpening many of the issues confronting the practitioner.
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