Thursday, March 30, 2017

Billingsley's Wild Ride

Recently I underwent a reconstructive procedure on my arms.  Jim and I travelled to Tulsa.
When I woke up in recovery, except for the male nurse, things seemed to be OK.  All except for my left arm.  By 4:00pm it was very painful, and it wasn't the same color as the other arm.  It was swelling, too.  The doctor was alerted, and thought I had held my arm in some way that occluded something.  
But holding my arm up on pillows in a perfect way didn't fix it and around 11:00pm the doctor arrived.  Soon I was having a second surgery.  Things weren't OK.  My arm looked like you might imagine an arm would look that had died, all purple and  black, swollen and mangled.  The manager of our hotel personally went into Jim's hotel room and rounded him up and took him over to the hospital.  The doctor wanted him to be there so he could give the OK to remove my arm, if it became necessary.  
They didn't remove my arm.  Two hours later I was in recovery waking up again, and was surprised to see how much better my arm looked, all six of them.  There seemed to be arms everywhere.  "Is that the arm that was so swollen and black?? "  "Yes..."  "I thought it would be months before I recovered from that!"
My doctor came in and said, "The artery in your left arm was nicked."  Nicked?  How nicked?  And I was sent to rest for a couple of days in the hospital.  
On Thursday I was discharged, and Friday morning I had my first post op with the doctor.  Before the appointment I called the doctor.  I was kind of alarmed.  I noticed that my legs were swollen, then my kidneys weren't working, then trouble breathing, then severe dizziness.  The receptionist got with the doctor and called me back.  "That's all normal," she said cheerfully.  I wondered what could happen that wouldn't be normal.  "The doctor says you need to move around..."  OK.  Jim is on oxygen, so I used that for my breathing, and started moving some, and resting some.  By the time of my appointment I did feel a lot better.  I had slept for, oh, eleven hours without moving, so right after surgery, the body doesn't like the lack of circulation.  
At the doctor's office, I asked if I was OK to drive.  He had insisted that I not drive for two weeks before surgery, but seeing that poor Jim was my ride, he decided I could drive for 30 minutes to spell Jim.  Away we  went for a three hour tour home.
Boy, what a ride.  Jim was in dire straigts, direr than mine, and as soon as we got out of Tulsa, he handed me the reins.  I was OK for about an hour, but I started fading.  However, I felt safer with me driving than with Jim.  
Before I go for any ride in a car, I pray for safety.  I pray before trips out of town that it will not rain.  No matter how bad the weather is, it almost never does.  This day was no exception.  I had also prayed that God would protect me from road rage.  This seems to be the hardest thing for God to arrange for me and the more impaired I am driving, the more people seem to want to express their displeasure about that with their semis.  So there was some of that.  We got half an hour from home, and even though we had stopped and walked three times, my legs were swollen again, and I was having trouble breathing.  Jim complained that his vision was very bad.  He could hardly see.  Everything seemed dark.  It was 3:00 pm so it wasn't dark out yet.  That was why he hadn't wanted to drive.  Then my vision suddenly just went.  Another normal problem.  First things were blurry, then things got darker and darker and darker.  Weird.
I've heard that at high noon, at the bottom of a well, one can look up into the sky and see the stars.  It was like that.  The lights of oncoming traffic shone out in the darkness.  Jim complained about people driving with their brights on and I wondered why all the bright headlights at this time of day.  And why was it so dark?  Dark, dark, dark.  
But we arrived home, and both dove into bed and stayed there, both on oxygen, until about two days passed.  Ahhh....  I revived and felt stronger.
I was very worried about my next appointment in a week with my doctor in Tulsa.  It was three hours there hours there and three hours back.  What if things went as bad on that drive as this one had gone?  So I broke down and asked Mrs. Billingsley to go with me as a backup driver.  OK.  
I imagined that the Muckogee Turnpike would be a nice place to change drivers.  I stopped at the first picnic area.  I didn't turn off the car to it would still be in cruise at 75, the speed limit.  It's a beautiful road, in good repair with not much traffic.  Practically the whole road to yourself.  Most trucks avoid it because the toll gets expensive for them.  Piece of cake.  I took a fairly long walk first, and climbed into the passenger seat, with Mrs. Billingsley at the wheel.
The sun shone bright in the west, which was the driver's side, and she stepped on the gas.  We were about five miles from the first toll.  The next thing I knew, we were going 90 and seemed to be picking up speed.  Mrs. Billingsley claimed also that the sun visor didn't work.  I had resumed the cruise so that she wouldn't have to deal with staying in the speed limit, so I asked her about her speed.  Also, she was having a whale of a time staying on the road.  First we raced down the shoulder, then careened over to the other lane, then back to the shoulder.  Her voice was becoming tense and kind of spooky.  Hmmm....  
I saw a movie once with Michael J.Foxx, I think.  An ex girlfriend picked him up as he walked down the road and gave him a ride.  They seemed to be having a nice conversation...  Not.  Her voice became shrill, and at the same time her speed picked up, this in heavy traffic in town.  He had RUINED her life!  Sixty mph, seventy mph...What to do?  What would you do?  Oh, I suppose people think that in that situation, they would unfasten their seatbelt and move over and fight with the driver or turn off the ignition, or step on the brakes from the passenger's seat or, or.  Or what?  He did what I did.  Try to talk to the agitated person, calm them down and hope they were able to think clearly enough to lift their foot off the gas pedal.  That's what he did.  That's what I did.  In that case, his girlfriend got up to, oh, a hundred and twenty and then went off a bridge.  What would Mrs. Billingsley do?  
Rather than distract her by speaking, I signalled with my hand for her to move back onto the road.  We were still going fast, at least 75.  We approached the toll booth.  About half a mile before you get to it, there's a sign that says, "Speed limit 65."  She ignored this and I pointed it out to her.  "Now the sign says 55 mph," I pointed out carefully.  She ignored that, too.  Then it said 45 mph...  "NOW IT SAYS 35 AND YOU'RE STILL GOING 75!!  HIT THE BRAKES!!"  I couldn't tell if we were heading through the gate and about to smash it to smitherins, or if we were going to crash into the little building where the guards live out their days.  I saw a toll guard in their blue policeman looking uniform walking around, walking across the road, apparently imaging we were going to stop.  Suddenly it occurred to Mrs. Billingsley to try the brakes and we screeched up to the basket.  She had trouble again with everything about that little basket, but somehow paid the toll, opening the door and getting out to reach the basket.  It's not that difficult!
On the other side of the toll is a parking area.  I pointed it out.  Did we pull over and park?  No.  Why didn't I leap from the car as soon as it was stopped at the toll booth?  I'm still asking myself that.  
I thought the flashing lights and bells and the myriad of warning signs and guards in their stern looking uniforms had unsettled Mrs. Billingsley, and once we were through all the confusion she would settle down.  I kept thinking, "I know she knows where the brake pedal is.  I know she knows where the gas pedal is.  She knows that one controls them with one's foot.  The steering wheel steers the car....She knows how to drive...: "  Soon we were bobbing and weaving through what little traffic there was, again going real fast, which is not typical of her driving habits.  She will drive along next to a semi for an hour before she passes it, rather and speed up past the speed limit.  The sun visor hung at a cockeyed angle as her foot put the pedal to the metal, glaring sunlight hurting my eyes.  We drove off and on the road over to the other lane and far shoulder.  I had tried to get her to slow down going through Muskogee, where the speed limit is only 70, but she also ignored this, passing everything in sight.  It seemed like one could at least use other traffic as a measure of speed.  No...not today!  Then we came to a work zone..."The speed limit is 45 here..." I pointed out hopefully.  "Oh, my," she responded.  "Oh my?" I wondered.  Why was that a problem?  Take your foot off the gas pedal.  In the work lane, they were digging up the road, and every now and then, there were mile deep holes in the road, and people milling around doing stuff.  There were barricades.  She seemed to zero in on them, then suddenly change her mind and zoom over to the far shoulder.  The deep holes went all the way to our lane, so there really wasn't room for error.  It wouldn't be pretty to run into a hole.  She finally seemed to slow down when she ran up on someone's tail who had slowed down to 60 anyway.  There weren't any other options.  Steady, steady....
The work zone went on for six long, frightening miles, miraculously without incident, and then the race down the road resumed.  I told her that in two miles we would come to a concession area.  I'd like to stop there.  The exit is on the left.  She seemed as agitated as ever, and I sensed that almost anything I said would be her cue to speed up to 120, let go of the wheel and take us into oncoming traffic.  To my great relief, I saw the concession area and told her again that we needed to exit on the left.  On the left.  OK, on the other lane than this lane.  She got into the left lane, but why were we not slowing down?  "This is the exit, on the left, this is the exit, on the left....you need to slow down...you need to actually get onto the exit..."   These words seemed to drift to heaven like a prayer that went seemingly unanswered.  I knew she spoke English.  Or did she?  Had she forgotten her words?  
She summoned her courage and put the left wheels over onto the exit.  I reminded her to slow down.  Could we get onto the exit?  Some daring fellow in a beautiful black BMW decided that we were indeed taking the exit, so therefore he would go ahead and go by us in the lane we were still in, assuming that we were exiting.   He passed by my window, missing us by inches.  
Mrs. Billingsley slowed, and after seeming to consider running into a grassy knoll, elected to stay on the exit.  Ahead of us lay many gas pumps.  She couldn't decide whether to run them down or not, but at least we were going slower and we were off the road.  I suggested we stop at the McDonalds.  There was a big sign with the golden arches...over there...over there.  We simply stopped, still sitting in the exit.  I pointed out the parking spaces.  She drove into one of them finally as if it were spring loaded with a trap for cars.  Was it over?  Really?  
We got out and headed for cover.  "What happened back there?" I asked.  She complained of being completely confused and disoriented.  "Yeah.  OK.  I'm OK to drive now..."  

Thursday, March 23, 2017

The Fall of Cushing, Oklahoma

http://kfor.com/2017/03/16/there-was-a-near-catastrophic-situation-concerns-rise-after-another-downtown-cushing-building-collapses/




CUSHING, Okla. - The days are numbered for a nearly century old building in downtown Cushing.
The Lion’s Den was damaged back in November by a 5.0 earthquake, and it recently collapsed.
City officials believe small earthquakes and last week’s high winds contributed to the building’s fall.
The Lion’s Club is taking bids for their old meeting place to be demolished.
"I think we've really got a safety issue here that's got to be addressed in the very immediate future," Attorney William Ahrberg said.
Ahrberg’s office is only a few doors down from the Lion’s Den.
He said it terrifies him to know that just minutes before the building caved, a class of little dancers walked past it.
"There was a near catastrophic situation that I don't think the town would have recovered from," Ahrberg said.
He said it is just a matter of time before another building gives way.
If you take a look downtown, you will see earthquake damaged buildings roped off.
NewsChannel 4 has learned at least one business has been forced to move.
Others are now questioning if they should stay.
"I've been debating on am I going to move? Am I going to repair my building? And I know I got about $50,000 in damage," Ahrberg said.
He said he will have to spend his own money to either fix it, or tear it down.
"I'm like most people down here. We didn't have earthquake insurance," Ahrberg said.
City Manager Stephen Spears said most buildings that have been damaged have been inspected.
"At this point, they're structurally okay for people to be in them," Spears said.
They may be structurally sound, but not necessarily earthquake proof.
“Most of the downtown area`s built early in the 1900s and supposedly either sandstone or brick. Unreinforced masonry construction which really isn`t designed to withstand lateral movement earthquakes cause,” Spears said.
The oil town is now trying to balance what boosts its economy, while keeping its infrastructure from crumbling.
"You know this country put a man on the moon in 1969 and surely there's a way to find an alternative to dealing with this situation," Ahrberg said.
Much of Cushing is dealing with the aftermath of earthquakes.
The city said it is looking at more than a million dollars in damage to its buildings.
City officials said luckily they have earthquake insurance.

Wednesday, March 22, 2017

Hope for Paralysis

Paralyzed people could walk again instantly after scientists prove brain implant works in primates


Grégoire Courtine holds a silicon model of a primate’s brain and a brain implant.

Grégoire Courtine holds a silicon model of a primate’s brain and a brain implant. CREDIT:ALAIN HERZOG / EPFL
Paralysed people could walk again instantly after scientists developed a brain implant which turns thought into electrical signals in the spine so that lost feeling can be restored after injury.
Currently people who break their backs or suffer a spinal trauma are unable to stand or move even though their legs still work, because the signal which connects their brains to their muscles is disconnected.
But an international team of scientists have shown it is possible to bypass the injury and reconnect the brain signals to electrodes at an undamaged part of the spine.  
Two monkeys who were temporarily paralysed in one leg were able to walk again instantly using the technique, which could be available for humans within a decade.
"For the first time, I can imagine a completely paralysed patient able to move their legs through this brain-spine interface, said neurosurgeon Jocelyne Bloch of the Lausanne University Hospital.
The implant works wirelessly to connect to a healthy part of the spine
The implant works wirelessly to connect to a healthy part of the spine CREDIT: NATURE 
Neuroscientist Dr Erwan Bezard of Bordeaux University who oversaw the experiments added: "The primates were able to walk immediately once the brain-spine interface was activated. No physiotherapy or training was necessary.”
Humans are able to move because electrical signals originating in the brain's motor cortex travel down to the lumbar region in the lower spinal cord, where they activate motor neurons that coordinate the movement of muscles responsible for extending and flexing the leg.
But injury to the upper spine can cut off communication between the brain and lower spinal cord.
To create a device which mimicked the natural communication of the brain and muscles, scientists needed to decode signals from the motor cortex and turn them into electronic signals which could fire electrodes and stimulate nerves in the spine.
The monkeys limped until the device was switched on then could walk
The monkeys limped until the device was switched on then could walk
The device works wirelessly so only two small implants are needed, one in the brain and one in the spine.
It was tested on two macaque monkeys with lesions that spanned half the spinal cord and who could not walk on one leg. When turned on, the animals began spontaneously moving their legs while walking on a treadmill. 
“With the system turned on, the animals in our study had nearly normal locomotion," said Dr David Borton, assistant professor of engineering at Brown and one of the study's co-lead authors.
Previous studies have shown that it is possible to use signals decoded from the brain to control movement of a robotic or prosthetic hands but it has never been shown to help stimulate muscles directly.
The researchers say not only could it help paralysed people to walk again, but in the long term may even encourage the regrowth of damaged circuits.
"There's an adage in neuroscience that circuits that fire together wire together," added Dr Borton.
"The idea here is that by engaging the brain and the spinal cord together, we may be able to enhance the growth of circuits during rehabilitation. That's one of the major goals of this work and a goal of this field in general."
The tiny device shown next to a silicone monkey brain
The tiny device shown next to a silicone monkey brain
The researchers say the device still has several limitations. Presently the signalling only works one way so sensations do not pass back to the brain and it is also unclear how much weight the legs can bear.
However British experts said the experiment was ‘very promising and exciting.’
“It is an important step forward in our understanding of how we could improve motor recovery in patients affected by spinal cord injury by using brain-spinal interface approaches,” said Prof Simone Di Giovanni, Chair in Restorative Neuroscience, Imperial College London.
“In principle this is reproducible in human patients. The issue will be how much this approach will contribute to functional recovery that impacts on the quality of life. This is still very uncertain.”
Dr Andrew Jackson, of the Movement Laboratory at the Institute of Neuroscience, Newcastle University, added: "The idea of using electronic implants to bypass damaged neural pathways dates back to the 1970s but the twenty-first century has seen remarkable progress in this field.
"It is not unreasonable to speculate that we could see the first clinical demonstrations of interfaces between the brain and spinal cord by the end of the decade."
The research was published in the journal Nature Neuroscience

Tuesday, March 21, 2017

Group Think...Once I thought I was wrong but I was right








http://pirate.shu.edu/~mckenndo/ethics-Groupthink-Janus%20article.htm
Groupthink among Policy Makers 
IRVING L. JANIS 
[From Sanctions for Evil, ed. Nevitt Sanford and Craig Comstock (San Francisco: Jossey-Bass, 1971), 71-89.] 
I have been studying a series of notorious decisions made by government leaders, including major fiascos such as the Vietnam escalation decisions of the Lyndon B. Johnson administration, the Bay of Pigs invasion plan of the John F. Kennedy administration, and the Korean Crisis decision of the Harry Truman administration, which unintentionally provoked Red China to enter the war. In addition, I have examined some fiascos by European governments, such as the policy of appeasement carried out by Neville Chamberlain and his inner cabinet during the late 1930s�a policy which turned over to the Nazis the populations and military resources of Austria, Czechoslovakia, and other small countries of Europe. In all these instances, the decision-making groups took little account of some of the major consequences of their actions, including the moral and humanitarian implications. 
            When we examine how each of these decisions was made, we find that it was rarely the work of just one man�even though historians may refer to it as the President's or the Prime Minister's decision. Rather, the decision was a group product, resulting from a series of meetings of a small body of government officials and advisers who constituted a cohesive group of policy makers. For example, when we look into the way the Vietnam policies of the Johnson administration were arrived at, we discover very quickly that the key decisions were made by a small cohesive group. In addition to the President, the group included McGeorge Bundy, the special White House assistant (later replaced by Walt Rostow); William Moyers, press secretary (later replaced by George Christian); Robert McNamara, secretary of defense (replaced during the last months of the Johnson administration by Clark Clifford); and Dean Rusk, secretary of state (who managed to remain in Johnson's policy-making group from the bitter beginning to the bitter end). For several years George Ball, who was undersecretary of state, also participated in the meetings. The group also included Earle Wheeler, chairman of the Joint Chiefs of Staff, and Richard Helms, director of the Central Intelligence Agency. 
            It was surprising for me to discover the extent to which this group and other such small groups of policy makers displayed the phenomena of social conformity regularly encountered in studies of group dynamics among ordinary citizens. For example, some of the phenomena appear to be completely in line with findings from social psychological experiments showing that powerful social pressures are brought to bear by the members of a cohesive group when a dissident begins to voice his objections to a group consensus. Other phenomena I describe are reminiscent of the shared illusions observed in encounter groups and friendship cliques when the members simultaneously reach a peak of group-y feelings. Above all, numerous indications point to the development of group norms that bolster morale at the expense of critical thinking. 
            To begin, I mention here the main sources for the Vietnam case study. One is an insightful article by James C. Thomson, Jr.,1 a historian at Harvard, who spent many years as a participant observer in the government, first in the State Department and then in the White House as an assistant to Bundy. Another is a book by David Kraslow and Stuart H. Loory,2 two journalists who interviewed many government officials involved in forming policies concerning the Vietnam war. The third is a book by Townsend Hoopes,3 who was acting secretary of the air force in the Cabinet. Hoopes's book is especially valuable for understanding the social and political pressures put on McNamara, Clifford, and other high officials who, toward the end of the Johnson administration, became disillusioned and began to favor de-escalation of the war. Using these and several other references, we can get some idea of the forces that enabled intelligent, conscientious policy makers to make the series of grossly miscalculated decisions that had such destructive effects on the people of Vietnam and such corrosive effects within our country. 
            One of the first things we learn from these accounts is that when the in-group of key advisers met with Johnson every Tuesday (they sometimes called themselves the Tuesday Luncheon Group), their meetings were characterized by a games theory detachment concerning the consequences of the war policies they were discussing. The members of this group adopted a special vocabulary for describing the Vietnam war, using terms such as body counts, armed reconnaissance, and surgical strikes, which they picked up from their military colleagues. The Vietnam policy makers, by using this professional military vocabulary, were able to avoid in their discussions with each other all direct references to human suffering and thus to form an attitude of detachment similar to that of surgeons. But although an attitude of detachment may have functional value for those who must execute distressing operations, it makes it all too easy for policy makers to dehumanize the victims of war and to resort to destructive military solutions without considering their human consequences. 
            Thomson, who has reported this tendency from close at hand, recounts a memorable meeting in late 1964 when the policy planners were discussing how much bombing and strafing should be carried out against Vietnamese villages. The issue was resolved when an assistant secretary of state spoke up saying, "It seems to me that our orchestration in this instance ought to be mainly violins, but with periodic touches here and there of brass." Thomson, in retrospect, came to realize that he had himself undergone attitude changes, that he had acquired the same sense of aloof detachment that pervaded the war policy discussions of Washington bureaucrats. Back at Harvard, after leaving his post in the White House, he was shocked to realize that the young men in front of him in the classroom were the human beings in the manpower pool he had been talking about so detachedly when discussing problems of increasing the number of draftees with the policy makers in Washington. 
            This dehumanization tendency is closely related to another characteristic of Johnson's policy-making group: reliance on shared stereotypes of the enemy and of the peoples of Asia. Their grossly oversimplified views overlooked the vast differences in political orientation, historic traditions, and cultural patterns among the nations of Asia. Their sloganistic thinking about the North Vietnam Communists overlooked powerful nationalistic strivings, particularly North Vietnam's efforts to ward off Chinese domination. As a historian, Thomson was shocked to realize the extent to which crudely propagandistic conceptions entered into the group's plans and policies. The policy makers, according to Thomson, were disposed to take a very hard-nosed, military stance partly because of these stereotyped notions. . . . The dominant view demonized the enemy as embodying all evils, which legitimized the use of relentlessly destructive means. These stereotypes were evidently incorporated into the norms of the policymaking group, so it was very difficult for any member to introduce a more sophisticated viewpoint. 
            In a cohesive group that adopts such norms, what happens when a member starts expressing his mild doubts and says, "Let's sit back for a moment and think this over; don't we need to make some distinctions here?" or "Shouldn't we talk about some of the consequences we may have overlooked?" Such questions must often go through the minds of the participants before they agree on a policy that has some obvious drawbacks. But as soon as anybody starts to speak about his doubts, he discovers, often in subtle ways, that the others are becoming somewhat irritated and that he is in the presence of powerful group pressures to be a booster, not a detractor. 
            Typically, a cohesive group, like the in-group of policy makers in the Johnson administration, develops a set of norms requiring loyal support of past decisions. Each member is under strong pressure to maintain his commitment to the group's decisions and to support unquestionably the arguments and justifications they have worked out together to explain away obvious errors in their judgment. Given this shared commitment, the members put pressure on each other to continue marching to the same old drumbeat and to insist that sooner or later everyone will be in step with it. They become inhibited about expressing doubts to insiders as well as outsiders with regard to the ultimate success and morality of their policies. 
            Whenever a group develops a strong "we feeling" and manifests a high degree of solidarity, there are powerful internal as well as external pressures to conform to the group's norms. A member of an executive ingroup may feel constrained to tone down his criticisms, to present only those arguments that will be readily tolerated by the others, and to remain silent about objections that the others might regard as being beyond the pale. We can surmise from studies of work teams, social clubs, and informal friendship groups that such constraints arise at least partly because each member comes to rely upon the group to provide him with emotional support for coping with the stresses of decision making. When facing any important decision, especially during a serious crisis, a group member often develops feelings of insecurity or anxiety about risks that could adversely affect the interests of the nation or organization and that could damage his own career. Moreover, most policy decisions generate conflicts between different standards of conduct, between ethical ideas and humanitarian values on the one hand and the utilitarian demands of national or organizational goals, practical politics, and economics on the other. A platitudinous policy maker is likely to reassure his colleagues by reminding them that you can't make an omelet without breaking some eggs. Nevertheless, each man's awareness that moral and ethical values are being sacrificed in order to arrive at a viable policy can give rise to distressing feelings of shame, guilt, depression, and related emotional reactions associated with lowering of self-esteem. Given all the uncertainties and dilemmas that arise whenever one shares in the responsibility of making a vital decision, such as war policies affecting the welfare and survival of entire nations, it is understandable that the members of a decision-making body should strive to alleviate stress. 
            Some individuals in public office are extraordinarily self-confident and may not need the support of a cohesive group when their decisions are subject to public criticism. I think, for example, of the spirited symphony orchestra conductor Thomas Beecham, who once said, "I have made just one mistake in my entire life and that was one time when I thought I was wrong but actually I was right." Not everybody who is accustomed to putting it on the line as a decision maker is able to maintain such unassailable self-confidence, however. So, not surprisingly, most members of a cohesive policy-making group strive to develop a sense of unanimity and esprit de corps that help them to maintain their morale by reaffirming the positive value of the policies to which they are committed. And, just as in friendship cliques, they regard any deviant within the group who insists on calling attention to the defects of the policies as objectionable and disloyal. 
            Social psychologists have observed this tendency in studies of students' clubs and other small groups. Whenever a member says something out of line with group norms, the other members increase communication with the deviant. Attempts to influence the nonconformist member to revise or to tone down his dissident ideas continue as long as most members of the group feel reasonably hopeful about tasking him into changing his mind. But if they fail after repeated attempts, the amount of communication they direct toward the deviant goes down markedly. From then on, the members begin to exclude him, often quite subtly at first and later more obviously, to restore the unity of the group. Asocial psychological experiment conducted by Stanley Schachter in America and replicated in seven different European countries showed that the more cohesive the group and the more relevant the issue to the goals of the group, the greater the inclination of the members to reject a recalcitrant deviant. 
            During Johnson's administration, when any member of the in-group began to express doubts�as some of them certainly did�they were treated in a rather standardized way that strongly resembled the research findings just described. At first, the dissenter was made to feel at home�provided that he lived up to two restrictions: that he did not voice his doubts to outsiders, which would play into the hands of the opposition; and that he kept the criticisms within the bounds of acceptable deviation, not challenging any of the fundamental assumptions that went into the prior commitments the group had made. Thomson refers to such doubters as domesticated dissenters. One domesticated dissenter was Moyers, who was described as Johnson's closest adviser. When Moyers arrived at a meeting, we are told, the President greeted him with, "Well, here comes Mr. Stop-the-Bombing." But Moyers and the other domesticated dissenters, like Ball, did not stay domesticated forever. These men appear to have become casualties of subsequent group pressures; they resigned long before the entire Johnson administration became a casualty of the Vietnam war policy, long before that startling day when Johnson appeared on television and tearfully explained why he was not going to run again.
            Given the series of cautionary examples and the constant reaffirmation of norms, every dissenter is likely to feel under strong pressure to suppress his doubts, misgivings, and objections. The main norm, as I have already suggested, becomes that of sticking with the policies on which the group has already concurred, even if those policies are working out badly and have some horrible consequences that may disturb the conscience of every member. The main criterion used to judge the morality as well as the practical efficacy of the policy is group concurrence. The belief that "we are a wise and good group" extends to any decision the group makes: "Since we are a good group," the members feel, "anything we decide to do must be good."
            In a sense, loyalty to the policy-making group becomes the highest form of morality for the members. That loyalty requires them to avoid raising critical issues, to avoid calling a halt to soft-headed thinking, and to avoid questioning weak arguments, even when the individual member begins to have doubts and to wonder whether they are indeed behaving in a soft-headed manner. This loyalty is one of the key characteristics of what I call groupthink
            I use the term groupthink as a quick and easy way to refer to a mode of thinking that people engage in when they are deeply involved in a cohesive in-group, when concurrence-seeking becomes so dominant that it tends to override critical thinking. Groupthink is a term of the same order as the words in the newspeak vocabulary George Orwell presents in his dismaying world of 1984, where we find terms like doublethink and crimethink. In putting groupthink into that Orwellian class of words, I realize that it takes on an invidious connotation. Exactly such a connotation is intended since the term refers to a decline in mental efficiency and in the ability to test reality and to make moral judgments. Most of the main symptoms of groupthink arise because the members of decision-making groups avoid being too harsh in their judgments of their leader's or their colleagues' ideas. They adopt a soft line of criticism, even in their own thinking. At their meetings, all the members are amiable and seek complete concurrence on every important issue with no bickering or conflict to spoil the cozy atmosphere. 
            Paradoxically, however, soft-headed groups can be extraordinarily hard-hearted when it comes to dealing with out-groups, or enemies. In dealing with a rival nation, policy makers in an amiable group atmosphere find it relatively easy to resort to dehumanizing solutions, such as authorizing large-scale bombing attacks on large numbers of harmless civilians m the noble cause of persuading an unfriendly government to negotiate at the peace table. An affable group of government officials is unlikely to pursue the ticklish, difficult, and controversial issues that arise when alternatives to a harsh military solution come up for discussion. Nor is there much patience for those members who call attention to moral issues, who imply that this "fine group of ours, with its humanitarianism and its high-minded principles," may be capable of adopting a course of action that is inhumane and immoral. Such cohesive groups also tend to resist new information that contradicts the shared judgments of the members. Anyone, no matter how central a member of the group, who contradicts the consensus that has already started to emerge is regarded as a deviant threatening the unity of the group. 
            Many other sources of human error, of course, can impair the quality of policy decisions. Some errors stem from psychological factors in the personalities of the decision makers. Also, special circumstances can create undue fatigue and other stresses that interfere with adequate decision-making. In addition, numerous institutional factors embedded in the social structure may make for inefficiency and may prevent adequate communication from knowledgeable experts. The concept of groupthink puts the finger on a source of trouble that resides neither in the single individual (as when a man's judgments suffer from his prejudices) nor in the institutional setting (as when an authoritarian leader has such enormous power over the individuals who serve on his policy-planning committees that they are intimidated into becoming sycophants). Along with these well-known sources of defective judgment, we must consider what happens whenever a small body of decision makers becomes a cohesive group. We know that group psychology has its own dynamics and that interactions within a friendly group often are not conducive to critical thinking. At times, the striving for group concurrence can become so dominant that it interferes with adequate problem-solving, prevents the elaboration of alternative courses of action, and inhibits independent judgment, even when the decision makers are conscientious statesmen trying to make the best possible decisions for their country or for all of humanity. 
            In my case studies of cohesive policy-making committees I have repeatedly noted eight main symptoms of groupthink, several of which I have already illustrated in the foregoing discussion: 
(1)   a shared illusion of invulnerability, which leads to an extraordinary degree of over-optimism and risk-taking; 
(2)   manifestations of direct pressure on individuals who express disagreement with or doubt about the majority view, making it clear that their dissent is contrary to the expected behavior of loyal group members; 
(3)   fear of disapproval for deviating from the group consensus, which leads each member to avoid voicing his misgivings and even to minimize to himself the importance of his doubts when most of the others seem to agree on a proposed course of action;
(4)   a shared illusion of unanimity within the group concerning all the main judgments expressed by members who speak in favor of the majority view (partly resulting from the preceding symptom, which contributes to the false assumption that any individual who remains silent during any part of the discussion is in full accord with what the others are saying); 
(5)   stereotyped views of the enemy leaders as evil, often accompanied by the assumption that they are too weak or too stupid to deal effectively with whatever risky attempts are made to outdo them; 
(6)   an unquestioned belief in the inherent morality of the in-group, which inclines the members to ignore the ethical or moral consequences of their decisions; 
(7)   the emergence of self-appointed mind guards within the group�members who take it upon themselves to protect the leader and fellow members from adverse information that may prevent them from being able to continue their shared sense of complacency about the effectiveness and morality of past decisions; and 
(8)   shared efforts to construct rationalizations in order to be able to ignore warnings and other forms of negative feedback, which, if taken seriously, would lead the members to reconsider the assumptions they continue to take for granted each time they recommit themselves to their past policy decisions. 
            When most or all of these interrelated symptoms are displayed by a group of executives, a detailed study of their deliberations is likely to reveal additional symptoms that are, in effect, poor decision-making practices because they lead to inadequate solutions to the problems under discussion. Among-the main symptoms of inadequate problem solving are the following: 
        First, the discussions are limited to a few alternative courses of action (often only two alternatives) without an initial survey of all the various alternatives that may be worthy of consideration. 
        Second, the group fails to reexamine the course of action initially preferred by the majority of members from the standpoint of nonobvious risks and drawbacks that had not been considered when it was originally selected. 
        Third, the group fails to reexamine any of the courses of action initially rejected by the majority of members from the standpoint of nonobvious gains that may have been overlooked and ways of reducing the seemingly prohibitive costs or risks that had made these alternatives appear to be inferior. 
        Fourth, little or no attempt is made to obtain information from experts within the same organization who may be able to supply more precise estimates of potential losses and gains to be expected from alternative courses of actions, particularly on matters about which none of the members of the group are well informed. 
        Fifth, selective bias is shown in the way the group reacts to factual information and relevant judgments from the mass media or from outside experts. The members show positive interest in facts and opinions that support their initially preferred policy and take up time in their, meetings to discuss them, whereas they tend to ignore facts and opinions that do not support their initially preferred policy. 
        Sixth, the members of the group spend little time thinking about how the chosen policy or set of plans may be unintentionally hindered by bureaucratic inertia, be-deliberately sabotaged by opponents, or be temporarily derailed by common accidents that happen to well laid plans; consequently, they fail to work out contingency plans to cope with setbacks that could endanger the overall success of the decision. 
            All six of these defects are products of groupthink. These same inadequacies can arise from other causes such as erroneous intelligence, informational overloads, fatigue, blinding prejudice, ignorance, panic. Whether produced by groupthink or by other causes, a decision that suffers from these defects has little chance of long-run success. When the group members try to implement their poorly worked out plans, they are soon shocked to find themselves caught in one new crisis after another, as they are forced to work out from scratch the solutions to vital questions about all the obstacles to be overcome�questions that should have been anticipated beforehand. Their poorly constructed decision, like a defective old auto that is starting to fall apart, is barely kept running by hastily patching it up with whatever ill-fitting spare parts happen to be at hand. For a time, the owners may loyally insist that they are still operating a solidly dependable vehicle, ignoring as long as possible each new sign that another part is starting to fail. But only extraordinary good luck can save them from the ultimate humiliation of seeing the whole thing fall so completely to pieces that it has to be abandoned as a total loss.
            I am not implying that all cohesive groups necessarily suffer from groupthink. All in-groups may have a mild tendency toward groupthink, displaying one or another of the symptoms from time to time, but it need not be so dominant as to influence the quality of the final decision of the members. The term groupthink also does not imply that there is anything necessarily inefficient or harmful about group decisions in general. On the contrary, a group whose members have properly defined roles, with methodical procedures to follow in pursuing a critical inquiry, is probably capable of making better decisions than is any individual in the group who works on the problem alone. However, the great gains to be obtained from decision-making groups are often lost because of powerful psychological pressures that arise when the members work together, share the same set of values, and, above all, face a crisis situation where everyone is subjected to a high degree of stress. In these circumstances, as conformity pressures begin to dominate, groupthink and its attendant deterioration in the quality of decision-making set in.
            Time and again in the case studies of major historic fiascos, I have encountered evidence that like-minded men working in concert have a great many assets for making adequate decisions but also are subjected to group processes that have serious liabilities. Under certain conditions, which I believe we can start to specify, the liabilities can outweigh the assets. A central theme of my analysis then can be summarized briefly in a somewhat oversimplified generalization, which I offer in the spirit of Parkinson's laws. The main hypothesis concerning groupthink is this: The more amiability and esprit de corps among the members of an ingroup of policy makers the greater the danger that independent critical thinking will be replaced by groupthink, which is likely to result in irrational and dehumanizing actions directed at out-groups. 
            Since this groupthink hypothesis has not yet been tested systematically, we must regard it as merely a suggestive generalization inferred from a small number of historical case studies. Still, one should not be inhibited, it seems to me, from drawing tentative inferences�as long as we label them as such�concerning the conditions that promote groupthink and the potentially effective means for preventing those conditions from arising. 
            Can we specify the conditions that help to prevent groupthink? Certainly not with any degree of certainty at present. But strong indications from comparative studies of good versus poor governmental decisions suggest a number of relevant hypotheses. So far, I have had the opportunity to examine only a small number of policy decisions, contrasting several major fiascos with two major decisions that provide counterpoint examples. One of the latter was the course of action decided upon by the Kennedy administration in October 1962, during the Cuban missile crisis. This decision involved the same cast of characters as the Bay of Pigs fiasco in 1961. My study of the Cuban missile crisis suggests that groupthink tendencies can be prevented by certain leadership practices that promote independent thinking. Another such counterpoint example I have looked into is the work of the small planning committees in the Truman administration that evolved the Marshall Plan in 1948. Like the White House group that developed the plan for coping with the Cuban missile crisis, these groups made realistic appraisals of how the Soviet Union and other out-groups were likely to respond to the various alternatives being considered, instead of relying on crude stereotypes and slogans. 
            One fundamental condition that appears to have an adverse effect on the quality of many vital decisions is secrecy. Frequently, only members of a small group of high-level officials are allowed to be in on a decision concerning the use of military force. The decision-making group is insulated from the judgments of experts and other qualified associates who, as outsiders, are not permitted to know anything about the new policies under discussion until after a final decision has been made. In the United States government there is a rule that even among men who have the highest security clearance, no one should be consulted or informed when a secret policy is up for discussion unless it is absolutely essential for him to know about it. 
            Small groups are highly susceptible to concurrence-seeking tendencies that interfere with critical thinking during crisis periods, especially if they restrict their discussions to the group itself. The chances of encountering effective, independent evaluations are greatest when the decision is openly discussed among varying groups who have different types of expertise, all of whom examine the decision and its probable outcomes from the standpoint of somewhat different value orientations. But when a decision is closed�confined to a small group�the chances of encountering anyone who can break up a premature emerging consensus is reduced. Similarly, insulation of the decision-making group greatly reduces the chances that unwarranted stereotypes and slogans shared by members of the group will be challenged before it is too late to avert a fiasco. . . . 
            Here I am speaking of more than isolation from out-groups. It is a matter of isolation from other potential in-group members, such as respected associates in high positions within the government who are not members of the specific policy-making group. If brought into the meetings, these nonmembers may be capable of presenting a fresh point of view and of raising critical questions that may be overlooked by the in-group. Their comments may induce members of the group to reconsider their assumptions. 
            If group isolation promotes groupthink, with its consequent mindless and dehumanized policies, then we should see what may be done to help prevent insulation of the members of a policy planning group. First, each member of the planning group could be expected to discuss the deliberations with associates in his home office�assuming he has associates who can be trusted�and then to report back to the planning group the reactions obtained from this source of relatively independent thinkers. 
            A second safeguard is to invite to each meeting one or more outside experts or qualified colleagues who are not core members of the policymaking group, including representatives from other branches of the government who are known to be critical thinkers, sensitive to moral issues, and capable of presenting their ideas effectively. Such outsiders were, in fact, deliberately brought into the Executive Committee meetings during the Cuban missile crisis and were encouraged to express their objections openly so that the group could debate them. This atmosphere was quite different from the one that prevailed throughout the Bay of Pigs planning sessions, which were restricted to the same small group of advisers and were dominated by the two CIA leaders who had developed the ill-fated plan. On one occasion, Chester Bowles was present as undersecretary of state to replace his chief. Rusk, who had to attend a meeting abroad. But Bowles was never asked about his reactions. He sat there silently, listening with horror to a discussion based on what he regarded as incredibly foolish and dangerous assumptions. After he left the meeting, he wrote down his objections in a memorandum to Rusk, who promptly buried it in the State Department files, In this instance. Rusk took on the role of what I call a self-appointed mind guard, 
            Third, a multiple-group procedure can be instituted so that instead of having only a single group work on a given major policy problem from beginning to end, responsibility is assigned to several planning and evaluation groups, each carrying out its deliberations, concurrently or successively, under a different leader. At times, the separate groups can be brought together to hammer out their differences, a procedure which would also help to reduce the chances that the decision makers will evolve a consensus based on shared miscalculations and illusory assumptions.
            Now we turn to factors other than isolation that determine whether groupthink tendencies will predominate in a cohesive policy-making group. In the light of my comparative case studies, the following additional prescriptions can be added to the three already mentioned as possible antidotes for counteracting groupthink. 
            Fourth, new leadership procedures and traditions may be established so that the leader abstains from presenting his own position at the outset to avoid setting a norm that evokes conformity before the issues are fully explored by the members. For example, the leader may deliberately absent himself from the initial policy-making discussions, as Kennedy did when the White House Executive Committee began to meet during the Cuban missile crisis. In order to introduce this corrective procedure, of course, the leader has to be willing to renounce some of his traditional prerogatives.
            Fifth, at every general meeting of the group, whenever the agenda calls for evaluation of policy alternatives, at least one member can be assigned the role of devil's advocate, to function like a good lawyer in challenging the testimony of all those who advocate the majority position. During the Cuban missile crisis, Kennedy gave his brother, the attorney general, the mission of playing devil's advocate, with seemingly excellent results in breaking up a premature consensus. When this devil's advocate's role is performed well, it requires the members of the group to examine carefully the pros and cons of policy alternatives before they agree upon the best course of action. 
            Sixth, throughout all the group meetings, each member can be assigned the primary role of critical evaluator of policy alternatives, a role which takes precedence over any factional loyalties and over the traditional forms of deference or politeness that often incline a man to remain silent when he objects to someone else's cherished ideas. This proposed practice, which could not be instituted unless it were wholeheartedly approved, initiated, and reinforced by the President and other top executives in the hierarchy, can help to counteract the spontaneous group pressures for concurrence-seeking. It should certainly prevent an illusion of unanimity from bolstering a premature consensus. 
            Seventh, whenever the policy issue involves relations with a rival nation or organization, at least part of a session can be devoted to surveying recent warning signals from the rivals, using special audiovisual techniques or psychodramatic role-playing, to stimulate the policy makers to construct alternative scenarios regarding the rival's intentions. In order to counteract the members' shared illusions of invulnerability and tendency to ignore or explain away any warning signals that interfere with a complacent outlook, this special effort may be required to induce them to become sharply aware of the potential risks and the need for making realistic contingency plans. 
            Eighth, after a preliminary consensus is reached concerning what seems to be the best policy alternative, a special session can be held at which every member is expected to express as vividly as he can all his residual doubts and to rethink the entire issue before making a definitive choice. This second-chance meeting should be held before the group commits itself by taking a final vote. 
            Two main conclusions are suggested by the case studies of foreign policy decisions: along with other sources of error in decision-making, the symptoms of groupthink are likely to occur from time to time within cohesive small groups of policy makers; and the most corrosive symptoms of groupthink are preventable by eliminating group insulation, overdirective leadership practices, and other conditions that foster premature concurrence-seeking. Awareness of these tentative conclusions can be useful to those who participate in policy-making groups if it inclines them to consider introducing one or another of the antidote prescriptions just listed�providing, of course, that they are aware of the costs in time and effort and realize that they must also watch for other disadvantages before they decide to adopt any of the prescriptions as standard operating procedure. . . . 
            Sometimes it may even be useful for one of the policy makers to ask at the right moment, before a decision is definitely made, "Are we allowing ourselves to become victims of groupthink?" I am not proposing that this question should be placed in the agenda or that the members should try to conduct a group therapy session, comparable to parlor psychoanalysis. Rather, I have in mind enabling some policy makers to adopt a psychological [mind]set that inclines them to raise critical questions whenever there are signs of undue complacency or premature consensus. One such question has to do with the consensus itself. A leader who is aware of the symptoms of groupthink, for example, may say, "Before we assume that everyone agrees with this proposed strategy, let's hear from those who haven't said anything yet, so that we can get all points of view onto the table." In addition to this commonsense application, some ingenious procedures may be worked out or spontaneously improvised so that the symptoms of groupthink are counteracted by participants who know about the groupthink hypothesis without constantly having to remind the group of it. 
  

Notes 

  1. J. Thomson, �How Could Vietnam Happen: An Autopsy,� The Atlantic, April 1968, pp. 47-53. 
  2. D. Kraslow and S. Loory, The Secret Search for Peace in Vietnam (New York: Vintage, 1968). 
  3. T. Hoopes, The Limits of Intervention (New York: McKay, 1969).